Definition of
Ostomies


 This section covers terminology in two primary areas: types of ostomies and continent procedures, and types of pouching systems (appliances) with the major accessories and supplies. The reader should be sure to "know your ostomy." This is critical information to provide any caregiver. The sections on types of appliances and accessories are intended to accelerate the new ostomates’ usage of the terminology and to teach that alternative systems and accessories exist. You are not locked into any pouching system. If you are having trouble with any appliance, consult your ET, caregiver or equipment supplier. Be receptive to trying a different appliance type or brand.

A. Types of Ostomies and Alternate Procedures.
 The terms ostomy and stoma are general descriptive terms that are often used interchangeably though they have different meanings. An ostomy refers to the surgically created openings in the body for the discharge of body wastes. A stoma is the actual end of the ureter or small or large bowel that can be seen protruding through the abdominal wall. The most common specific types of ostomies are described below:


  Colostomy
- The surgically created opening of the colon (large intestine) which results in a stoma. A colostomy is created when a portion of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall.. It may further be defined by the portion of the colon involved and/or its permanence:


Temporary colostomy
- performed to allow the lower portion of the colon to rest or heal. It may have one or two openings (if two, one will discharge only mucous).

Permanent colostomy
- usually involves the loss of part of the colon, most commonly the rectum. The end of the remaining portion of the colon is brought out to the abdominal wall to form the stoma.

Sigmoid or descending colostomy
- the most common type, in which the end of the descending or sigmoid colon is brought to the surface of the abdomen. It is usually located on the lower left side of the abdomen.

Transverse colostomy
- the surgical opening created in the transverse colon resulting in one or two openings. It is located in the upper abdomen and can be right or left sided.

Loop colostomy
- usually created in the transverse colon. This is one stoma with two openings; one discharges stool, the second mucous.

Ascending colostomy - a relatively rare opening in the ascending portion of the colon. It is located on the right side of the abdomen.

  Ileostomy - This is the surgical procedure during which the small intestine, usually at the end of the ileum, is brought through the abdominal wall to form a stoma. Ileostomies may be temporary or permanent, and may involve removal of all or part of the entire colon.


  Ileoanal Anastomosis - This is now the most common alternative to the conventional ileostomy. Technically, it is not an ostomy since there is no stoma. In this procedure 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 such that the existing anal sphincter muscles can be used for continence. This procedure should only be performed on patients with ulcerative colitis or familial polyposis, and who have not previously lost their rectum or anus. It is also called J-pouch, pullthrough, endorectal pullthrough, pelvic pouch, or a combination of these terms.

  Continent Ileostomy - This surgical variation of the ileostomy is also called a Kock pouch. A reservoir pouch is created inside the abdomen with a portion of the terminal ileum. A valve is constructed in the pouch which is brought through the abdominal wall. A catheter or tube is inserted into the pouch several times a day to drain feces from the reservoir. This procedure has generally been replaced in popularity by the ileoanal pouch. A newer version of this procedure called the Barnett Continent Ileal Reservoir is practiced at a limited number of facilities.  

Urostomy - This is a general term for a surgical procedure which diverts urine away from a diseased or defective bladder. The ileal or cecal conduit procedures are the most common urostomies. Either a section at the end of the small bowel (ileum) or at the beginning of the large intestine (cecum) is surgically removed and relocated as a passageway (conduit) for urine to pass from the kidneys to the outside of the body through a stoma. It may include removal of the diseased bladder. Other common names are the ileal loop or the colon conduit.

Continent Urostomy - There are two main continent procedure alternatives to the ileal or cecal loop (others exist). In both the Indiana and Kock Pouch versions, a reservoir or pouch is created inside the abdomen with a portion of either the small or large bowel. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted several times daily to drain urine from the reservoir.

  In the Indiana Pouch version, the ileocecal valve that is normally between the large and small intestines is relocated and used to provide continence for the pouch which is made from the large bowel. With a Kock Pouch version, which is similar to that used as an ileostomy alternative, the pouch and a special "nipple" valve are both made from the small bowel. In both procedures, the valve is located at the pouch outlet to hold the urine until the catheter is inserted.

  B. Types of Appliances.

  The term appliance refers to the combination of a flange (barrier or wafer) and pouch (or collection bag or reservoir). Often the entire appliance is called a pouch. The appliance attaches to the abdomen by the adhesive backed faceplate and is fitted over and around the stoma to collect the diverted output, either feces or urine. Other common terms for the barrier are wafer, faceplate, flange, disc, body holder, mounting ring or adhesive ring. The barrier is made from either soft molded rubber or plastic, which together with its karaya, pectin or other adhesive backing, is designed to protect the skin from the stoma output and to be as neutral to the skin as possible.

  Colostomy and ileostomy pouches can be either open-ended, requiring a closing device usually called a clamp or tail clip; or closed and sealed at the bottom. Open-ended pouches are called drainable and are reused after they are emptied. Most commonly closed end pouches are used by colostomates who can irrigate (see below), or by patients who have regular elimination patterns. Closed end pouches are usually discarded after one use.

Two piece systems consist of a separate flange and pouch. The pouch contains a closing ring which mechanically attaches to a mating piece on the flange. The most common closure is a pressure fit snap ring, very similar to that used in Tupperware (TM).

One-piece systems, as the name implies, are those in which the wafer and pouch are assembled together in one piece and not separate.

Both two-piece and one-piece appliances can be either drainable or closed.

Urinary pouching appliances used by urostomates can also be either one or two piece systems. However, these systems also contain a special valve or spout which adapts to either a leg bag or to a night drain tube connecting to a special drainable bag or bottle.

Some colostomates can "irrigate," using a procedure analogous to an enema. This is done to clean stool directly out of the colon through the stoma. This requires special irrigation appliances. These consist of an irrigation bag and a connecting tube (or catheter), a stoma cone and an irrigation sleeve. A special lubricant is sometimes used on the stoma in preparation for irrigation. Following irrigation, some colostomates can use a stoma cap, a one- or two-piece system which simply covers and protects the stoma. This procedure is usually done to avoid the need to wear an appliance.

These are the major types of appliances. There are also a number of styles. For instance there are flat faceplates and convex shaped ones. There are fairly rigid and very flexible ones. There are faceplates with and without adhesive backing and with and without a perimeter of tape. The decision as to what particular type of system to choose is a personal one geared to each individuals needs. ETs will tell people that there is no right or wrong choice, but each person must find the system that performs best for him or her.

A wide selection of equipment options exist. Generally the larger mail-order catalogues will illustrate the types and styles from all or most of the suppliers. If you have any trouble with your current pouching system, discuss the problem with an ET or other caregiver and find a system that works better for you. It is not uncommon to try several types until the best solution is found. Free samples are readily available for you to try. There is no reason to stay with a poorly performing or uncomfortable appliance.

 C. Types of Accessories.

You may need or want to purchase certain pouching accessories. The most common items are listed below.

Cleansers are available for sanitizing reusable ostomy equipment.

Convex inserts are convex shaped plastic discs that are inserted inside the flange of specific faceplates.

Ostomy belts wrap around the abdomen and attach to the loops found on certain pouches. Belts can also be used to help support the appliance or as an alternative to adhesives if skin problems develop. These usually add a measure of security.

Ostomy rings fit around the stoma almost like a cushion to provide a better fit and protect against leakage.

Peristomal (around the stoma) cleansers are specifically designed for cleaning the area near the stoma, usually under the barrier.

Pouch covers made with a cotton or cotton blend backing, easily fit over the pouch and protect and comfort the skin. They are often used to cover the pouch during intimate occasions.

Skin barrier liquid, wipes and powder and skin prep help protect the skin under the wafer and around the stoma from irritation caused by digestive products or adhesives. They also aid in adhesion of the wafer.

Skin barrier paste can be used to fill in folds, crevices or other shape or surface irregularities of the abdominal wall behind the wafer, thereby creating a better seal.

Tapes are sometimes used to help support the flange or wafer (faceplate) and for waterproofing. They are available in a wide range of materials to meet the needs of different skin sensitivities.

Tape remover is helpful in cleaning the adhesive that might stick to the skin after removing the tape, faceplate or from other adhesives.


*Reference   "Ostomy Resource Guide, for the Greater Boston Area, 1995."  Published by the Ostomy Association of Boston.

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Last updated on March 14, 2001.
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