What is an Ostomy?

There are over 500,000 Ostomates in the U.S. Alone. If you are reading this...

...it is very likely that you or someone you know has at some point woken up from surgery with an ostomy pouch attached. Each year, thousands of lives are saved by ostomy surgery; the information below describes what an ostomy is and its various types.

First, let's familiarize ourselves with the intestines:

Human Colon
  1. Ascending Colon
  2. Transverse Colon
  3. Descending Colon
  4. Sigmoid Colon
  5. Rectum

....and a look at the human urinary system:

Human Urological System
  1. Kidneys
  2. Ureters
  3. Bladder
  4. Urethra

What exactly is an "ostomy" then?

An ostomy is any surgery that creates an opening in the body. This surgery is usually performed for urinary or bowel diversion, i.e., redirecting the "pipes" to move urine and feces out of the body through a surgical hole in the belly. This circumvents a diseased, removed, or healing portion of the digestive tract.

Ostomy Stoma

That surgical opening is called a stoma. The stoma protrudes through the abdomen to allow waste to exit the body. There are many types of ostomy surgery, the most common being a colostomy (large intestine), ileostomy (small intestine) or urostomy (urinary diversion).

Here are some examples of a Colostomy, Ileostomy and Urostomy. You can recognize the stoma in light pink below.

Colostomy

Colostomy

Ileostomy

Ileostomy

Urostomy

Urostomy

Why would someone have ostomy surgery?

An ostomy may be temporary or permanent, depending on the medical reason for the surgery. The ostomy surgery is intended to relieve suffering from illness and even save the life of the indivdual requiring the ostomy. Some of the medical reasons for ostomy surgery are:

All types of ostomy have similarities, but there are also some distinct differences.

Ostomy Stoma

A stoma is unique to the individual. Even if two individuals had the same surgery, the shape and size of the stoma will always heal differently. The stoma looks like a red, moist "button" that sticks out from the abdomen. A stoma does not cause pain, although just after surgery, the skin may be swollen and sensitive. After several weeks and proper care the skin and tissues will heal.

The skin surrounding the stoma is known as the peristomal skin. Peristomal skin is particularly vulnerable. Harsh cleaners, barrier leaks or removing ostomy appliances / pouches too roughly can cause rashes, redness and soreness. It is critical for good health to take care of this skin.

Quick facts about stomas:

Different Kinds of Ostomies

Colostomy - Large

Colostomy

A colostomy is a surgical ostomy where the colon (large intestine) is brought through the surface of the abdomen through a stoma. Often, a portion of the colon is removed during the operation due to disease or damage. A colostomy can be temporary or permanent, depending on whether or not the doctor can reconnect the colon to the rectum. The location of the stoma is different depending on the type of ostomy. Here is an overview of the usual types of colostomies:

Transverse Loop Ostomy - Usually located in the center of the upper abdomen with one or two openings. Stool is typically pasty. A transverse loop ostomy can have two openings through a single stoma.

Sigmoid End Colostomy (Descending Colostomy) - This type of ostomy is pictured to the left. Usually located in the sigmoid colon, closer to the rectum. Stool is usually similar to a regular bowel movement. This is a very common type of colostomy.

Ileostomy - Large

Ileostomy

An ileostomy is a surgical ostomy where the small intestine is brought to the surface of the abdomen through a stoma, entirely bypassing the colon. This procedure is usually performed when the colon, rectum and/or anus are unable to effectively process waste due to disease (i.e., Crohn's Disease, Ulcerative Colitis, Familial Andenomatous Polyposis) or serious damage from injuries.

The function of the large intestine is to absorb water and store waste; an individual can live without their large intestine, but the stool produced with an ileostomy tends to be more liquid and paste-like since it contains more water. Because of this, and also because the output often contains more digestive enzymes, it is critical to have a skin barrier that keeps the peristomal skin well protected.

An ileostomy can be temporary or permanent, depending on whether or not the doctor can reconnect the small intestine and close the stoma. The location of the stoma is different depending on the type of ileostomy you have. Here is an overview of the types of ileostomies:

Loop Ileostomy - A loop ileostomy is usually temporary. An incision is made in the abdomen and a part of the small bowel is lifted through the skin, forming a "loop". An incision is made in this loop and each end is rolled down onto the skin.

End Ileostomy - An end ileostomy can be temporary or permanent. An end portion of the small bowel is brought through the abdomen to form the stoma.

Internal Pouches - Today, the main alternative to an ileostomy is an internal J-Pouch, or Ileoanal Reservoir. (Note there are many variations of this pouch.) An internal pouch is formed from portions of the ileum (the portion that empties waste from the small intestine to the large intestine.) That portion is attached to the anus. This creates an internal reservoir to hold waste and allow for an individual to maintain continence through the use of their functioning sphincter muscles. Because of this, it is not acutally an ostomy since there is no stoma.

Urostomy - Large

Urostomy

Urostomy is a surgical ostomy where the bladder and the urethra are bypassed through a stoma on the surface on the abdomen. This procedure is usually performed after a cystectomy (removal of the bladder due to disease or damage), congenital defects, damage to the bladder or urinary tract.

The kidneys function by creating urine and sending it to the bladder through two tubes called the ureters. The urine that is passed through is stored in the bladder until nature calls. (Naturally, the urine passes through the urethra).

A urostomy diverts urine from the ureters through a stoma in the abdomen and into a collection pouch. The bladder and urethra are skipped entirely. The urostomy operation is usually done one of two ways; an ileal conduit or a colon conduit. For an ileal conduit, surgeons first remove a 5-6 in. piece of the small intestine. They then reconnect the small intestine so that it functions normally. The surgeons then remove the ureters from the bladder and connect it to this piece of small intestine. The other end of the small intestine is brought through an opening on the body, rolled back and stitched to form the stoma.

The colon conduit is almost identical, but instead of the small intestine, a portion of the large intestine is used.

Learn More About Ostomy

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