Everything You Always Wanted To Know About Ostomy


Most people are only vaguely aware of the term, 'ostomy'.  If you or a loved one has never had severe intestinal and/or urinary health issues, you may not have registered ever hearing this term before. But for the millions of people worldwide who do require intestinal or urinary diversions, this is a life-giving procedure that they literally depend on to survive.

An 'ostomy' refers to a surgical procedure that creates an artificial opening for the elimination of bodily wastes.  A 'stoma' is either a natural or surgically created opening in the body which connects a portion of the body cavity to the outside environment.  An example of a natural stoma is the mouth, while any hollow organ can also be manipulated into an artificial stoma as necessary, including the esophagus, stomach, duodenum, ileum, colon, pleural cavity, ureters, urinary bladder and kidney pelvis.  Surgical procedures that create a stoma are ended in the suffix '-ostomy' and begin with a prefix attached to the organ or area being operated upon.

Examples of these surgical procedures include a 'colostomy' which is an opening in the large intestine (colon) that allows the flow of feces out of the body, and a 'urostomy' which is an opening in the abdomen that allows the flow of urine out of the body.  An 'ileostomy' is similar to a colostomy in that it is performed to help remove feces from the body, but is generally done when the entire large intestine has been removed.  An ileostomy stoma is formed by bringing the end or loop of the small intestine (the ileum) out onto the surface of the skin.  The J-Pouch is now the most common alternative to conventional ileostomy and this procedure is not technically an ostomy because there is no stoma; 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 in such a way that the existing anal sphincter muscles can be used for continence and control.

Although there are historical references to stomas and a few early, creative ostomy kinds of 'surgery', the practice didn't really start becoming an efficient and humane way to save lives until the middle of the 20th century.  The oldest written document that pertains to an opening in the abdominal wall that helped toxic material to drain out is in The Bible, specifically Judges 3:21-22.  Many early physicians such as Hippocrates, Aurelis Cornelius Celsus, and Claudius Galen knew that injuries to the abdomen and intestines were often fatal, but they did not understand why this was so.

Later physicians started paying more attention to the natural stomas there were sometimes formed by the intestinal wound itself, thus helping toxic material to drain out naturally.  Paracelsus, William Cheselden, Jean Amussat and M. Pillore are just a few of the brave and forward-thinking surgeons who saw the life saving possibilities of stomata and ostomies for the treatment of severe intestinal and urinary wounds and health issues.  French surgeon M. Pillore is actually recorded as being the first physician to perform a successful colostomy in 1776.  His patient, Mrs. M. Morel had a malignant tumor in her rectum and could not eliminate feces at all.  An opening was made in her appendix, and a sponge held on by an elastic band collected the feces.  She did quite well until she died suddenly of peritonitis 18 days later.  However, the autopsy revealed that she had not died because of this new fangled operation, but from a narrowing in her intestine where they also recovered 1 kilogram of mercury, which had been previously administered to help fight the contamination in her colon.

Thankfully, much progress has been made in the development of the ostomy surgeries since its humble and somewhat scary origins, especially in the last 50 years.  "Most lay persons, as well as all too many physicians and surgeons, have a horror image of the constantly discharging intestinal stoma and frequently think, out of ignorance, that death is preferable to an ileostomy," said Dr. Albert Lyons in 1952.  While the construction of the stoma is now seen as a relatively simple and low-risk surgical procedure, it is still for many people a very difficult choice to make.  Yet it would serve us well to remember that in previous times, people had little chance of survival with bowel diseases and wounds.
 
The pouches and collection devices have come a very long way from the original 'sponges', and subsequent super bulky and odoriferous devices, too.  Pouching systems may include a one-piece or two-piece system that include a skin barrier/wafer/faceplate.  The pouch attaches to the abdomen by the skin barrier and is fitted over and around the stoma to collect the diverted output, either feces or urine.  The skin barrier 'plate' is designed to protect the skin from the stoma output and to be as non-irritating to the skin as possible.  There are a wide variety of styles and types of pouching systems to choose from.  The decision as to what particular type of system to choose is a personal one and must be geared to each individual's needs, comfort and preference; there is no right or wrong choice.
 

There are also many types of wonderful ostomy accessories available today that greatly help the ostomy patient.  Ostomy belts help to support the pouch and keep it in place and can also be used as an alternative to adhesives that can sometimes cause skin problems in susceptible individuals.  Pouch covers made with cotton or cotton blend backing easily fit over the pouch and are much more comfortable against the skin while also helping to cover the pouch during intimate encounters.  Skin barrier liquids, pastes, wipes and powders help protect the skin under the barrier/wafer/plate and around the stoma itself from infection, irritation and inflammation.  Special tapes that help support the barrier/wafer and keep it in place are available in a wide range of materials to help meet the needs of different skin sensitivities and allergies.
 
 
If you do find that you have any trouble with your current pouching system, discuss the problem with your ostomy nurse or caregiver and experiment with different systems that might work better for you...it is not uncommon to try several types of systems before the best solution for you and your individual needs is found.  There is absolutely no reason to stick with a poorly performing, uncomfortable pouching system, especially in this age of technology and innovation.  Indeed, there are many ostomy surgeries performed today that make wearing an external pouch totally unnecessary.  Surgeons such as Nils Kock and Rudolph Nissen have greatly innovated ostomy surgery in this way, while R.J. Nichols and A.G. Parks were instrumental in the creation of the J-pouch procedure, mentioned earlier in this article.
And the innovations continue...brilliant minds continue to explore what we have known about ostomy, and what we might not know yet.  Before this amazing surgery, most people died from abdominal wounds or severe intestinal and urinary issues that prevented the elimination of feces and urine.  And now, with all of the state-of-the-art technology and scientific wisdom in our hands, we are not just saving more lives, but we are helping people with ostomy to live much more easily, comfortably and without embarrassment or worry.  To not just stay alive, but to absolutely thrive!
 
To view all of the ostomy supplies that Rehabmart offers, please go to the Ostomy Supplies page.  Also view the pages of the One Piece Ostomy Systems page, the Two Piece Ostomy Systems page, the Skin Barriers page, or the Ostomy Pouch page.


Carol Koenigsknecht, Medical Consumer Writer
and
Hulet Smith, OT
Rehabmart Team Leader & CEO