Physicians of the Zane Cohen Centre

Ileostomy

An ileostomy is an opening made into the small bowel, the ileum. The resulting opening is called a stoma from the Greek word meaning "mouth". Initially after surgery, the stoma tends to be quite swollen due to the handling of the bowel. The size may decrease, however, this will occur over a period of time often taking up to six weeks. The bowel is not unlike the inside of our mouths. The stoma is red, soft, and moist. The stool from an ileostomy stoma contains many harsh enzymes. If stool should come in contact with skin, irritation can occur. To avoid this problem, the surgeon will construct the stoma so that it protrudes approximately 2.5 mm from the skin and well into the opening of the appliance.

The stoma can be either a loop or an end portion of the ileum. Through the opening, the bowel is turned back on itself almost like a cuff and stitched to the skin. The loop ileostomy will have two openings - the top opening called the proximal opening where stool is passed and the distal opening or bottom opening that is connected to the resting portion of bowel. An ileostomy may be temporary or it may be permanent. Ileostomies are usually located in the right lower quadrant of the abdomen.

End Ileostomy
Loop Ileostomy
End Ileostomy
Loop Ileostomy


The person with an ileostomy has no voluntary control over the passage of stool or gas because, unike the anus, the stoma has no sphincter muscle. As a result, an external appliance must be worn at all times.

The stool from an ileostomy is initially quite loose. It may take 24-48 hours before the ileostomy will start to function. Prior to that, there may be bloody drainage present in the appliance. Once the ileostomy starts to function, the contents may be loose, thin, watery and greenish looking. This is know as bile. Ileostomy stool will always be loose because the colon, large bowel, has either been removed or bypassed with the surgery and less water and salt is absorbed. As the small bowel adapts to this change (which takes several weeks), the stool should gradually thicken to a porridge or toothpaste consistency. The stool from an ileostomy should never be formed. Changes in the consistency of the stool will vary during the course of a day depending upon the types and quantities of fluids and foods consumed. You might find that stool will pass into your appliance anywhere from 1 ½ to 4 hours after eating and drinking.

Colostomy

A colostomy is an opening made in the large bowel or colon. Most commonly, colostomies are made in the sigmoid colon or the descending colon, but can also be made from the transverse colon. The resulting opening is called a stoma from the Greek word meaning "mouth". After surgery, the stoma tends to be quite swollen due to the handling of the bowel. The size may decrease, however, this will occur over a period of time often taking up to six weeks.

The bowel is not unlike the inside of our mouths. The stoma is red, soft, and moist. It is not as critical that a colostomy stoma protrude like an ileostomy stoma because of stool consistency and most colostomy stomas tend to be quite flush. The stoma can be either a loop or an end portion of the colon. Through the opening the bowel is turned back on itself almost like a cuff and stitched to the skin. The loop colosotmy will have two openings - the top opening called the proximal opening where stool is passed and the distal opening or bottom opening that is connected to the resting portion of bowel. A colostomy may be temporary or it may be permanent. Colostomies are usually located in the left lower quadrant of the abdomen.

The stool from a colostomy can vary slightly in consistency, depending upon how much of the colon has been removed or bypassed. For most colostomies (in the sigmoid or descending colon), the stool will be formed because the water, salt and potassium has been absorbed by the time the stool enters into the sigmoid portion of the and used by the body. How quickly it returns to a formed bowel movement is dependent upon how quickly you return to a regular diet. Initially you might find that the stoma will function for small amounts of stool, either pasty or formed, several times a day. However, once you return to your regular habits of diet and exercise, you may find that stool function becomes somewhat more regulated, less often (once or twice a day) and perhaps even predictable.

Ostomy - Overview

Living with Inflammatory Bowel Disease will sometimes require surgical intervention in order to manage the disease and its symptoms. Certainly the prospects of surgery alone can be overwhelming, while the addition of an ostomy, whether it be temporary or permanent, can also be met with fear and worry. Numerous supports are available for individuals who are facing ostomy surgery, including: written information, booklets and videos, Ostomy Visitor Programs, support groups, and Enterostomal Therapy Nurses; all of which will help with the adaptation process and will provide reassurance that you can live a full and productive with an ostomy.

What is an Ostomy?

Healthy End IleostomyAn ostomy is a surgeically created opening in a part of either the small or large bowel. The bowel is brought up through the abdominal wall (through the muscle and fat layers), everted or "cuffed", and the edges of the bowel are sutured to the surrounding skin surface. The resulting "bud" of bowel is called a "stoma". It will be moist, warm and red in colour, and may either be flush with the surrounding skin (as for colostomies) or may be protruding from the skin surface (as for ileostomies). The stoma is often referred to as resembling a puckered mouth. While it may look sore, a stoma actually has no nerve endings so will not be painful to the touch. For some individuals, a loop of bowel is brought to the surface instead of the end of bowel, so a small plastic rod will be used under the stoma to support it while healing.

The rod is generally removed about four to six days after surgery with very little if any discomfort. The stoma will always have some degree of movement (peristalsis), particularly while functioning for stool. Stomas are initially swollen after surgery, but will decrease in size about six weeks following surgery. Because there are no sphincters associated with a stoma, there is no voluntary control over when the stool (bowel movements) will be passed. Since there is no control, an external appliance must be worn to collect the stool.

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