Care of Colostomies & Ileal Conduits: Part 1 of 3

Surgery today is far more complicated than ever before. Newer techniques are saving more and more lives. However, some of these surgeries require special and continuing care on the part of the patient. "Ostomy" surgery is one.

Sometimes the pathways of the digestive or urinary tracts need to be diverted. Disease such as cancer, trauma, and birth defects are reasons for "diversion." An ostomy is a general term meaning an opening made into the body. When this opening is made into the "colon" (the large intestine) and a segment of colon is sewn to the abdomen, then a person is said to have a "colostomy." If this opening is made into the small intestine, then a person is said to have an "ileostomy." And if the surgery involves the urinary tract, then a person is said to have a "urostomy."

It is estimated that approximately one million people in the United States and Canada have had ostomies. About one hundred thousand new ostomies are created each year. Therefore, one in every two hundred people has had ostomy surgery. Chances are someone you know has had a colostomy, ileostomy, or urinary diversion. Let's discuss the colostomy and the ileal conduit (a type of urinary diversion) a little bit.

If a person has a cancer of the colon which is very near the rectum, then that person may have to have a colostomy. This surgery is performed as a life-saving measure. There are people with colostomies who are able to engage in sports, eat all the foods that anyone else eats, be free of any discomforts, and live their lives just as they did before surgery.

Managing a Colostomy

There are two generally accepted methods of managing a colostomy. Because the rectum has been by-passed, a person with a colostomy is unable to control the elimination of feces. Either that person will wear a pouch over the stoma—the "stoma" is the term given to the portion of the intestine which extends beyond the abdominal wall-or that person will take an enema every day, or every other day, so that no stool will be eliminated from the stoma over the intervening 24-48 hour period. Choosing which method of colostomy care would be best is often made as a joint decision reached by your doctor, enterostomal therapist, and yourself.

When a person chooses to care for the colostomy by wearing a pouch continuously over the stoma, then that pouch may need to be emptied 3 to 4 times a day. One empties the pouch directly into the toilet; and, quite frankly, many people with colostomies spend less time in the bathroom than people who have not had a colostomy.

Types of Pouches

There are many different types of pouches one can wear. In fact, over 30 manufacturers of colostomy supplies make some 200 differing pouches. All of these have certain things in common: they can be emptied from the bottom; they have some type of adhesive which holds the pouch to the skin; they have some feature that protects the skin around the stoma; and most are absolutely odor resistant.

Pouches come in all shapes and sizes, are either clear or opaque, and can be selected with or without a belt for added security. Usually, by the time a person leaves the hospital, the enterostomal therapist or nurse specialist will have selected a pouch which is comfortable, gentle to the skin, and not noticeable under clothing. After regaining one's strength, it may be wise to visit the enterostomal therapist regularly so that any new advancements in care, changes in the stoma or the skin around the stoma, or questions concerning diet and clothing can be discussed.

The second method of caring for a colostomy is to take an enema. The medical term for an enema into a colostomy is an "irrigation." One takes these irrigations at the same time each day (or every other day), minimizing the chances of an intervening fecal discharge-so that one need only wear a very tiny pouch or even just a piece of gauze over the stoma, If you choose to try irrigating, you will be taught this procedure by an enterostomal therapist or nurse specialist before you leave the hospital. At first, the procedure may take about an hour. But after practice, most people irrigate in about half an hour. Some people with colostomies have absolutely no feces from the stoma between irrigations; they are the ones who are able to wear a small piece of gauze over the stoma.

Read Care of Colostomies and Ileal Conduits: Part 2 of 3


Editor's Note: This article was authored by Victor Alterescu, RN, ET.