What is an Ostomy? | Ostomy 101

Caregiver Advocate | Shield HealthCare

06/28/11 3:38 AM PST

What is an Ostomy ?

An ostomy is a surgical operation that creates a new outside opening for body wastes. The new opening is called a stoma. A stoma may be created to divert feces, urine or both. You can watch a video with our Ostomy Lifestyle Specialist, Laura Cox, explaining what an ostomy is by clicking below:

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The stoma is created from a piece of the intestines or urinary tract which is pulled through a cut in the abdomen and stitched to the skin. Ostomies can be permanent or temporary, and sometimes more than one is needed. The type and placement of ostomies depend primarily on medical necessity.

Reasons for an Ostomy

There are many medical conditions that might require an ostomy, including:

– tumor removal

– to give the intestines a rest period for self-repair of bowel or bladder injuries.

– congenital or nerve defects of the digestive or urinary tract

– injuries that have caused permanent loss of bowel or bladder control

– as a last resort treatment in medically unmanageable cases of inflammatory bowel diseases, including Crohns disease and Ulcerative Colitis

Ostomy Types

There are three main types of ostomies, along with several sub-types:

1. Colostomy – a stoma is formed from the large intestine (various types below)

Sigmoid
Descending
Ascending
Transverse
- Loop
- Double Barrel

2. Ileostomy – a stoma is formed from the small intestine

End (Standard, Brooke)
Loop

3. Urostomy – a stoma is formed from the urinary tract (also called ureterostomy)

Ileal Conduit
Bilateral

Colostomy

Colostomies are surgical openings created for the passage of waste from the large intestine (colon). The damaged part of the large intestine is removed or temporarily left inactive until healing is completed.

Since digestion takes place ahead of the colon, with the body absorbing most of its nutrition through the small intestine, nutrient absorption is less impacted in a person with a colostomy. ***

There are several types of colostomies, each differentiated by location, and type of discharge.

Ascending Colostomy

The ascending colostomy is located in the ascending colon. Since this type of colostomy is so close to the small intestine (ileum), waste discharges continuously for lack of storage space. The material is rich in digestive juices and very irritating to the skin.

Transverse Colostomy

A transverse colostomy is located in the transverse colon. It usually appears in the upper abdomen, either in the middle or a little to the right side of the body. The discharge from a transverse colostomy varies, depending on how far away from the small intestine the opening has been made. The discharge may be firm at infrequent intervals, but many discharge all the time with a soft or loose stool.

Loop Colostomy

In order to create this type of colostomy, a loop of the transverse colon is lifted. The colon is partially divided and a rod placed underneath to give it support. The loop colostomy appears like one very large stoma but actually has two openings. There is one opening for the normal discharge of waste and another (the disconnected portion) for the drainage of mucous. The rod is removed after a few days.

Double Barrel Colostomy

A loop of the transverse colon is lifted and divided completely. In this case two openings (barrels) are created and they may or may not be separated by skin. A rod is not required for a double barrel colostomy. One barrel discharges the waste, the other discharges mucus from the disconnected portion of the colon.

Descending Colostomy

A descending colostomy is located in the descending colon. Since it is located in the lower portion of the intestinal tract, the discharge is likely to be semi-solid to firm and therefore can often be regulated.

Since both descending and sigmoid colostomies are the furthest from the small intestine, storage capacity is greater, and the stool is more solid and without rich digestive enzyme content.

Sigmoid Colostomy

A sigmoid colostomy is located in the sigmoid colon. Since it is located in the lower portion of the intestinal tract, the discharge is likely to be firm and therefore can often be regulated.

Ileostomy

An ileostomy is located in the small intestine (ileum). Normally the large intestine (colon) has been removed. The discharge from an ileostomy is continuous, soft, and wet. It contains digestive enzymes which can seriously damage the skin. Stomas are generally small in size (one inch in diameter) since they are constructed with the small intestine.

End Ileostomy (also called Standard, Brooke)

In an end ileostomy, the colon and rectum may be partially or completely removed. The end of the ileum is brought out through a cut in the stomach and stitched to the skin to form the stoma.

Loop Ileostomy

In a loop ileostomy, the colon and rectum are not necessarily removed. A loop of the small intestine is bought out through the stomach, and this loop (also called bridge) forms the stoma.

Urostomy

A urostomy diverts the urine away from the bladder. There are two types:

Ileal Conduit

The most common type of urostomy is the ileal conduit. A 6 to 8 inch section of the small intestine is removed to construct a conduit. One end of the conduit is closed and both ureters are implanted into the tissue near the closed end. The other end of the conduit becomes the stoma.

The conduit has no storage capacity and is not considered a substitute bladder. Urine flows almost continually.

Bilateral Urostomy (or Bilateral Ureterostomy)

The bilateral urostomy does not utilize a conduit. Instead, the ureters are brought to the surface and used to create a stoma on each side of the body.

There is no storage capacity with a bilateral urostomy ande urine flows almost continually.

Continent Ostomy

In some cases, an internal pouch can be constructed within the body to collect the waste from the small intestine or ureters. For a person with a continent ileostomy, this internal pouch is also called a kock pouch. For a person with a continent urostomy, this internal pouch is also called an Indiana pouch.

Continent Ileostomy

A loop of the small intestine is constructed into a pouch within the abdominal cavity. Waste from the small intestine is collected there and is drained at intervals by a catheter. A one-way nipple valve is created in the pouch to prevent leakage.