Ostomy - Clinical Overview


An ostomy is a surgically created opening through the abdominal wall to allow passage of waste material (feces or urine) to the outside. The portion of intestine or ureter which is brought out through the opening is folded back to form a cuff. The outside edge of the cuff is stitched to the surrounding skin Whatever the location or size, this opening is called the "stoma." Ostomies may be temporary or permanent, depending on the nature of the surgery performed. A permanent ostomy occurs when a client's rectum and/or anus, and the bladder, have been removed. A temporary ostomy is created when removal of the anus or the bladder is not possible because of a particular condition, but one which can be resolved within a given period of time. Time for a temporary ostomy varies, it is determined by how long a certain condition takes to heal.

Stomas: A stoma, originating from the Greek word for mouth, is the opening into the organ to allow for drainage. The color is reddish pink, very similar to that of the cavity inside the mouth. A stoma size is determined by the location of the ostomy. A urostomy stoma is smaller than that of an ileostomy. Stomas have no sensations as they are without nerve endings. The majority of stomas shrink during the first few months after surgery and should be measured regularly so that the proper size of appliances can be purchased.

Colostomy: A colostomy, from the words colon and ostomy, involves bringing a portion of the colon (large intestine) to the surface of the body. The surgery involves removing the damaged portion of the large intestine and rectum due to disease or trauma. Descending and sigmoid colostornies are the most common types. The waste material can be quite solid; some clients may exercise sufficient control to adopt an irrigation system rather than wearing a permanent appliance. Irrigation is an enema administered through the stoma on a regular basis. Irrigation must be done on a doctor's request only.

lleostomy: Due to ulcerative colitis, the surgeon removes the entire large intestine and rectum. Since a portion of the ilium is brought through the abdomen, it is known as an ileostomy. In ileostomies, the stoma is usually extended further out from the body in order to minimize the risk of skin irritation. Stool passing through is continuous and largely fluid, therefore drainable pouches are recommended due to frequent emptying.

Urostomy: A urostomy is a surgical diversion of the urinary process. The most common being the ileal conduit. A portion of the ileum is detached, one end closed, and the ureters attached to that end. The open portion becomes the stoma. The balance of the ileum is rejoined and continues to perform normally. This process entails detachment of the ureters from the bladder and re-directing them to the surface of the body (ureters drain urine from the kidneys to the bladder). Pouches are made with a nonreturn valve that minimizes urine returning to the stoma or the skin around it, keeping the stoma clear of any infections. Appliances available for urostomy clients include urostomy pouches, wafers (two-piece systems), as well as night drainage container sets.

It is evident that whatever type of ostomy has been performed, the client has undergone a radical alteration to the body's appearance and function. Tremendous support is required from family, friends, and health care professionals to overcome the negative aspects of this traumatic experience. It should be emphasized that most ostomies are performed to neutralize life-threatening conditions. Because of modern medical techniques, the ostomate can now look forward to many years of normal life.

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