What is an ostomy?
An ostomy is a surgically created artificial opening that allows the elimination of excretory products such as urine or stool from the body. These are made after a portion of the intestine or lower urinary tract is removed due to its dysfunction or disease. The end of the remaining portion is opened and sutured outside the body on the skin to form an opening (stoma) and a bag is attached that collects the stool or urine (pouch).
A stoma usually protrudes above the skin and is red to pink in color without any sensory innervation. As stoma is also devoid of any sphincter or muscle the patient has no control over the movement of excretory products that comes out of it. It is estimated around 120,000 Americans of all age groups receive an ostomy annually. Recently the incidence of ostomy procedure is seen increasing especially among military personnel due to increased traumatic injuries.
Ostomy is indeed both a lifesaving and life-altering procedure. Living with an ostomy may be an uncomfortable experience but many patients adjust their lifestyle according to this challenge so it becomes easier to live with. Therefore, here are some essential ways you can care for an ostomy to ensure it functions smoothly without any complications.
Types of osteotomies?
There are three main types of ostomies, that are classified according to the anatomical site they are created at. These include:
It is the most common type of ostomy followed by ileostomy and Urostomy. Here a portion of the diseased large intestine is removed or by-passed, with the reminder opened outside through the abdominal wall to form a stoma. Colostomy diverts normal intestinal fecal matter towards the stoma instead of the anus. It may be a temporary solution until the healing of the diseased part occurs or it may be left in place permanently. Both drainable and closed-end pouches can be used in a colostomy.
A colostomy is indicated in the following conditions:
- Diverticular disease
- Crohn’s disease
- Ulcerative colitis
- The colostomy pouch should be emptied when it is one-third to one-half full.
- The pouch should be changed twice weekly or immediately in cases of leaking.
- The skin surrounding the pouch should be vigilantly cleaned with a wet cloth.
- Wipes that can decrease the adherence of wafer on the skin should be avoided.
- The correct size of the pouching appliance should be used.
- The adhesive barrier (wafer) should be snugly secured around the stoma to prevent leaking.
An ileostomy is derived from ileum that is usually placed around the right lower abdomen. Here the entire colon, rectum, and anus are either by-passed or resected. The excreted product, in this case, is loose or liquid and therefore, has more chances of leaking from the pouch. An ileostomy is also associated with more dietary restrictions, peristomal skin breakdown, and blockage problems (due to narrower diameter).
- Patients with an ileostomy are advised to always stay adequately hydrated with around 10-12 glasses of water/liquids per day.
- The dietary restriction includes avoiding foods that are difficult to digest such as nuts, popcorn, seeds, celery, and corn, etc. Enteric-coated pills and other time-release medications are also not recommended in these individuals. The food intake should be slow and all food should be chewed slowly.
This type of ostomy is also known as the ileal conduit. Here, the bladder is surgically removed or by-passed, and a new connection between the ureters and the ileum is made. The attached segment of ileum is then detached and a stoma is created in the abdominal wall. The urine flows from this stoma into the pouching appliance. Urostomy is recommended in the following conditions:
- In patients with bladder cancer,
- In patients with a history of trauma or pelvic surgery,
- In patients with a dysfunctional bladder,
- In patients with congenital anomalies,
- In patients with spinal cord injuries,
- In patients with chronic bladder inflammation,
- And in patients with radiation damage.
- The intestinal lining produces mucus that gives the urine a cloudy appearance and therefore, needs to be cleaned off stoma every time during appliance change.
- The patient should maintain adequate fluid intake around 8-10 glasses daily to prevent the development of urinary tract infection unless contraindicated.
- The patient may need an overnight drainage system at night.
- White, gritty crystals may deposit on and around the stoma, and require cleaning of peristomal skin with 1:1 vinegar and water.
- The Urostomy pouch should be changed every 3-7 days depending upon the access to supplies.
How to take care of the ostomy at home?
The most essential step is the vigilant monitoring that should be carried out routinely to detect and address any complaints immediately as observed. The pouching system should be checked regularly for any leaks.
In cases of irritated, itchy, or red skin around the pouch: the pouch should be removed gently. The irritated skin should be cleaned with water and patted dry. An ostomy powder should be sprinkled directly on the skin and access gently wiped out. The cleaning should be completed with reattaching or replacing the pouch. In case of persistent or severe irritation, medical attention should be immediately sought.
When to call for help?
Immediate medical attention should be sought if any of the following sign or symptom is observed:
- If the patient is vomiting continuously,
- If the patient experiences acute or worsening abdominal pain,
- If the patient develops a fever,
- If the patient is unable to pass stool or gas,
- If the stoma turns pale or changes in color.
- If no waste is observed to be collected in the pouch.
Patients with co-morbidities such as disabilities and conditions like arthritis, Parkinson’s disease, and paralysis may be unable to manage and take care of the ostomy themselves. An ostomy can also bring about unwanted psychological burdens such as low self-esteem, body image, and quality of life. Therefore, in these cases getting help from professional medical personnel and health care providers is essential.
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