Understanding An Ostomy
An ostomy is a surgical opening between the urinary or digestive system and the surface of the body. The surgeon makes an incision in the abdomen, and a piece of intestine (or the ureter, in some urostomies) is pulled through the incision. The protruding part of the intestine, called the stoma, serves as an outlet for waste.
Ostomy surgery can be a lifesaving procedure, because it allows waste to leave your body when your urinary or digestive system isn’t functioning normally. Ostomy may be permanent when a health condition damages your normal intestinal or urinary function, or when part of the urinary or digestive system isn’t working properly or must be removed. Some ostomies are temporary, put in place long enough to allow your system to heal after a surgery, inflammation or blockage.
In most cases, people with an ostomy must wear a pouching system attached to their stoma to collect waste, whether urine or stool. There’s a wide array of ostomy products available to help people manage their ostomy and live full, active lives.
A colostomy diverts the large intestine. A portion of the colon or the rectum is removed, and the remaining colon is connected to the abdominal wall to form a stoma.
After a colostomy, stool will no longer pass through your anus. Instead, it will be expelled through the stoma, into your ostomy pouching system. The location of your colostomy (whether in a higher or lower segment of your colon) will affect the output from your stoma. You won’t be able to control bowel movements, but you may be able to predict when they will occur.
An ileostomy involves the ileum, which is the lowest part of the small intestine. The intestine is brought through the abdominal wall to form a stoma.
A standard ileostomy diverts stool from your small intestine to the stoma, where it flows into your ostomy pouching system. Ileostomy output is constant, so the pouch should be emptied often.
Some ileostomies do not require an external pouching system. A J-pouch ileostomy creates an internal pouch to store waste, which is excreted through the anus. A K-pouch ileostomy also stores waste in an internal pouch, which is then removed by inserting a catheter into the stoma.
A urostomy diverts urine from a bladder that’s not functioning. In a urostomy, a short piece of the bowel is removed and attached to the ureters, becoming a conduit for urine to drain through a stoma. (The ends of the bowel are reattached, and function normally.) Urine drains from the kidneys to the stoma, where it is collected in a urostomy pouch.
Stoma Site Selection
A crucial part of preparing for your ostomy surgery is selecting the site for your stoma. Your nurse and/or surgeon will work with you to determine the ideal place for it.
The main factor determining stoma placement is the type of ostomy you’ll have. Generally, a stoma is located on the lower part of the abdomen, below the navel. Ileostomies are typically placed in the right lower quadrant of the abdomen, while colostomy stomas are placed in the upper or lower left quadrant. An ileal conduit for a urostomy is usually in the right lower quadrant.
Your specific stoma placement may be customized to best fit your body and your needs. Ostomy pouching systems need a flat, smooth surface to adhere to. Deep creases or skin folds, old scars, hernias and other irregularities in your skin can interfere with skin barrier adhesion. The stoma should generally be placed away from the belt line. If your abdomen is rounded, the stoma may be placed on the upper part of the curve so that you can easily see it.
The skin around your stoma is called the peristomal skin. It’s important to take excellent care of this area, because peristomal skin is susceptible to irritation, injury and infection. When peristomal skin comes into contact with fluid leaking from the stoma, it gets damaged; when the skin is damaged, it’s harder to adhere your ostomy pouching system properly. This cycle can result in painful, recurring skin conditions.
To keep your peristomal skin healthy, practice a regular skin care routine. Wash the area with water or gentle soap every time you change your skin barrier. Use a correctly sized skin barrier with products that ensure a good fit, such as an ostomy barrier ring or stoma paste. If you notice skin problems beginning to develop, call your healthcare provider.
Read more: How To Care For Your Peristomal Skin
Urostomy Guide (United Ostomy Associations of America)
Stoma Site Selection (GI Society)
Peristomal Skin: Here’s Why You Need to Keep It Healthy (Hollister)