Colostomy or Ileostomy Issues

An ostomy or stoma is created when a cut end of intestine is brought out to the skin, where an attached bag can collect the eliminated fecal waste. When the cut end of colon was brought out, it is called a colostomy. When the last part of small intestine, the ileum, was brought out, it is called an ileostomy. You may have an ostomy created as part of a planned operation, or during an emergency surgery. The ostomy may be permanant or temporary. If you have only one stoma opening, you may or may not know if only one end of intestine was brought out (as an end ostomy) or both ends were brought out (as a loop ostomy). An ostomy is typically done for the following reasons:

• when reconnecting the intestine after a segment was resected is not safe or feasible due to high risk of the connection not healing and falling apart

• when disease process in certain part of your intestine prevents normal stool passage and elimination and needs to be bypassed

• when your surgeon recommends that no stool passage (thus less bacteria) through a particular segment of intestine is beneficial for healing

Problems you may encounter having an ostomy

Depending on the type of stoma and how long you have had the stoma for, you may experience one or more of the following problems:

• Leakage of stool around the pouch - occurs when the wafer does not adhere to your skin well, could be a result of skin irritation, non-flat contour such as near a scar, improperly fitted pouching system.

• Peristomal skin irritation - occurs when stool remains in contact with skin for prolonged time, worse with liquid stool. Could be due to wafer opening is cut too big, or incomplete seal allowing some stool to seep under the wafer.

• Stoma prolapse - when the stoma appears to protrude more than previously. When the prolapse is of significant length, it may cause difficulty with pouching, and when it gets very swollen, there is a risk of compromised blood flow to the stoma (the stoma turns dark red, purple or black).

• Parastomal hernia - when a gap between the stoma and the abdominal wall muscle around it gets big enough to allow intestine or intraabdominal fat to slip through, forming a bulge under the skin. This may cause discomfort and difficulty pouching. If intestine was trapped in the hernia, there is a risk of bowel obstruction or compromised blood flow to the intestine.

• Stoma retraction - when the stoma appears more sunken then previously, could be due to scar tissue or other intraabdominal disease process "pulling" the stoma in. It typically leads to difficulty with pouching, leak around the pouch and skin irritation.

• High output ostomy - when there is persistent large amount of liquid stool output on a daily basis. This typically occurs in an ileostomy or other small bowel stoma, where much of the fluid content in the stool are not reabsorbed due to limited length of intestine. This can lead to dehydration, electrolytes imbalance and malabsorption. The liquid stool also tend to leak around the pouch and cause skin irritation.

Management of ostomy issues

Problematic stoma may be prevented partially by having proper marking to determine an optimal location for placement of the stoma before the surgery. This could be done by your surgeon in an emergency situation, or by a Wound, Ostomy, Continence Nurse (WOCN) in an elective setting. A WOC nurse also provide education regarding care of your stoma, and can work with your surgeon to help you manage many of the peristomal skin irritation and pouching and fitting issues. If you stool is on the liquid side, Dr. Choi may recommend you to adjust your diet or take certain medications to minimize loose watery stool. For stoma prolapse, retraction or parastomal hernia, non-operative management as mentioned above are usually tried first. Surgery is only recommended if despite above, you continue to experience severe symptoms, or in urgent/emergent situation when there is bowel obstruction or compromised blood flow to the intestine. If the ostomy is not meant to be permanant, closing or reversing the ostomy (reconnecting the intestine) may be the best option.

Can my ostomy be closed, and when?

If you have regular follow up with the surgeon who created your ostomy, he/she would be the best person to answer the question. Sometimes an ostomy may be created during an emergency surgery, or for various reasons you do not get to follow-up with your surgeon again. You may schedule a consultation with Dr. Choi so she can assess if closing the stoma is feasible. Typically the waiting period before a temporary ostomy can be closed (such as a colostomy created during surgery for perforated diverticulitis) is at least 3-4 months. This is to allow you to recover from the initial illness and for the adhesions (the scar tissues that normally form inside your abdominal cavity after surgery) to soften up. Closing an ostomy is not a minor surgery, and careful planning is needed. As part of the assessment and preparation, some additional tests such as colonoscopy or imaging studies to evaluate the altered anatomy may need to be done. If Dr. Choi determines that your stoma can be closed, she may offer to do the surgery via a laparoscopic (minimally-invasive) approach, via an open incision, or locally at the stoma site, depending on your anatomy.

Helpful links:

• Ostomy*

• United Ostomy Association of America**

• Ostomy Home Skills Program***

Source:

*American Society of Colon and Rectal Surgeons

**United Ostomy Association of America

***American College of Surgeon

Related conditions:

• Anal cancer

• Colon cancer

• Constipation

• Crohn's disease

• Diverticulitis and diverticular disease

• Proctitis

• Rectal cancer

• Ulcerative colitis