Ostomy

What is an ostomy?

An ostomy is a surgical operation that helps your body remove waste (poop or pee) when the usual way of removing it isn’t working. You might need an ostomy if part of your digestive tract or urinary tract is damaged or needs time to heal.

During ostomy surgery, a surgeon creates a small opening in your belly, called a stoma, for waste to come out. They separate the functional part of your digestive or urinary tract from the dysfunctional part and connect it to your stoma.

After an ostomy, poop or pee comes out of your stoma instead of your genitals. The waste collects into a pouch (ostomy bag) that you wear attached to your stoma. This new arrangement may be temporary or permanent.

A temporary ostomy can give your digestive or urinary tract a chance to heal after surgery or disease. A permanent ostomy can replace the damaged part of your digestive or urinary tract if it’s permanently damaged or must be removed.

You may need an ostomy if you have:

• Bladder cancer
• Colorectal cancer
• Chronic incontinence (urinary or bowel)
• Diverticulitis
• Inflammatory bowel disease (like ulcerative colitis or Crohn’s disease)
• Intestinal obstruction

They’re more common than you might realize. About 1 in every 500 Americans lives with an ostomy.

Types of ostomies

The type of ostomy you have depends on which part of your digestive or urinary tract your surgeon is bypassing.

• Colostomy: Redirects part of your colon (large intestine) to the stoma in your abdomen
• Ileostomy: Redirects your ileum (the end of your small intestine) to your stoma
• Urostomy: Redirects your ureters (the tubes that carry pee) to your stoma

What happens before ostomy surgery?

Prior to your ostomy surgery, you’ll meet with your medical team to discuss the details of the procedure. During this appointment, a healthcare provider will determine the best location for the stoma in your abdomen and mark it.

What happens during ostomy surgery?

You’ll have general anesthesia for your procedure. If you have open surgery (laparotomy), your surgeon will make one long incision in your abdomen. If you have minimally invasive surgery (laparoscopic), they’ll make several small incisions.

Ostomy surgery usually occurs as part of a larger surgery. So, the steps can vary depending on the condition your surgeon is treating. Your surgeon may need to remove diseased tissue or make other repairs in your digestive or urinary tract.

When it’s time to create your ostomy, they’ll divide your digestive or urinary tract above the diseased or nonfunctioning part. They’ll create your stoma at the place marked on your abdomen and connect your bowel or ureter to this opening.

If you don’t have enough healthy intestine or ureter to connect to your stoma, your surgeon will create an extension piece to bridge the gap, or to hold more waste. They create it from a piece of your intestine. This is called an ileal conduit or ileal pouch.

What happens after ostomy surgery?

You’ll spend a few days in the hospital after ostomy surgery. During this time, your healthcare team will monitor your recovery and care for you closely. You’ll also learn all about how to care for your stoma and living with an ostomy bag.

What are the benefits of having an ostomy?

If you need to have part of your digestive system or urinary system removed, or if you need to stop using it, an ostomy can be lifesaving. It allows the functional parts of these systems to continue working without the dysfunctional parts.

In other cases, an ostomy can improve your quality of life. If you live with a chronic disease that causes you constant distress at the toilet or at other times, ostomy surgery can be a way out. It can allow you to live without these complications.

What are the possible risks or complications of having an ostomy?

The risks and complications of ostomies can range from mild to severe. They include:

• Skin irritation. Irritation from pee or poop leaking around your stoma is the most common complication of having an ostomy. A better-fitting ostomy bag and more frequent emptying may help. You can also get products to treat and protect your skin.
• Electrolyte imbalances. Your large intestine absorbs water, electrolytes and nutrients from your food. If your ostomy bypasses your large intestine, it can cause dehydration or electrolyte imbalance. Your healthcare provider will explain how to prevent this.
• Obstruction. Scar tissue in your bowel or ureters could make it more difficult for poop and pee to pass through. You might also find it more difficult to digest some foods after bowel surgery. Undigested foods can cause a temporary blockage in your bowel.
• Parastomal hernia. If your abdominal wall becomes weak around your stoma, you could develop a hernia. That’s when abdominal tissues bulge through the opening. A hernia could block your stoma’s output. If this happens, you might need surgery to correct it.
• Prolapsed stoma. Stoma prolapse is a complication of colostomy or ileostomy. It’s a type of hernia where your bowel pushes itself out through the stoma. Often, your healthcare provider can push your bowel back into place. In rare cases, it needs surgery.

Your healthcare provider will explain how to recognize signs of possible ostomy complications.

What is the recovery time following ostomy surgery?

It may take up to eight weeks to recover completely from ostomy surgery. Your bowel movements may take a few weeks to become regular again. Getting up and moving a little each day will help you recover faster.

Ostomy bag care and maintenance

After ostomy surgery, you’ll wear an ostomy bag most or all of the time. A wound ostomy continence nurse (WOCN) will show you how to attach, empty and change the pouch. Most pouches include a disposable liner and a skin barrier.

How often should I change my ostomy bag?

It depends on the type of pouching system you have. Most people will need to change their ostomy bags every three to seven days. Some need or prefer to change it daily. When changing your ostomy bag, be sure to:

• Wipe away any mucus on your stoma
• Use warm water, mild soap and a washcloth to clean the skin around your stoma
• Rinse your skin well
• Dry the area completely

In addition to keeping your stoma clean, be sure to examine it daily and notice any changes. If the size, shape or color looks different from normal, or it feels swollen or sore, contact your healthcare provider immediately.

When should I call my healthcare provider?

If you’ve recently had ostomy surgery, it can be challenging to know which symptoms warrant a call to your healthcare provider. Trust your instincts and call if something doesn’t seem quite right. Call right away if you develop:

• An unpleasant odor from your stoma
• Excessive bleeding from your stoma
• Signs of infection, like fever, nausea or vomiting
• Severe cramping that lasts more than three hours
• Skin irritation, burning or a rash
• Watery discharge that lasts more than six hours

Is ostomy surgery reversible?

Sometimes, an ostomy is reversible. This depends on your overall health after ostomy surgery. If your digestive or urinary tract recovers and becomes fully functional again, you can discuss ostomy reversal with your surgeon at that time.

Do you still use the toilet with an ostomy bag?

After an ostomy, you’ll still use the toilet to poop or to pee, but not for both. If you have a urostomy, you’ll still use the toilet to poop, but not to pee. If you have a colostomy or ileostomy, you’ll use the toilet to pee but not to poop.

You’ll also use the toilet to empty your ostomy bag. With an ostomy, you won’t be able to control when your pee or poop comes out and collects into your pouch. But you’ll still decide when to go to the bathroom to empty or change it.

Can you live a long life with an ostomy?

Having an ostomy has no effect on your lifespan, and it doesn’t prevent you from living a full, active life. The condition that caused you to need an ostomy may or may not affect these things. Sometimes, an ostomy extends your life.