An ostomy is a surgically-created intestinal or urinary tract diversion that modifies the normal pathway for waste elimination. In a classical ostomy, an opening called a "stoma" is made through the abdominal wall and the patient must usually wear an appliance (plastic bag) to collect waste that flows out from the stoma (The word stoma is derived from the Greek for "mouth"). An ostomy may be temporary or permanent. There are three kinds of classical ostomies:
Colostomy - An abdominal opening from any part of the large intestine (colon), made because part of the colon has been removed or must be bypassed. The most common type is a sigmoid colostomy, where only the rectum has been removed or must be bypassed, and the stoma is usually on the lower-left abdomen. Output from a sigmoid colostomy has nearly the same consistency as normal stool because it has passed through the whole small intestine and most of the large intestine. Colostomies of this type are often managed successfully with irrigation (enemas through the stoma). Colostomies from the transverse or ascending colon have a less solid output--more like an ileostomy:
Ileostomy - An abdominal opening from the terminal small intestine (ileum), made because the entire colon has been removed or must be bypassed. An ileostomy stoma is usually on the lower-right abdomen. Its output has passed through all or most of the small intestine, but none of the large intestine; consistency of this output may vary from very liquid to a semi-solid paste. Ileostomies are never managed with irrigation.
Urostomy - An abdominal opening from the urinary tract. The stoma for a urostomy is often built from a short length of ileum (This is called an ileal conduit), and may look nearly the same as an ileostomy. In fact, people sometimes mistakenly use the word "ileostomy" when referring to a urostomy. But the difference is simple: If it flows urine, it's a urostomy. An ileostomy flows digestive waste.
In addition to the three classical ostomies, some patients who previously would have required an ileostomy or urostomy can now opt for alternative "continent" procedures that avoid wearing an appliance. In these procedures, an internal pouch is fashioned from the patient's intestine to replace the missing rectum or bladder. In some continent ileostomies and urostomies, the patient still has an opening on the abdomen, but wears only a light dressing (similar to a band-aid), and inserts a catheter when necessary to empty the pouch. In other variants, the internal pouch is attached directly to the patient's retained anus or urethra, so the patient continues to void in a more or less "normal" manner.
Continent procedures are not available to all patients. For example, the ileoanal reservoir (pelvic pouch or "J-Pouch") is now an option for many patients with Ulcerative Colitis, but is generally not done for patients with Crohn's disease. Also, while these procedures enable patients to avoid wearing an appliance, they are not free of problems. For example, people with continent ileostomies and pelvic pouches may get "pouchitis" - inflammation of the internal pouch. We're here to help all people with both classical ostomies and the newer alternative procedures cope with their problems and live fully productive lives.
Additional information about ostomies can be found in the definitions at the UOAA National Website and a set of diagrams on the UOA Canada Website.
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