The term ostomy originates from the Latin word ‘Ostium’ which means ‘an opening’. Ostomy is a surgical procedure to construct an opening on the abdominal wall which allows an alternative route for the urine and feces to be eliminated by the body. This opening is known as ‘stoma’ which is derived from the Greek word for ‘mouth’ and bears a resemblance to the mucous membrane of the mouth. There is no valve or muscle present to control the expulsion of waste from the stoma hence the passage of the waste from the stoma cannot be controlled. The indications for performing an ostomy include Crohn’s disease, colorectal cancer, ovarian cancer, ulcerative colitis, colonic polyps, chronic IBS (irritable bowel syndrome), extensive surgery, spinal cord deformity, neuromuscular disorders, trauma or obstruction.
The advancements in medical technology and the expertise of surgeons have greatly minimized the complications associated with ostomy resulting in improved prognosis. The surgeon will decide on performing an ostomy only after reviewing the case history, physical examination, and tests relevant to the procedure. The patient is usually asked to fast hours before the ostomy procedure is due to cleansing the bowel. Ostomy is performed under general anesthesia and a stay in the recovery room is recommended post-surgery. The patient is explained how to manage the ostomy and continue living a normal life after the procedure. In the present day and age, the support and sensitivity of people towards ostomy procedures have grown tremendously. Efforts are being made to eradicate the stigma around the procedure by the formation of ostomy associations and self-help support groups worldwide for people having recently undergone an ostomy procedure. Various ostomy management products are now available to maintain the ostomy.
Ostomy is of three types - ileostomy, urostomy, and colostomy.
An ileostomy is a surgical ostomy that creates an opening in the ileum to bypass the large intestine. An ileostomy is indicated in cases of Crohn’s disease, colorectal cancer, ovarian cancer, ulcerative colitis, etc. An ileostomy might be temporary or permanent. Regular X-rays and follow-ups are required to make sure the anastomosis has healed. The ileostomy procedure is of two types – end Ileostomy and loop ileostomy
- End Ileostomy - In an end ileostomy, the colon and rectum are surgically removed and the end of the ileum is brought out through the stoma
- Temporary/Loop Ileostomy - In a loop ileostomy, the rectum and colon are not removed but a loop from the small intestine is brought out through the small intestine
Caring for an Ileostomy involves changing the ileostomy pouch regularly and following the guidelines provided by the hospital post the surgery. A person with an ileostomy can comfortably do most tasks they were able to prior to the procedure and continue living a normal life.
Urostomy is the surgical procedure for a urinary diversion that directs the urine to leave the body after surgical removal of the diseased or damaged part of the urinary tract. Urostomy is indicated after extensive surgery, spinal cord deformity, neuromuscular disorders, or obstruction. The two main types of urostomy are:
- Ileal Conduit – In this type of urostomy a short segment of the end of the intestine is used to create the stoma while the other end is connected to the ureters allowing for a urine passage through the newly formed ileal conduit into the stoma where it is collected by an ostomy bag
- Ureterostomy – In this type of urostomy, the ureters are directly connected to the abdominal wall to create a stoma. The flow of urine is not controlled hence an ostomy bag has to be placed at the stoma to collect the urine
- Sigmoid colostomy - It is done to divert the waste from the bottom portion of the large intestine. The stool produced after a sigmoid colostomy is more solid when compared to other types of colostomies
- Transverse colostomy - The transverse colon passes through the top of the abdomen. The transverse stool is usually softer as water has not been completely absorbed from it. A transverse colostomy is further divided into loop colostomy, single barrel colostomy, and double barrel colostomy
- Descending colostomy - The descending colon passes through the left side of the abdomen. The stool produced after a descending colostomy is firmer because the stool has passed through the functioning parts of the colon and extra water has been absorbed by the body
- Ascending colostomy - The ascending colon is located from the starting of the intestine and passes from the right side of the intestine. In this type of colostomy, a small part of the intestine remains functional which increases the liquid content in the stool