Over the last few years, something amazing has happened…
Brave ostomates (people with an ostomy bag) have been proudly baring all with their stoma bags on show in the media and the general public. As a community, over the last few years more and more awareness campaigns have been orchestrated to break stoma stigma and raise awareness that even with a stoma bag we are all beautiful, sexy and warriors of our individual diseases!
However are you aware of the different types of stomas?
To help navigate through the different types of stomas here is a comprehensive guide in detail and at the ending touching on my story briefly!
A colostomy is a surgical procedure during which the large intestine or colon is cut and brought to the surface of the abdominal wall. During the procedure, one end of the colon is diverted through an incision in the abdominal wall to create a stoma. A stoma is an opening in the skin where a pouch for collecting faeces is attached.
A colostomy can be formed from any part of the colon depending on the underlying condition:
- Ascending colostomy – this is close to the small intestine (ileum) and not much large intestine is left to absorb nutrients so output may be loose.
- Transverse colostomy – is created in the transverse colon and the stoma is normally formed in the upper abdomen, either in the middle or a little to the right side of the body. The output may vary depending on how far the opening is away from the small intestine.
- Descending colostomy – This is the most common type of colostomy and is formed in the descending colon which is further down the digestive tract the output is likely to be semi-solid to firm with low digestive enzyme content which can irritate the skin.
- A sigmoid colostomy is located in the sigmoid colon nearly at the end of the digestive tract and again output is semi-solid to firm.
- Double Barrel wet colostomy – this is quite rare and is usually for patients with cancer that has involved the bladder and bowel and the ureters are attached to a colostomy bag so the output is a mixture of faces and urine. This procedure reduces the tome for urinary and faecal diversion.
An ileostomy is a surgical procedure which usually involves the end of the ileum (the lowest part of the small intestine) is brought through the opening to form a stoma, usually on the lower right side of the abdomen. Ileostomy surgery may be necessary when the entire large intestine needs to be removed, placing the stoma higher up in the digestive tract. The output from an ileostomy is continuous due to the shortened intestinal tract and soft, wet and less digested compared to a colostomy. The output will also contain high levels of rich digestive enzymes which can cause the skin some irritation.
- End Ileostomy is usually known as a permanent stoma and is where the end of the ileum is brought out through the abdomen. In most cases, with an end ileostomy, the colon and rectum may be partially or completely removed which involves the back passage being sewn up. However, some people can have an end ileostomy with their rectum in situ.
- Loop ileostomy – usually known as a temporary stoma is where a loop f the small intestine is lifted through the abdomen to form the stoma. In loop ileostomies, the colon and rectum may not be removed and in the future could allow possible reattachment.
- Continent ileostomy (Kock pouch) – where a loop of small intestine is constructed into a pouch within the abdominal cavity. Waste from the small intestine collects inside the Kock pouch and a small catheter is inserted to drain at a convenient time.
This is quite unusual but does occur. This is similar to the ileostomy but the surgeon will create a stoma higher up in the jejunum of the small intestine. The output is a lot higher and a lot more watery because of where it is in the small intestine. Usually, jejuostomy is formed because of further medical conditions and complications and there may be a few issues with leaks to start with and skin irritation.
Also, you can have a jejuna feeding tube which is different to a jejunostomy. Jejunostomy produces output and a jejuna feeding tube is where feed is attached.
A urostomy is a surgical procedure that creates a stoma that re-directs urine away from the bladder. The bladder may be removed completely (cystectomy) or diverted from due to cancer, birth defects, fowlers syndrome, Interstitial cystitis, overactive bladder, neurological conditions, trauma, radiation damage.
There are quite a few different urinary diversions available and I will cover them here.
- Ileal conduit – The most common type of urostomy where a conduit is created from the small intestine. One end of the conduit is connected to both ureters and the other forms the stoma. The conduit has no storage capacity and is not considered a substitute bladder because it cannot hold volume, the urine flows continually out of the stoma.
- Continent urostomy – also known as an Indiana pouch, kick pouch and a mitrofanoff comes under this, is an internal pouch constructed just under the skin from a piece of small intestine or bowel connected to the ureters (mitrofanoff usually use the appendix if available). The urine is drained at intervals throughout the day by pushing a catheter through the stoma into the pouch. The output can be contained and no need for an external pouch to be used every day so this is a continent urostomy.
- Cutaneous Ureterostomy – The surgeon detaches one of both Ureters and attaches them directly to abdominal wall forming a tiny stoma where pouches are needed. Quite rare but this does happen especially if for some reason the bowel cannot be used. AN opening may be placed on one side or on both sides this depends on your medical surgery and your surgeon.
- Neo-Bladder – where a surgeon creates an internal reservoir from bowel that connects to the urethra. Urine empties from the reservoir in a more natural process. However, the neo-bladder does not function as well as a natural bladder and in some cases, a catheter must be inserted through the urethra to completely empty the reservoir. This does work for some people but there may be a higher chance of incontinence and only certain people would qualify for this procedure
As you can see there is more to the stoma family than the simple ‘colostomy’. I have an ileostomy and a urostomy (ileal conduit) but still, people assume they are colostomies.
A little bit about me
I have been ill now for 10 years where my bladder and bowel stopped functioning. After a long time, I was eventually diagnosed with Autonomic Neuropathy in the form of Pure Autonomic Failure. In 2012 I had to have an ileostomy because my bowel would not empty at all without using a medical Peristeen irrigation System. When I first had this stoma I was not in a good place and I did struggle accepting it and my ‘new normal’. It didn’t help that I had a supra-pubic catheter at the time which was causing me horrific problems. Eventually, that came to a head in 2015 a routine cystoscopy revealed my bladder was extremely small, damaged and a biopsy revealed the cells had started to mutate, so within 2 weeks my bladder was removed and an ileal conduit was formed. I had a long 3 months stay due to some complications but when I left I felt strong, empowered and I knew my life would be better.
I am what the stoma world would call as a ‘double bagger’ and I cannot tell you the opportunities my 2 buddies have brought me; friends who also have stomas, an amazing man that has an ileostomy and starting a blog (http://rocking2stomas.co.uk/blog) to document my journey and help raise more urostomy awareness. It has not been easy and is a journey of acceptance which takes time but now I can truly see what a ‘gift’ my stoma bags are today.
If anybody reading this has just had a stoma and is struggling then please hang on in there and reach out to somebody else who has a stoma. Having that identification is priceless and will help. Subsequently, you can follow me on… Facebook Rocking2stomas, Twitter @rocking2stomas, Instagram – rocking2stomas.