Pacific Coast Region
|
Ostomy Guide Introduction Ileostomy: An Ileostomy is a surgically created opening in the abdominal wall. The end of the small intestine, the ileum, is brought through the abdominal wall to form an exit for the stool call a stoma. The stoma is actually the lining of the intestine, which is similar to the lining of your mouth and is pink and moist. Ileostomy surgery is usually performed when a diseased or injured colon cannot be successfully treated by other methods. The most common reasons for surgery is inflammatory bowel disease (IBD) which includes Crohn's disease and ulcerative colitis. Ileostomies are also created because of birth defects, familial polyposis, injury or complications from cancer. Ileostomies may be temporary or permanent. Temporary ileostomies are performed to protect and rest the colon or small intestine while it is healing or as the first stage in the formation of an ileal anal reservoir (J-pouch). The major function of the small intestine is to absorb the nutrients and water from food. Enzymes released by the stomach and small intestine break food into small pieces so that proteins, carbohydrates, fats, vitamins and minerals can be absorbed. These enzymes are also present in ileostomy discharge and they may cause skin irritation. Because of this, a protective collection device (pouch) must be worn at all times. The consistency of ileostomy output will be liquid to pasty, depending on diet, medications and other factors. Because the output is constant, the pouch will need to be emptied several times per day. Colostomy: A Colostomy is an opening in the large intestine (colon), through the abdominal wall. This opening is called a stoma. The stoma is actually the lining of the intestine, which is similar to the lining of your mouth and is pink and moist. Colostomy surgery is performed for many different diseases and conditions. These include cancer of the colon, rectum or anus, inflammatory bowel disease, diverticulitis, trauma and birth defects. Colostomies can be temporary or permanent. Temporary colostomies may be necessary to protect a section of colon during healing The colostomy functions similarly to the natural bowel. The body's chemistry, digestive function and ability to nourish itself are usually not altered by it. However, because there is no muscle left to control stool or gas, a protective collection device (pouch) is necessary for management. Consistency of colostomy output will depend on where in the large intestine the stoma is constructed, diet, medication and other factors. Some colostomy patients chose to regulate their bowel function by diet or routine irrigations of the stoma. Irrigation is similar to an enema and causes the bowel to evacuate at a given time and place. Urostomy A urostomy (urinary diversion) is one of a number of surgical procedures which divert urine away from a diseased or defective bladder. Cancer, birth defects, spinal cord injury and interstitial cystitis are the most common diseases that lead to urostomies These operations bring urine to the outside of the body through an opening on the abdominal wall. This opening is called a stoma. The stoma is actually the lining of the intestine, which is similar to the lining of your mouth and is pink and moist. There is no voluntary control of the urine therefore a collection device (pouch) is necessary for management. The function of the kidneys is not changed by the urostomy. The urostomy pouch is usually emptied when 1/3rd full. Generally trips to the bathroom are not increased by the presence of a urostomy. The pouch should be connected to a larger collection container at night to insure a good night sleep and reduce the time urine stays in the pouch. This reduces the potential for urinary tract infections. Frequently Asked Questions: Will caring for the stoma be difficult? Learning to care for your ostomy may seem hard at first, but with practice and your own adaptations, the entire process will become second nature, just like shaving or bathing. Everyone is anxious about how they will be able to manage the process, but with the help of the nursing staff or an ostomy nurse specialist, most people are feeling confident in just a few weeks. For the first six weeks the stoma will be shrinking due to reduction in post-operative swelling. This means that the opening in the skin barrier must be changed to accommodate the changing size of the stoma. Most ostomy care products include a measuring device in order to measure the stoma and cut the appliance skin barrier to the appropriate size leaving 1/8th inch of clearance around the stoma. The pouch is emptied as needed, usually when it is 1/3rd full. The skin barrier and pouch are changed on a routine basis. Most ostomy patients can wear their appliance 4 to7 days without difficulty. A conversation with someone who has already mastered the art of stoma care can boost you confidence. Ask about getting a referral to a local ostomy support group. Will there be odor or noises? Concerns about gas and odor are normal. Modern pouching systems are odor proof, as long as it remains properly sealed. Immediately after surgery, it may seem that you have excessive gas almost all the time. This is normal because of the swelling that occurs after surgery. Once post surgical swelling is resolved, excessive gas usually is not a problem. Gas can be reduced by eating regularly. Skipping meals should be avoided as this actually makes the small intestine more active and produce more gas and watery stool. Some foods may cause increased gas such as: eggs, cabbage, onions, fish, baked beans, milk, cheese, and alcohol. Will I need a special diet? Most people with ostomies return to a regular diet soon after recovering from surgery. A few precautions are important such as chewing well; eating a well balanced diet and drinking plenty of fluids especially water. If you experience problems with a certain food, wait a couple of weeks and try the food again. Ileostomy patients may need to limit some high fiber foods and need to increase fluid intake to reduce the risk of dehydration. Urostomy patients need to make sure to have an adequate fluid intake to keep the kidneys functioning well. Will I be able to return to work? Once your strength returns, you can go back to work. Heavy lifting may be discouraged the first few weeks as the incisions heal. People with ostomies do all kinds of work including strenuous types such as fire fighters, truck drivers and construction workers. Ask your surgeon when and how much lifting you can do. Can I wear regular clothing? You need no special clothing because ostomy pouches are fairly flat and inconspicuous. Pressure from undergarments with elastic will not hurt the stoma or prevent it from working properly.
What do I do about bathing or swimming? You may bathe with or without your pouching system in place. Exposure to air, water or soap will not harm the stoma. Water cannot enter the body through the stoma. When swimming, you may want to choose a swim suit with some support or a lining for a smoother profile. Some people add tape to the edges of the pouch for greater security. Can I travel? There are no barriers to travel both here and abroad. Just make sure to take plenty of you ostomy supplies with you. If flying, take your supplies onboard as checked luggage is sometimes misplaced. A note from you doctor stating that you need to carry ostomy supplies, medication or other supplies on the plane can speed you way through inspection lines. Can I participate in sports? An ostomy should not limit your involvement in sports. Many people with ostomies are distance runners, skiers, swimmers, etc. and participate in most athletic activities. Check with your physician about strenuous physical activity such as weight lifting. What if I feel Depressed or Discouraged? There will be times after surgery when you may feel low, discouraged or even depressed. You may feel alone and isolated, even unable to enjoy life again. These are common feelings. Serious illness, medication, hospitalization, and the surgery itself, all cause feelings if insecurity, dependence, concern, and discouragement. Feeling discouraged is real and normal. You might cry, be hostile or angry, or react in ways that are unusual for you. Talking to a trusted relative, friend, nurse, clergyman, or another person with an ostomy may be helpful for you. You may be able to work through your feelings and discover new hope and encouragement. Talk to your physician if feeling of discouragement persist and affect your ability to return to the level of emotional health you desire. How do I tell others about my surgery? It is natural to wonder how you will explain your surgery and how others will accept you. You can tell them as much as you want them to know. A brief explanation would be that you had abdominal surgery or that you had part or your entire colon removed. If you have children, answer their questions simply and truthfully. A simple explanation will be enough for them. Talking about your surgery in a natural way will dispel any misconceptions that they have. What about sex and intimacy? Sexual relationships and intimacy are important and fulfilling aspects of your life that should continue after ostomy surgery. Your attitude is a key factor in reestablishing sexual expression and intimacy. Sexual function is generally not affected by the surgery itself. Discuss any problems with your physician or ostomy nurse. If you are considering marriage, discussions with your future spouse about life with an ostomy and its effects on sex, children and family acceptance will help to alleviate misconceptions on the part of the spouse. Attending an ostomy support group meeting together may be helpful and reassuring. The UOAA (United Ostomy Associations of America) has support groups in many areas of the United States. Excerpted from: Resources: Wound, Ostomy, Continence Nursing Society (WOCN) - A group of professional nurses trained to assist patients with ostomies to return to a normal life. They provide education and support for new ostomy patients and are experts in managing problems related to stoma care www.WOCN.org United Ostomy Associations of America (UOAA) - A nationwide volunteer organization for those affected by an ostomy or diversionary surgery that need information, support, education or advocacy. Information booklets are available on-line that have additional explanations on each type of ostomy. www.UOAA.org. International Ostomy Association (IOA) - An international volunteer organization for ostomy patients providing support, education and advocacy. www.ostomyinternational.org
|