For people with colorectal cancer, an ostomy may be necessary after surgery to remove part or all of the colon or rectum. The ostomy provides a way for stool to pass out of the body. There are different kinds of ostomies, and depending on the patient’s situation the ostomy may be temporary or permanent. Learning to live with an ostomy can take time and practice, but ostomy nurses and groups such as the United Ostomy Associates of America (UOAA) can ease the transition by providing important guidance and support.
Overview of Bowel Anatomy
In order to understand that different types of ostomies that may be used for patients with disease of the colon or rectum, it helps to understand the structure and function of the small and large intestines.
The small intestine plays an important role in the digestion of food. It connects the stomach to the large intestine and consists of three parts: the duodenum (the part closest to the stomach), the jejunum (the middle part), and the ileum (the part that connects to the large intestine).
The large intestine consists of the colon, the rectum, and the anal canal. The large intestine is where stool is formed and stored before being passed from the body through the anus. Fluids and some nutrients are absorbed from the large intestine before stool leaves the body.
Types of Ostomies
Depending on what part and how much of the large intestine has been surgically removed, different approaches may be used to divert stool to the outside of the body. Each of these approaches involves the creation of a stoma. To create a stoma, the surgeon brings a cut end of the small or large intestine to the surface of the body through an opening in the abdomen. Once at the surface, the end of the intestine is rolled back on itself (somewhat like a turtleneck sweater) and stitched to the wall of the abdomen. This portion of bowel that is visible on the surface of the abdomen is the stoma. Stool leaves the body through the stoma.
Ileostomy: An ileostomy connects the last part of the small intestine (the ileum) to the outside of the body, completely bypassing the colon, rectum, and anus. The waste that leaves the body at this point in the digestive system is only semi-solid. Waste passes through the stoma into a collection bag (an ostomy pouch) that is worn on the outside of the body. This bag must be emptied several times a day.
Colostomy: A colostomy is similar to an ileostomy, but it is a part of the colon that is diverted to a stoma. As with an ileostomy, waste can be collected outside of the body in an ostomy pouch. Some patients may also have the option of irrigation (insertion of water through the stoma) to have more regulated bowel movements.
Continent Ileostomy: This is a procedure that allows some patients to avoid wearing an ostomy bag. After surgery to remove the large intestine, an internal pouch is made from the end of the ileum. The pouch is connected to a stoma. Stool collects in the pouch inside of the body and is drained using a tube inserted through the stoma.
Living with an Ostomy
Ostomy appliances: Many patients with a colostomy or ileostomy will need to wear pouches over their stoma to collect waste. There are several different types and sizes of pouches, and patients may find that they use different types at different times. Some pouches are drainable (able to be opened at the end so that stool can be discarded) and others are closed (meant to be removed and discarded when filled). The pouch is connected to a faceplate that adheres to (and protects) the skin around the stoma. Because there are many different pouching systems available, talk with your doctor or ostomy nurse about the types that will best fit your body and your lifestyle.
Irrigation supplies: Irrigation is a process that allows some patients with a colostomy to regulate their bowel movements. Water is inserted through the stoma and causes stool to be expelled. This process requires specific supplies, and you should work with your doctor or ostomy nurse to learn to use them properly.
Dietary considerations: For several weeks after surgery, your doctor may recommend a limited diet. After this recovery period, however, you will probably be able to gradually return to your regular diet. Some foods are more likely than others to cause gas or odor in stool, so you may want to start with small servings of these foods until you learn how your body reacts to them. Foods that may cause gas, for example, include beans, cabbage, and carbonated beverages. Eating at regular intervals can also help to reduce gas.
Returning to the activities that you enjoyed before: Once you heal from surgery and learn to use your pouching or irrigation system, you are likely to be able to return to the activities that you enjoyed before having an ostomy. These activities may include sex, work, exercise (including swimming), and travel. It’s natural to feel hesitant or self-conscious when you first return to normal activities, but these feelings generally diminish as you become comfortable with your ostomy appliance and learn which pouching systems or ostomy accessories you prefer for which activities. During sex, for example, some people choose small, closed pouches, or use pouch covers.
In some cases, you may need some extra help to get back to your normal activities. After surgery for rectal cancer, for example, some men have difficulty achieving or maintaining an erection, and some women may experience discomfort during intercourse. Sexual problems (as well as other problems that you may experience) can often be effectively managed, so don’t hesitate to discuss your concerns with your doctor.
The good news for people with an ostomy is that support networks are available. These networks can provide practical advice on many aspects of living with an ostomy, and can also be an important source of emotional support. Sources of ostomy information and support include ostomy nurses, local support groups within your hospital or community, and national groups such as the United Ostomy Associations of America (www.ostomy.org).
 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Digestive Diseases Information Clearinghouse. Bowel Diversion Surgeries: Ileostomy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy. NIH Publication No. 09-4641. February 2009.
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