Introduction:
An ostomy is a surgery done when the intestine can no longer dispose of waste. Sometimes, an ostomy may also be done to the bladder to help urinate. The gastrointestinal tract part perforated and brought to an artificial opening directed towards the skin is called a stoma, with the bowel protruding part of it at the opening and not having nerve endings. Hence, it is not painful. A pouch or bag is connected to the stoma, from which the fecal matter is collected, called an ostomy bag/pouch. An ostomy may be permanent or temporary, based on the condition.
What Are the Types of Ostomy?
An ostomy diversifies the route through which waste, such as urine or feces, leaves the body. It protects the abdominal cavity because it facilitates healing for damaged or inflamed portions of the digestive system. Waste from the body exits via an opening in the abdomen and is collected by a pouch attached to the skin via a special device. Oostomies are often needed for conditions like specific birth defects, cancer, inflammatory bowel disease, diverticulitis, incontinence, or trauma from accidents and wounds to soldiers.
Ostomies are usually classified as belonging to a particular type based on the section of the gastrointestinal tract used to create the ostomy.
There are three primary types:
Ileostomy: In this procedure, the ileum, the final part of the small intestine that absorbs water and nutrients, is removed through an opening in the abdominal wall. This procedure is performed when part or the whole colon and rectum are removed. The stoma could be permanent or temporary and appear in the right abdomen. Most ileostomies are short-term and usually last for three to six months. The stool that comes out from this ostomy is usually loose and watery.
Colostomy: In a colostomy, the colon-part of the large intestine; here, water and nutrients are absorbed, leaving stool-is brought to an opening in the front of the abdomen. Depending on the situation, the stoma can often be on the right or left side. Since the colon is at a lower place in the digestive tract than the ileum, the stool would be softer and firmer because of increased water absorption. The kind of colostomies vary depending on the portion of the colon used, such as transverse, sigmoid, ascending, or descending.
Urostomy: This is the diversion of the ureters, tubes that transport urine from the kidneys to an opening in the abdominal wall. A urostomy is usually done when the bladder's function is compromised, or the bladder is absent.
What Are the Causes of Surgical Ostomy?
Temporary Causes:
- Colorectal cancer (colon/rectal cancer), consists of sections of the large intestine.
- Inflammatory bowel disease (gastrointestinal tract inflammation).
- Diverticulitis (inflammation of small pouches that protrude into the intestine).
- Intestinal blockage.
- Injury-related causes.
Long-term Causes:
- Cancers of the gastrointestinal system.
- Anal or rectal cancer.
- Crohn's disease.
- Familial adenomatous polyposis (FAP) is a genetic disorder where polyps develop in the large intestine.
- The colon and rectum in ulcerative colitis inflame and develop an ulcer.
- Colonic dysmotility.
- Colon obstruction.
- Bowel incontinence.
- Traumatic disruption of the intestinal tract
What Is the Procedure of Surgical Ostomy?
The procedure for both ileostomy and colostomy is similar but differs in location.
- Prior to the surgery, the patient must avoid food and drink to ensure bowel clearance. In some cases, the surgery may be done laparoscopically, which involves smaller incisions and faster recovery.
- The stoma site is marked, and general anesthesia is administered.
- The surgeon removes a circular section of skin, approximately 2.5 to 3 cm in diameter, from the abdomen.
- An incision is created, and the necessary areas are identified.
- Based on the condition, a portion of the ileum or colon is connected to the abdominal wall, and the surgeon will stitch around the stoma.
- Depending on the situation, the surgeon may remove the colon or stitch it for healing to allow for later reattachment.
- The ureters can be loops, ends, or reservoirs, depending on the surgical construction. In urostomy, the ureters are connected to a section of the small intestine that is redirected to the abdominal wall.
What Is the Recovery Process After an Ostomy Surgery?
- Following the ostomy surgery, the patient will stay in the hospital for 1 to 2 weeks to fully recover and receive pain management.
- Dietary guidelines are provided, and patients are nourished through veins or intravenously.
- IV fluids may also be administered to keep the patient hydrated.
- Regular check-ups for postoperative complications.
- Avoid intense physical activities for three months and driving or lifting heavy objects for two to three weeks.
What Is an Ostomy Bag/Pouch?
Feces from the digestive tract are collected into a pouch using a plastic bag or pouch attached to the abdomen through a stoma. The pouch system can either be one piece of apparatus, such as a sticky back applied to the abdomen, or two pieces—a sticky ring or flange fits around the stoma, and the individual attaches the pouch to the ring/flange. Pouches can come in a style and size of choice and can be reusable or single-use bags. It can be an ostomy bag, big or small. It can be attached using paste, powder, or belts to keep the pouch in place. Most of the ostomy bags change every three to seven days. This depends upon the various kinds of systems.
Features of the Bag: It is not smelly, easy to wear, and cannot be viewed by wearing clothes. It is friendly to the skin and leak-free. Various ostomy accessories, including rings and sealants, ostomy paste, skin protectants, adhesive removers, barrier strips, and odor eliminators, can be used.
They can also be used in a couple of ways: by sprinkling powder on the skin-safe portion, in charcoal-filtered pouches to eliminate gas, mints to eliminate odors, or by packing a small sack inside the pouch and discarding the pouch when it gets full. It should be replaced when it is one-third or half full.
What Are the Complications of Surgical Ostomy?
- The skin above the stoma becomes red, itchy, and painful.
- Intestinal lining infection, pouchitis, that irritates and treated with antibiotics
- There is a chance for solid gas during the first two months.
- There can be stomal bleeding
- Risk of no fecal input
- There may be diarrhea
- There may be nausea.
- There could be vomiting.
- Phantom rectum syndrome is another complication in which a patient may feel the need to evacuate even after having the rectum removed.
- If the stoma turns a different color than normal, immediate medical attention is required. This could indicate that the stoma has not received enough oxygen.
What Are the Lifestyle Changes After Surgical Ostomy?
After ostomy surgery, patients must make significant lifestyle changes to achieve proper care and lead a comfortable and happy life. Diet, exercise, personal hygiene, and so forth are generalizations of the same concept.
Dietary Changes
- Low fiber intake must be started in ostomy patients.
- Fluids must be given appropriately during the day.
- The foods that produce gas, such as cabbage, broccoli, etc., should be avoided.
- Chewing gum is avoided as the complications may develop later on.
- The food must be appropriately chewed, or the stoma will be inconvenient.
Pattern of Food Intake
- A small amount of food and snacks at regular time duration of the day
- It keeps digestion proper and painless.
Exercise
- Avoid heavy exercise immediately after surgery.
- Gradual initiation of low-level activities with medical follow-up would be beneficial.
- Protective appliances over the ostomy site can be used during exercise.
Ostomy Care
- The skin around the ostomy should be adequately cleaned and dried completely at bath time.
- Evaluation of the stoma. The patient checks for unusual changes in size, color, and shape.
- If something unusual is seen around the stoma, he or she should call the health care provider immediately.
- Ostomy surgery lets a patient carry on his sexual life without any interference.
- A person remains unrestricted in his or her social life and relationships.
- These lifestyle changes enable ostomy patients to live effectively by communicating openly with healthcare providers about their needs.
Conclusion:
Ostomy surgeries can be life-saving but require a great deal of lifestyle adjustment and careful care. Although they are a life-changing procedure, one may return to a regular life routine in several months. Individuals should be prepared psychologically and emotionally and speak to their caregivers should problems arise.
