Ostomy

An ostomy is a surgical procedure that creates a new opening, called a stoma, in your abdomen to allow waste to leave your body. This opening connects to your digestive or urinary system, diverting stool or urine into a collection pouch worn outside your body. It is often a life-saving or life-improving procedure performed by trained surgeons.

What is Ostomy?

An ostomy is a surgical procedure that creates an artificial opening, known as a stoma, on the surface of your abdomen. This stoma serves as a new pathway for waste products, such as stool or urine, to exit your body when the natural route is no longer functional or safe. A collection pouch is then worn over the stoma to gather the waste.

The word "ostomy" comes from Greek, meaning "mouth" or "opening." During the procedure, a surgeon brings a part of your intestine or urinary tract through the abdominal wall. This creates a small, moist, pink or red opening that looks similar to the inside of your mouth. There are different types of ostomies, named for the part of the intestine or urinary tract involved. A colostomy involves the large intestine (colon), an ileostomy involves the small intestine (ileum), and a urostomy involves the urinary tract, typically using a small piece of intestine to create a new path for urine. Regardless of the type, an ostomy requires a pouching system, often called an ostomy bag, to be worn over the stoma. This system collects the output (effluent) from the stoma. Modern pouching systems are designed to be discreet, secure, and odor-proof, allowing individuals to maintain an active lifestyle.

Why it's done

An ostomy is performed when a part of your digestive or urinary system is diseased, damaged, or needs to rest, preventing waste from passing through its normal route. This procedure can be temporary, allowing a damaged area to heal, or permanent, providing a long-term solution for conditions that cannot be otherwise corrected.

Many medical conditions can necessitate an ostomy. Common reasons include inflammatory bowel diseases like Crohn's disease or ulcerative colitis, which can severely damage the intestines. Cancer, particularly colorectal cancer or bladder cancer, often requires removal of parts of the bowel or bladder, making an ostomy necessary. Other reasons include diverticulitis, a condition where small pouches in the colon become inflamed or infected, and traumatic injuries to the abdomen or pelvis. Birth defects that affect the digestive or urinary system can also lead to the need for an ostomy, especially in infants. In some cases, an ostomy is created temporarily to divert waste away from a surgical repair, allowing the affected area to heal completely without contamination. Once healing is complete, another surgery may be performed to reverse the ostomy and reconnect the bowel or urinary tract. In other situations, the damage or disease is too extensive for reconnection, making the ostomy a permanent solution to improve health and quality of life.

How to prepare

Preparing for an ostomy involves medical evaluations, dietary adjustments, and education about stoma care. Your healthcare team, including a surgeon and an ostomy nurse, will guide you through each step, ensuring you understand the procedure and how to manage your stoma afterward. This preparation helps ensure a smoother recovery and better long-term adjustment.

Before surgery, your doctor will conduct a thorough medical evaluation. This includes reviewing your medical history, performing physical exams, and ordering tests like blood work, imaging scans, and colonoscopies. These steps help assess your overall health and determine the best surgical approach for your specific condition. A key part of preparation involves meeting with an ostomy nurse or enterostomal therapist. This specialist will teach you about living with an ostomy, including how to care for your stoma and manage your pouching system. They will also help you choose the best location for your stoma on your abdomen, ensuring it is in a place that is easy for you to see and manage. You may need to adjust your diet in the days leading up to surgery. This often involves a clear liquid diet and bowel preparation, such as laxatives or enemas, to cleanse your intestines. You will also receive instructions on which medications to stop taking, especially blood thinners, and when to stop eating and drinking before the procedure.

What happens during

During an ostomy procedure, a surgeon creates a stoma by bringing a section of your intestine or urinary tract through an incision in your abdominal wall. The edges of this section are then stitched to your skin, forming the new opening. The specific steps vary depending on the type of ostomy and whether it is temporary or permanent.

The surgery is performed in a hospital operating room under general anesthesia, meaning you will be asleep and feel no pain. The surgeon begins by making an incision in your abdomen. This can be a single large incision (open surgery) or several small incisions using a laparoscope (minimally invasive surgery), depending on your condition and the surgeon's recommendation. For a colostomy or ileostomy, the surgeon identifies the appropriate section of the bowel. This section is then brought through a small opening created in the abdominal wall, usually on the right or left side of your belly. The end of the bowel is then everted, or folded back on itself, like a cuff, and stitched to the skin around the opening. This creates the stoma, which will be moist and red. For a urostomy, a small segment of your small intestine is typically removed and used to create a conduit, or channel, for urine. The ureters, which carry urine from your kidneys, are connected to this intestinal segment. One end of the segment is then brought through the abdominal wall to form the stoma, allowing urine to drain into a collection pouch. The other end of the intestinal segment is closed off inside the body.

Recovery & timeline

Recovery from ostomy surgery typically involves a hospital stay of several days to a week, during which you will learn to care for your stoma. Initial recovery focuses on pain management, monitoring the stoma, and gradually resuming normal activities. Full adjustment and healing can take several weeks to months as you adapt to living with your ostomy.

Immediately after surgery, you will be monitored closely in a recovery room. Pain medication will be provided to keep you comfortable. Your stoma will begin to function within a few days, and your ostomy nurse will start teaching you how to empty and change your pouching system. This education is crucial for managing your ostomy at home. During your hospital stay, you will gradually resume eating and drinking, starting with clear liquids and progressing to solid foods as tolerated. You will also be encouraged to get out of bed and walk to help prevent complications like blood clots and to promote bowel function. Before you leave the hospital, your healthcare team will ensure you feel confident in managing your ostomy. Once home, it's important to follow your surgeon's instructions regarding activity levels, diet, and wound care. You should avoid heavy lifting for several weeks to prevent hernias. Most people can return to light activities and work within 4 to 6 weeks, but full recovery and adjustment to a new routine can take longer. Regular follow-up appointments with your surgeon and ostomy nurse are essential to monitor your progress and address any concerns.

Risks & side effects

Like any major surgery, ostomy procedures carry potential risks and side effects, though serious complications are relatively uncommon. These can include infection, bleeding, leakage from the stoma, skin irritation around the stoma, or problems with the stoma itself. Your healthcare team will discuss these risks with you and monitor for them during recovery.

Common surgical risks include infection at the incision site or within the abdomen, bleeding, and reactions to anesthesia. After an ostomy, specific complications related to the stoma can occur. These include parastomal hernia, where a part of the intestine bulges near the stoma, and stoma prolapse, where the stoma extends out further than usual. Skin irritation around the stoma (peristomal skin irritation) is a common side effect, often caused by leakage of waste onto the skin. This can usually be managed with proper pouching techniques and skin care products. Other potential issues include stoma retraction, where the stoma pulls back into the abdomen, or stoma stenosis, a narrowing of the stoma opening. Less common but more serious risks include bowel obstruction, where the flow of waste is blocked, or internal leakage. It is important to contact your doctor or ostomy nurse if you experience severe pain, fever, persistent nausea or vomiting, significant changes in stoma output, or any signs of infection around your stoma or incision.

Success rate

The success of an ostomy procedure is generally high, significantly improving the quality of life for many individuals who undergo it. While success is measured by the stoma functioning correctly and the absence of major complications, it also encompasses a patient's ability to adapt to their new body and resume daily activities with confidence.

For many people, an ostomy is a life-saving procedure that effectively treats severe conditions like cancer, inflammatory bowel disease, or traumatic injuries. It allows individuals to recover from debilitating illnesses and often leads to a substantial improvement in their overall health and well-being. The immediate surgical success, meaning the stoma is created and functions as intended, is very common. Long-term success is also measured by how well individuals adapt to living with an ostomy. With proper education, support from healthcare professionals, and access to modern ostomy supplies, most people learn to manage their stoma effectively. They can typically return to work, engage in hobbies, travel, and participate in physical activities, including sports. While challenges like skin irritation or occasional leaks can occur, these are often manageable with adjustments to the pouching system or care routine. Studies and patient experiences consistently show that an ostomy can lead to a significant increase in quality of life, allowing individuals to regain independence and control over their health that was lost due to their underlying medical condition.

Frequently asked questions

Can I eat normally with an ostomy?

Yes, most people with an ostomy can eat a normal, balanced diet. Initially, your doctor or ostomy nurse may recommend avoiding certain foods that can cause gas or blockages, especially with an ileostomy. Over time, you will learn which foods work best for you. Chewing food thoroughly and staying hydrated are always important.

Will my ostomy smell?

Modern ostomy pouches are designed with advanced filters and odor-barrier materials that effectively prevent odors from escaping. While you may notice a slight odor when emptying or changing your pouch, it is generally not noticeable to others. Dietary choices can also influence the odor of your output.

Can I swim or shower with an ostomy?

Yes, you can swim and shower with an ostomy. The pouching system is waterproof and designed to stay securely in place. Many people choose to wear a smaller, more discreet pouch for swimming. Always ensure your pouch is sealed properly before getting it wet.

Will an ostomy affect my sex life?

An ostomy does not prevent you from having a fulfilling sex life. It's normal to have concerns about intimacy, but with open communication with your partner and some adjustments, many people find they can maintain intimacy. Wearing a smaller pouch or special covers can help with discretion and comfort.

How often do I need to change my ostomy pouch?

The frequency of changing your ostomy pouch depends on the type of ostomy, your output, and the specific pouching system you use. Generally, a pouch is emptied several times a day when it's about one-third to half full, and the entire system (wafer and pouch) is typically changed every 3 to 7 days. Your ostomy nurse will provide personalized guidance.

Can an ostomy be reversed?

Whether an ostomy can be reversed depends on the reason it was created and your overall health. Temporary ostomies are often reversed once the underlying condition has healed. Permanent ostomies are usually not reversible. Your surgeon will discuss the possibility of reversal with you based on your specific medical situation.

Sources

• MedlinePlus — Ostomy
• Mayo Clinic — Ostomy
• Cochrane Library — Ostomy