An ostomy is a surgical procedure to create an opening from an area inside the body to the outside. The opening created by ostomy surgery is called a stoma. Ostomies are performed for a number of reasons. Each type of ostomy serves a different function.
Many people are able to adapt to and live normally after having ostomy surgery, although they have to learn new skills and how to care for the stoma.
The stoma:
- is round or oval shaped, red and moist – and looks like the inside of the mouth
- often sticks out a little above the skin surface to make it easier to look after
- does not have a nerve supply, so it does not hurt
- bleeds easily because of the many tiny blood vessels close to the surface
- may stretch to expel contents
- will be slightly swollen just after surgery but does get smaller (after about 6 weeks)
- may also expel some mucus
Uses
An ostomy may be needed for a number of different reasons and for different types of cancer, such as gastrointestinal, urinary tract, oral, throat or laryngeal cancers.
- A tracheostomy is used to help a person breathe easier.
- A colostomy and ileostomy allow digested food and waste (stool) to pass through it out of the body.
- A urostomy is made to serve as passageway for urine, when the bladder or another part of the urinary tract has to be bypassed or removed.
- A feeding tube (such as a gastrostomy or jejunostomy) is used to give liquid nutrition when cancer or its treatment affects a person's ability to eat or drink.
Occasionally 2 stomas are needed. After a pelvic exenteration, for example, one stoma is created to allow urine to pass and a separate stoma is made for stool.
Types
There are different types of ostomies.
- tracheostomy – an opening is made in the windpipe (trachea) at the front of the neck
- colostomy – part of the rectum or colon is removed or disconnected and the bowel is brought out through an opening in the front of the abdomen
- ileostomy – the colon, rectum and perhaps part of the small bowel may be removed and the last part of the small bowel (ileum) is brought out through an opening in the front of the abdomen
- urostomy (urinary diversion) – the ureters are attached to a short piece of the small bowel (ileum), which has been removed from the bowel, and is then brought out through an opening in the abdomen
- gastrostomy or percutaneous endoscopic gastrostomy (PEG) tube – a feeding tube is put into the stomach through a very small opening in the abdomen
- jejunostomy – a feeding tube is put into the jejunum through a very small opening in the abdomen
Ostomy surgery can result in a temporary or permanent stoma. When a temporary ostomy is done, the surgery is later reversed and the person will no longer have a stoma. With a permanent ostomy, the person will have a stoma for the rest of their life.
Stoma care
Specially trained enterostomal or ostomy therapists teach people how to live with and care for their stoma. Caring for a stoma varies depending on the type of ostomy surgery a person has had.
Pouching systems are most often used to collect wastes released through a stoma such as a colostomy, ileostomy or urostomy. Pouches are:
- also called ostomy appliances
- one or two piece systems
- made up of a flange and a collection pouch
- A flange is a barrier or base, which is sticky and fits over and around the stoma. It protects the skin from any contents coming out of the stoma.
- The pouch collects stool or urine.
- One-piece systems have the skin barrier already attached to the pouch.
- Two-piece systems consist of a separate flange and a pouch that snaps onto the flange.
- odour proof
- disposable or reusable
- made by different manufacturers
- emptied or changed when necessary and convenient
If it is a colostomy that expels solid contents, then a tiny pouch or soft pad can be worn over the stoma at times.
The skin around the stoma is called peristomal skin. It is important to take good care of this skin and the stoma so that it doesn't become irritated and cause problems. Using a skin barrier and well-fitting pouch helps prevent problems. Any swelling, redness, excess bleeding or rash should be reported to the doctor or enterostomal therapist right away.
Supplies
There are many different ostomy appliances to choose from, so most people find one that fits well and works with their lifestyle. A variety of skin products and barriers are also available to prevent skin breakdown. Supplies can be purchased at drug stores or medical supply stores. Costs vary but may be reimbursed, so check with provincial or private health plans about how much and what is covered.
Bathing or showering
Bathing and showering may be done with or without a pouch in place in many instances. A person with a tracheostomy will have to be careful not to let water enter their stoma.
Nutrition
Diets of people with ostomies often require little change. People with ileostomies may find that high-fibre foods are difficult to digest.
For people with a colostomy or ileostomy:
- Reintroduce new foods one at a time in small amounts. This will help to identify foods that cause digestive problems.
- Avoid gas-forming foods if they cause too much gas. Most gas is caused by swallowing air.
Clothing
A person can usually wear the same clothing they did before their ostomy surgery. Waterproof pouches and seals are available for swimming or water sports for people with colostomies, ileostomies or urostomies.
Activity
A stoma does not usually get in the way of normal activity. Once the person has recovered from surgery and depending on the type of ostomy, participation in most sports is possible. Rough contact sports or very heavy lifting (such as weight lifting) may be exceptions after some ostomy surgeries. An enterostomal therapist can give advice on how to protect the stoma during sporting activities. Sport shields are available for contact sports.
Work
Having a stoma does not usually interfere with work. Once recovered from ostomy surgery, most people can successfully return to work. Heavy lifting may be an exception after some ostomy surgeries because this can cause a stoma to protrude (herniate). Check with the doctor about any adjustments that need to be made if your job involves heavy lifting.
Travel
Travel is usually not restricted but it is a good idea to take along extra supplies when travelling – about twice as much as normally would be used at home. Carry these supplies with you, do not check them in with your luggage.
Sexuality and intimacy
Many people continue to have strong, supportive relationships and a satisfying sex life after having ostomy surgery. But some people feel uncomfortable with their bodies if they have had an ostomy. Their self-esteem can be threatened.
There are simple strategies that may help a person have a satisfying sexual experience after undergoing an ostomy.
- Spend time cuddling and holding each other in loving ways that do not involve sexual intercourse.
- Tell your partner about the things that are especially pleasurable – maybe touching or stroking.
- It is normal to feel sexual pleasure when the stoma is touched. But a stoma is delicate and can be irritated or even torn by too much rubbing. Never put an object into the stoma unless the doctor says so.
- Plan sexual activity for a time of day when the stoma is usually not active. Empty the ostomy pouch before lovemaking.
- A cover or small pouch may be worn during sexual activity, depending on the type of ostomy you have had. Some people wear gauze over the stoma during sexual activity because a pouch can be awkward and get in the way.
- Make sure the pouch fits correctly. Check the seal and empty the bag before sexual intercourse. Keep the pouch from flapping by taping it to the body.
- Use deodorizers or odour eliminators if concerned about odours.
- Some people wear clothing to cover the stoma if they feel uncomfortable with its appearance.
- Try different positions that keep a partner's weight off the stoma to reduce rubbing against the appliance. Experiment to find out what works best.
- If you have had a colostomy or urostomy, avoid eating foods that produce gas or give urine a strong odour, on days when lovemaking might occur.
Enterostomal therapists, people with an ostomy (ostomate), and professional individual or couple counsellors can help address questions and concerns you and your partner may have about sex and intimacy.
Resources available
Local or national ostomy groups and associations are available to provide support and information. These groups and associations can help with a successful adjustment to living with an ostomy. The enterostomal therapist can provide information about these groups.