Types of Ostomies
An ostomy is a surgically created opening in the abdomen, called a stoma, that allows waste to be eliminated from the urinary or digestive system.
What is a Colostomy?
A colostomy connects the large intestine to an opening in the abdomen. In an end colostomy, the end of the colon is brought through an incision to form a stoma. In a loop colostomy, which is intended to be temporary, a hole is cut in the side of the colon, which is attached to the abdominal wall. Later, this procedure can be reversed, restoring normal function to the large intestine.
After a colostomy, stool will no longer pass through your anus. Instead, it’s expelled through the stoma, into your ostomy pouching system.
There are four types of colostomy, distinguished by the location of the ostomy and stoma. To understand the differences, it helps to picture your large intestine as an upside-down U. Digested food goes up the right side (the ascending colon), then across your body (the transverse colon), then down the left side (descending colon), and finally through the sigmoid colon and the rectum.
As digested food passes through the large intestine, water is absorbed and digestive enzymes break down. Therefore, the location of your ostomy determines the nature of the output.
A sigmoid colostomy involves the very end of the colon. The stoma is typically placed on the lower left side of the abdomen, and output is usually firm.
A descending colostomy involves the descending colon. The stoma is usually placed on the lower left side of the abdomen, and output is semi-firm
A transverse colostomy involves the middle part of the colon, and the stoma is placed on the upper abdomen. A transverse colostomy is often temporary, performed for conditions such as diverticulitis, inflammatory bowel disease, a blockage, or an injury. A transverse colostomy may have two openings: a stoma for stool (typically soft) and a stoma for the mucus that the resting section of your colon will keep producing.
An ascending colostomy involves the right side of your abdomen, which means only a short part of the colon remains active. An ascending colostomy is generally performed when blockage or severe disease prevents the colostomy from being located further down the colon. Output is typically more liquid in form.
What Is an Ileostomy?
An ileostomy connects the small intestine to an opening in the abdomen. Ileostomies may be temporary or permanent, and are performed when illness, injury or other problems prevent the large intestine from processing waste.
A standard (or Brooke) ileostomy diverts stool from your small intestine to the stoma, where it is collected in an ostomy pouching system. Ileostomy output drains constantly, so the pouch should be emptied often. The output also contains digestive enzymes that can damage the skin, so it’s essential to prevent leaks by maintaining a good seal with your ostomy pouching system.
A J-pouch ileostomy creates an internal pouch to store waste, which is excreted through the anus without involving the large intestine. Surgeons use loops of the ileum (the last part of the small intestine) to construct a pouch shaped like the letter J, which is then connected to the anus.
A K-pouch (Kock) ileostomy is also called a continent ileostomy, because it does not require someone to wear an external ostomy pouching system. As in a J-pouch surgery, surgeons create an internal pouch to store waste, which is connected to the abdominal wall. A special valve prevents waste and gas from escaping. Four to five times per day, a patient drains waste from the pouch using a small catheter.
What Is a Urostomy?
A urostomy allows urine to drain from the body when the bladder is not functioning. Urine passes from the kidneys to the stoma, where it is collected in a urostomy pouch. The flow of urine from a urostomy can’t be controlled, so the pouch needs to be emptied several times a day.
Urostomies are often performed when injury or disease means the bladder or urethra needs to be removed, or isn’t working as it should. Common reasons for a urostomy include bladder cancer, birth defects, spinal cord injury, and severe urinary incontinence. Urostomy is typically permanent, and can’t be reversed.
In an ileal conduit urostomy, the surgeon takes a piece of your small intestine (ileum) to create a tube that connects your ureters to a stoma in your abdomen. Urine flows from the bladder through the ureters and out the stoma.
A colonic conduit urostomy is similar, except that the tube is made from a piece of the large intestine (colon).
A continent urostomy involves creating a pouch inside your body to store urine, so you don’t have to wear an external ostomy pouch. Instead, you use a tube to drain urine from the stoma at intervals. Or, the surgeon will create a neobladder — new bladder — inside your body from your intestine. In this case, you still urinate normally and can control urination.