Health Care Personnel and Ostomies

What do health care personnel need to know about ostomy surgery? Communication is the key.

Now that you have an ostomy or an internal diversion, some changes have occurred in the normal routines of life. This is especially true of medical treatment and hospitalization.

Some medical and hospital assumptions and routines applicable to non-ostomates may no longer apply to you. For your comfort, well-being and, in some instances, your health and personal safety, it is important that you know how you need to be treated differently. You need to communicate this information appropriately to doctors and medical attendants who need to know.

Your doctor, ostomy nurse and others who normally attend your ostomy are no doubt well-informed of the differences in treatment you require and will help you communicate with medical personnel uninformed about ostomy matters.

The fact that some health care personnel may be uninformed is quite understandable. The staffs of the thousands of hospitals in North America see relatively few ostomy patients. Few nurses and other hospital attendants have ever cared for an ostomy patient. And many of those who have are not aware of the different types of ostomies and the special considerations each requires.

Doctors have become highly specialized to bring more expert care to patients. Therefore, many rarely have the occasion or the time to develop expertise in ostomy, which is very much a specialty in itself.

So don't be shy about communicating your condition and its special requirements to all who attend you for non-ostomy ailments. This is for their benefit as well as your own. If strong insistence should fail to bring about understanding, you have the right to refuse any procedure you consider harmful to yourself.

Dr. Marshall Sparberg, author of the excellent book Ileostomy Care and a frequent writer on ileostomy matters, has this to say: "It is within the individual patient's right to refuse any hospital procedure, and no amount of insistence from an uninformed individual should change this decision.

Ostomies are different. One of the most serious misunderstandings is that all stomas represent colostomies, and that all colostomies are the same. This can be disastrous for the patient who has an ileostomy or urostomy. It can cause trouble for the person with a transverse colostomy when treated as a sigmoid colostomy. In addition, even those with the same type of ostomy require variations in care and treatment. Ostomies vary greatly in nature just as individuals vary.

Irrigations and enemas: Those with urostomies should never be given an irrigation or enema through the stoma. An irrigation could cause serious kidney infection and damage.

Those with ileostomies should never be given an irrigation unless a doctor, ostomy nurse or other expert gives one to break up a blockage, or for other compelling reasons. An irrigation or enema of the small intestine may cause the ileostomate ill effects. However, a colostomate may require irrigations; this poses no danger if it is done properly.

A stoma is not an anus. Some medical attendants do not realize the difference between a stoma and an anus. They may treat a stoma as roughly as they treat an anus. If an enema or irrigation with a catheter is involved, care must be taken to avoid bowel injury. Some catheters, though streamlined on the end, are stiff and should not be inserted into a stoma unless performed by a physician or ostomy nurse. A cone is much safer, easier to use and does a better job than a catheter.

Editor's note: On the topic of this article, I had a routine physical a few years ago. I had already explained to the doctor that I have a permanent ileostomy following a failed J-pouch. Then, as he told me to bend over and started putting on his gloves, I realized suddenly that he was preparing to do a digital rectal exam. I protested: "You can't do that; I have an ileostomy!" He said he hoped to do the exam through the remnants of my failed J-pouch. I pointed out that my J-pouch had been removed and my apparently normal-looking anus was actually sealed shut a few millimeters below the surface. He still wanted to try the exam using whatever remained of my anal canal but I refused, fearing that he would do serious damage if he forced his way in. As it says in the article, remember that you can refuse any procedure that you think would be harmful.