Colostomy
From Wikipedia, the free encyclopedia
A colostomy is a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma. This opening is formed from the end of the large intestine drawn out through the incision and sutured to the skin. After a colostomy, feces leave the patient's body through the stoma, and collect in a pouch attached to the patient's abdomen which is changed when necessary.
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[edit] Indications
There are many reasons for this procedure: a section of the colon has had to be removed, for example due to colon cancer, diverticulitis, injury, etc, so that it is no longer possible for feces to pass out via the anus; or a portion of the colon has been operated upon and needs to be 'rested' until it is healed. In the latter case, the colostomy is often temporary and is usually reversed at a later date, leaving the patient with a small scar where the stoma was.
[edit] Perception
Colostomies are viewed negatively due to the misconception that it is difficult to hide the smell of feces and the pouch and even keeping it securely attached. However, modern colostomy pouches are well-designed, odor-proof, and allow stoma patients to continue normal activities. Latex-free tape is available for assuring a secure attachment.
Colostomates with ostomies of the sigmoid or descending colon might have the option of irrigation. This procedure allows for the person to not wear a pouch, but rather just a gauze cap over the stoma. By irrigating, a catheter is placed inside the stoma, and flushed with water, this allows the feces to come out of the body into an irrigation sleeve. Most colostomates irrigate once a day or every other day, though this depends on the person, their food intake, and their health.
Placement of the stoma on the abdomen can occur at any location along the colon, the majority being on the lower left side near or in the sigmoid colon, other locations include; the ascending, transverse, and descending sections of the colon. Colostomy surgery that can be planned ahead often has a higher rate of long-term success and satisfaction than those done in emergency surgery.
[edit] Living with a colostomy
People with colostomies must wear an external pouch to collect intestinal waste. Modern pouches are made of lightweight plastic and are attached to the skin with an adhesive wafer made of pectin or similar organic material. The wafer is cut with a hole to fit snugly around the base of the stoma to prevent leakage of stool onto the skin (and consequent skin irritation). Wafers are available with the hole pre-cut for convenience and accuracy of a snug fit. The pouch and wafer may be purchased as a one-piece unit or as two separate pieces which attach with a plastic locking ring. The latter arrangement allows pouches to be swapped without removing the wafer; for example, some people prefer to temporarily switch to a "mini-pouch" for swimming or other activities. There are two types of pouches, closed ended and open ended. The closed end pouch requires that the pouch be removed and thrown away each time it is full whereas the open ended pouch can be emptied as necessary by removing the leakproof clip. Many manufacturers now offer a velcro-type closure at the end which eliminates the need for the clip. Ordinarily the pouch must be emptied several times a day (many ostomates find it convenient to do this whenever they make a trip to the bathroom to urinate) and changed every 2-5 days, when the wafer starts to deteriorate.
Ostomy pouches fit close to the body and are usually not visible under regular clothing unless the wearer allows the pouch to become too full.
[edit] Alternatives
In some rare situations it may be possible to opt for an internal colo-anal pouch which eliminates the need for an external pouch. In place of an external appliance, an internal ileo-anal pouch is constructed using a portion of the patient's lower intestine, to act as a new rectum in replace of the original that has been removed.
