Ostomy Care

Ileostomy

The surgically created opening of the colon (large intestine) which results in a stoma. A Colostomy is created when a portion of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall. It may further be defined by the portion of the colon involved and/or its permanence.

Reservoir (J-Pouch)
This is now the most common alternative to the conventional Ileostomy. Technically, it is not an ostomy since there is no stoma. In this procedure, the colon and most of the rectum are surgically removed and an internal pouch is formed out of the terminal portion of the ileum. An opening at the bottom of this pouch is attached to the anus such that the existing anal sphincter muscles can be used for continence. This procedure should only be performed on patients with ulcerative colitis or familial polyposis who have not previously lost their anal sphincters. In addition to the “J” pouch, there are “S” and “W” pouch geometric variants. It is also called ileoanal anastomosis, pull-thru, endorectal pullthrough, pelvic pouch and, perhaps the most impresssive name, ileal pouch anal anastomosis (IPAA).

Continent Ileostomy
(Kock Pouch) In this surgical variation of the Ileostomy, a reservoir pouch is created inside the abdomen with a portion of the terminal ileum. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted into the pouch several times a day to drain feces from the reservoir. This procedure has generally been replaced in popularity by the ileoanal reservoir (above). A modified version of this procedure called the Barnett Continent Intestinal Reservoir (BCIR) is performed at a limited number of facilities.

Reasons for Surgery:

Ulcerative colitis, Crohn's disease, familial polyposis.

Care of Ileostomy:
A pouching system is worn. Pouches are odor free and different manufacturers have disposable or reusable varieties to fit your lifestyle. Ostomy supplies are available at drug stores, ostomy supply houses and through the mail.

Living with a Ileostomy:

Work:
With the possible exception of jobs requiring very heavy lifting, an Ileostomy should not interfere with work. People with Ileostomies are successful business people, teachers, carpenters, welders, etc.

Sex and Social Life:
Physically, the creation of an Ileostomy usually does not affect sexual function. If there is a problem, it is almost always related to the removal of the rectum. The Ileostomy itself should not interfere with normal sexual activity or pregnancy. It does not prevent one from dating, marriage or having children.

Clothing:
Usually one is able to wear the same clothing as before surgery including swimwear.

Sports and Activities:

With a securely attached pouch one can swim, camp out, play baseball and participate in practically all types of sports. Caution is advised in heavy body contact sports. Travel is not restricted in any way. Bathing and showering may be done with or without the pouch in place.

Diet:
Usually there are no dietary restrictions and foods can be enjoyed as before.

Urostomy

This is a general term for a surgical procedure which diverts urine away from a diseased or defective bladder. The ileal or cecal conduit procedures are the most common Urostomies. Either a section at the end of the small bowel (ileum) or at the beginning of the large intestine (cecum) is surgically removed and relocated as a passageway (conduit) for urine to pass from the kidneys to the outside of the body through a stoma. It may include removal of the diseased bladder.

Continent Urostomy
There are two main continent procedure alternatives to the ileal or cecal conduit (others exist). In both the Indiana and Kock pouch versions, a reservoir or pouch is created inside the abdomen using a portion of either the small or large bowel. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted several times daily to drain urine from the reservoir.

Indiana Pouch
The ileocecal valve that is normally between the large and small intestines is relocated and used to provide continence for the pouch which is made from the large bowel. With a Kock pouch version, which is similar to that used as an Ileostomy alternative, the pouch and a special “nipple” valve are both made from the small bowel. In both procedures, the valve is located at the pouch outlet to hold the urine until the catheter is inserted.

Orthotopic Neobladder
A replacement bladder, made from a section of intestine, that substitutes for the bladder in its normal position and is connected to the urethra to allow voiding through the normal channel. Like the ileoanal reservoir, this is technically not an ostomy because there is no stoma. Candidates for Neobladder surgery are individuals who need to have the bladder removed but do not need to have the urinary sphincter muscle removed.

Reasons for Surgery:

Bladder cancer, spinal cord injuries, malfunction of the bladder and birth defects such as spina bifida.

Care of Urostomy:
A pouching system is worn. Pouches are odor free and different manufacturers have disposable or reusable varieties to fit your lifestyle. Ostomy supplies are available at drug stores, medical supply stores and through the mail.

Living with a Urostomy:

Work:
With the possible exception of jobs requiring very heavy lifting, a Urostomy should not interfere with work. People with Urostomies are successful business people, teachers, carpenters, welders, etc.

Sex and Social Life:
Sexual function is influenced by the reasons for which the Urostomy is performed. The Urostomy itself should not interfere with normal sexual activity or pregnancy. It does not prevent one from dating, marriage or having children.

Clothing:
Usually one is able to wear the same clothing as before surgery including swimwear.

Sports and Activities:
With a securely attached pouch one can swim, camp out, play baseball and participate in practically all types of sports. Caution is advised in heavy body contact sports. Travel is not restricted in any way.

Diet:
Usually there are no dietary restrictions and foods can be enjoyed as before. It is suggested that 8-10 glasses of fluid per day be consumed to help decrease the chance of kidney infection.