Terminology

What is an Ostomy

The word ostomy signifies a type of surgery required when a person has lost the normal function of the bladder or bowel due to birth defects, disease, injury or other disorders. Such operations include colostomy, ileostomy and urostomy. The surgery allows for normal bodily wastes to be expelled through a new surgical opening (stoma) on the abdominal wall. Most persons with ostomies must wear special appliances over the stoma.


Types of Ostomies

The Normal Digestive Tract

The Normal Digestive Tract
The Normal Digestive Tract

The digestive tract is a hollow tube which stretches from the mouth to the anus and is lined with mucous membrane. As food travels through the system, enzymes are added which break down the food into a form that can be absorbed and used by our bodies. It is important to remember that digestion and absorption of nutrients takes place in the small bowel. Therefore, if there is a need for the removal of the large bowel because of disease, the normal digestive process is minimally unchanged. The main function of the colon is to extract fluid and salt from the stool and act as a storage organ.

Ostomies are created to overcome problems with the bowel or bladder which are caused by injury, disease or congenital defect. All ostomies allow for the discharge of normal waste through a surgically-created opening (stoma) in the abdomen. Most ostomates wear a pouch to cover the stoma and to collect body waste, but a few have some control over discharge of waste and do not need an appliance.

Colostomy

This type of ostomy involves the surgical construction of a connection from the colon to the abdomen, forming a stoma, which allows the waste to be discharged from the body without passing through the diseased part of the colon and the rectum.

Descending or Sigmoid – This type of colostomy may often produce formed stools. Irrigation (enema) may be recommended by the physician to regulate bowel movement, in which case only a special pad or small security pouch is needed to be worn over the stoma.

Transverse – This type of colostomy generally does not result in formed stools, it being more likely that stools will be loose. Irrigation may regulate bowel movement in some but not in the majority of cases. Special care must be taken to protect the skin from discharge. It is probably necessary to wear an appliance at all times.

Ileostomy

This type of ostomy involves the surgical construction of a connection from the small bowel to the abdomen, forming a stoma which allows for the discharge of body wastes. Surgery often involves removal of the colon and rectum.

The discharge will vary from being quite liquid at first to semisolid as time goes on. It is necessary to wear an appliance at all times, and special care must be given to protecting the skin. It is important for the ileostomate to take meals at regular hours and to drink lots of fluid to keep electrolytes in balance. Diet will have a bearing on the quantity and character of output.

Urostomy

This type of ostomy involves the surgical construction of a connection from the ureters to the abdomen, forming a stoma, which permits the discharge of urine after removal or dysfunction of the bladder.

The ureters carry the urine from the kidneys to the Ileal Conduit (pipeline created from a small section of the ileum) through which it flows to the outside of the body. Wearing an appliance is needed at all times and great care must be taken to protect the skin around the stoma. After the 15 cm piece of ileum is removed to create the conduit and stoma, the cut ends of the ileum are joined and the intestinal tract will soon function the same as before the surgery.

Continent Ileostomy

This type of ostomy involves utilizing the lower part of the small intestine to surgically create an internal reservoir (pouch) having a leak-free nipple valve and conduit to the outside forming a stoma in the abdomen. Fluid intestinal secretions (gas and feces) are collected in the pouch, which is emptied periodically by inserting a small catheter through the stoma into the reservoir. To achieve maximum efficiency and comfort, the pouch should be emptied 3 to 5 times daily.

Continent Urostomy

This type of ostomy involves the surgical construction of an internal ileal pouch, into which urine is maintained until it is emptied by insertion of a catheter into the pouch through the abdominal stoma. The pouch has two nipple valves, one to prevent urine from backing up into the kidneys and the other to maintain the urine in the pouch until it is removed. The pouch is drained periodically perhaps four or five times day). The daily schedule for pouch catheterization should be established by the physician or ET nurse.

Ileoanal Reservoir

This type of surgery is usually done only for ulcerative colitis and familial polyposis patients. The colon (large bowel) is removed. A reservoir is made from the ileum (small bowel) and connected directly to the anus. The sphincter muscle is in place. A temporary ileostomy is performed to allow the reservoir to heal. Later, the ileostomy is closed and feces exits normally through the anus.

Note that the type of surgery depends upon the disease and its severity and also upon the physical condition and age. There may or may not be a choice. The surgeon is the person to advise upon this.

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Terminology

Adhesion – bands of fibrous tissue, usually resulting from inflammation; act of adhering or sticking.

Anastomosis – joining together of the parts of one or more hollow organs.

Anus – the last 4 cm (1.5 inches) of the large bowel below the rectum, forming the excretory opening or anal canal.

Appliance – pouch and accessories worn by an ostomate over the stoma to contain body wastes.

Bladder – organ acting as a container for urine.

Bowel – the intestine; the part of the digestive tract that lies between the stomach and the anus.

Colitis – inflammation of the large bowel.

Colon – large bowel (large intestine) which stores digestive materials and absorbs water.

Colostomy – surgical opening from the colon to the surface of the abdomen to form a stoma.

Continent Ileostomy – see Kock Pouch

Continent Urostomy – surgical construction of an intra-abdominal pouch from a section of bowel for retention of urine, after dysfunction or removal of the bladder.

Crohn’s disease – Ileitis, regional enteritis, or granulomatous disease of the bowel -inflammatory bowel disease which can penetrate the deep lining of any part of small or large bowel and can affect the entire digestive system from mouth to anus.

Dehydration – loss of water or moisture.

Diverticulitis – inflammation or outpouching of sac arising from the bowel wall.

Electrolytes – compounds (salt, potassium, etc.) which maintain the body’s chemical balance.

Enterostomal Therapy Nurse – a person who specializes in the care and teaching of ostomy patients.

Familial Polyposis – rare disease which runs in families. The colon and rectum contain many polyps. Has strong tendency to malignancy.

Feces – bowel waste or excrement.

Fistula – abnormal opening from bowel to surface of skin, usually causing great discomfort.

Gastroenteritis – inflammation of the stomach and bowel.

Hernia – abnormal bulging or extrusion of part of an organ through tissue which contains it.

Ileitis – inflammation of the small bowel.

Ileoanal – joining the small bowel to the sphincter at the anus.

Ileostomy – surgical opening from the ileum (next definition) to the surface of the abdomen to form a stoma.

Ileum – lower half of the small intestine which ends at the beginning of the large intestine in lower right part of abdomen; the small bowel.

Irrigation – flushing of large bowel through colostomy opening (stoma).

Karaya – available as gum, powder and paste, for protecting the skin around the stoma.

Kidneys – two organs that filter impurities from the blood and excrete them in the urine.

Kock Pouch – surgical technique of constructing an intra-abdominal pouch from part of the ileum, referred to as “continent ileostomy.”

Malignant – cancerous, when referred to tumors.

Mucosa – mucus-secreting lining of hollow organs such as the intestines.

Mucus – thick liquid secreted by the mucosa of the gastrointestinal tract.

Nitrazine paper – (litmus) paper which changes color in the presence of acid or alkaline urine.

Ostomate – person who has had ostomy surgery.

Ostomy – surgical opening from the intestines or ureters to the surface of the abdomen to form a stoma.

Perineal – region of body containing sex organs and anus.

Polyps – soft tumors.

Rectum – lower part of intestinal tract about 15 cm (6 inches) long, ending in the anus.

Stoma – surgical opening in the abdomen to allow for disposal of body wastes.

Stenosis – narrowing of a passageway.

Trauma – body injury caused by shock, violence, etc. (sometimes a cause for ostomy surgery).

Ulcerative Colitis – an inflammatory bowel disease in which ulcers form in the intestinal lining of the colon and rectum causing severe, often bloody diarrhea.

Ureters – ducts which carry urine from the kidneys to the bladder.

Urethra – duct by which urine is discharged from the bladder.

Urine – liquid containing body wastes, secreted by the kidneys, usually stored in the bladder and discharged through the urethra.

Urine crystals – sharp crystals which can form on a urinary stoma or surrounding skin. Dissolved with soaks using white vinegar and water in a 50/50 solution.

Urostomy – surgical connection (with a piece of ileum) from the ureters to the mid-abdomen to form a stoma for discharge of urine after removal or dysfunction of the bladder.

Wafer – molded plate of an ostomy pouch system. Fits against and adheres to the skin.

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What Is Enterostomal Therapy?

Enterostomal therapy is a comparatively new specialty in the field of professional nursing. The first Enterostomal Therapy (ET), Norma Gill-Thompson (deceased 1998) came on the scene in the very early sixties under the tutelage of Dr. Rupert Turnbull from the Cleveland Clinic. Canada’s first ET is Bertha Okun of Montreal who has just recently retired. Both Norma and Bertha were ostomates before being trained as ETs.

ET Nurses give preoperative and postoperative counselling to patients who must have ostomy surgery. The duties include marking the stoma site on the abdomen prior to surgery and assisting the patient with postsurgery rehabilitation. This entails education on daily management of the ostomy, and adjustments to diet, exercise and as well as to social and marital relations. ET nurses are responsible for helping patients to cope with fear and frustration and for the involvement of the family in the rehabilitation program.

ET nurses contribute special nursing skills and understanding in the promotion of better patient care by education health-care personnel, both in the hospital and the community. Also, they are involved in the special care of draining wounds, fistulas and decubitus ulcers. ET nurses are obliged to attend and participate in seminars and workshops, to keep themselves up-to-date on new techniques and information, and to carry out research which will result in optimal care for the ostomate.

Approximately 70,000 patients undergo some form of ostomy surgery each year in the United States and Canada. Most, if not all, are aided by an ET.

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