Types of Ostomies,Procedures and Psychological Issues.

So after the Post I put up yesterday about the hate some people have on Ostomy bags, I thought I would add another page to my Blog. This page will be about Ostomies and Stomas. I want to give out as much information as possible about them. These things are rarely mentioned or talked about and I know I have said before, A lot of people don’t even know what they are. There is a lot of bad judgment on Ostomies and I need to show you all, like I have with my pictures and topics, that Ostomies are a terrific thing. So here I go,

TYPES OF OSTOMIES-

An ostomy refers to the surgically created opening in the body for the  discharge of body wastes. A stoma is the actual end of the   small or large bowel that can be seen protruding through the abdominal  wall.

There are many different types of Ostomies and Procedures;

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.

Temporary Colostomy-

A temporary Colostomy allows the lower portion of the colon to rest or heal. It may have one or two openings (if two, one will discharge only   mucus).

Permanent Colostomy-

A 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/Decending Colostomy-

The most common type of ostomy surgery, 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-

A Transverse Colostomy is the surgical opening created in the transverse colon resulting in one or two openings. It is located in the upper   abdomen, middle or right side.

Loop Colostomy-

A Loop Colostomy is usually created in the transverse colon. This is one  stoma with two openings; one discharges stool, the second  mucus.

Ascending Colostomy-

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

Ileostomy-

An Ileostomy is a surgical opening in the small intestine, it is usually the end of the ileum. The intestine is brought through the abdominal wall to form a stoma. Ileostomies may be temporary or permanent and may involve removal of the entire colon or just part of it.

TYPES OF POUCHING SYSTEMS-

The pouching system is either a one piece or a two piece system. Both kinds include a skin barrier or wafer and a collection pouch (bag)  The bag attatches to the abdomen by the skin barrier/wafer and is fitted over and around the stoma to collect the output of stool or urine. The barrier/wafer protects the skin from the stoma output.

Colostomies and Ileostomy Pouches-

There pouches can either be open-ended, requiring a closing device, either a clamp,clip or velcro clip. Or they can be closed and sealed at the bottom.

Open ended pouches are called drainable and are left  attached to the body while emptying. Closed end pouches are most commonly used by   patients who have regular elimination patterns. Closed end pouches are usually discarded after one use.

Two Piece Systems-

Two Piece systems allow you to change the pouch while leaving the barrier/wafer attatched to the skin. The wafer/barrier is part of a “flange” unit.The pouches include a closing ring that attaches mechanically to a mating  piece on the flange. A common connection mechanism consists of a pressure fit snap ring, similar to that used in Tupperware.

One Piece Systems-

One piece systems consist of a skin barrier/wafer and pouch joined together as a single unit. They provide greater simplicity than two-piece   systems but require changing the entire unit, including skin barrier, when the pouch is changed.

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

These are the major types of pouching systems. There are also a number of styles. For instance there are flat wafers and convex shaped ones. There are fairly rigid and very flexible ones. There are barriers with and without adhesive backing and with and without a perimeter of tape. Some manufacturers have introduced drainable pouches with a built-in tail closure that doesn’t require a separate clip. The decision as to what particular type of system to choose is a personal one geared to each individual’s needs. There is no right or wrong choice, but each person must find the system that performs best for him or her.

TYPES OF ACCESSORIES FOR OSTOMY BAGS-

Convex Inserts-

Convex inserts are convex shaped plastic discs that are inserted inside   the flange of specific two-piece products.

Ostomy Belts-

Ostomy belts are belts that wrap around the abdomen and attach to the loops found on certain pouches. Belts can also be used to help   support the pouch or as an alternative to adhesives if skin problems   develop. A belt may be helpful in maintaining an adequate seal when using a convex skin barrier.

Pouch Covers-

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. Many pouches now include   built-in cloth covers on one or both sides, reducing the need for   separate pouch covers.

Skin Barrier Liquid/Wipes/Powder-

Wipes and powder 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-

Skin Barrier paste is paste that 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. Paste is used as a   “caulking” material; it is not an adhesive.

Tapes-

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

Adhesive Remover-

Adhesive remover may be helpful in cleaning the   adhesive that might stick to the skin after removing the wafer or  tape, or from other adhesives.

With my Pouch, I use a One piece system. I have never tried the two piece, but I myself have found the one piece to be great. With the different types of bags and accessories, I wear a convex bag, it helps to push my stoma out so it isn’t so flush towards my skin. I also wear a belt to keep the bag close to my skin. When changing my bag and cleaning the area, I use Adhesive remover and wipes. I then use a powder and a paste around my stoma before putting the bag over it.

PSYCHOLOGICAL ISSUES

Concerns about Surgery-

The reaction to intestinal surgery varies from one individual to the other. To some people, having an ostomy is a disaster, to others, an ostomy is life saving. Each person will adjust to their ostomy in their own way over time.

Body Image and Self Esteem Concerns-

With having any type of these surgeries done, they do change the appearance of your body. Many people feel self conscious about themselves and their body, they hate the way they look and it can cause a lot physical and mental upset.

Fear of loss is 100% normal and facing any sort of loss is difficult. There are many questions that buzz around in your mind, like, ” What am I giving up by having this surgery? ” “Is there any gain?”  “How changed will I be?”  The answers to these questions are unknown until you have had the surgeries completed. Some people will completely deny having surgery because of these questions.

In my experience, I haven’t given up anything since the surgery, I did however GAIN my life back, I have a future because of the surgery. Yes, It did change my like A LOT, but it was a change for the better.

It is very important to understand the impact these surgeries can have on a patients self-image and how they perceive themselves. Some people may refuse to acknowledge their ostomies existence, or say to themselves that it is only a temporary situation and that it will all go away.

Within the recovery period after surgery, patients should express their feelings about their surgery,the changes in their body or their self imagine. It helps to talk about these things as much as possible!.

Self care Concerns-

Once your ostomy has been created, your surgeon or wound ostomy continence nurse (a WOC nurse specializes in ostomy care) will teach you to attach and care for the ostomy bag. An ostomy appliance, or pouch, is designed to catch eliminated fecal material (stool). The pouch is made of plastic and is held to the body with the adhesive.  The adhesive, in turn, protects the skin from moisture. The bag is disposable and is emptied or changed as needed. The system is quite secure; “accidents” are not common, and the bags are odor-free.

Your bowel movements will naturally empty into the pouch. The frequency and quantity of your bowel movements will vary, depending on the type of ostomy you have, your diet, and your bowel habits prior to surgery. You may be instructed to modify your eating habits in order to control the frequency and consistency of your bowel movements. If the ostomy is a colostomy, irrigation techniques may be learned which allow for increased control over the timing of bowel movements.

Having an Ostomy, does not stop you from having a normal life. If you are an athlete or loves sports, you can still play all the sports you love with having an ostomy. You can still go swimming,running,flying,go overseas, you name it! You can still do it all.

Complications of an Ostomy-

As you should already know, there are complications to having an ostomy. But there are complications with EVERYTHING that you choose to do in life. So don’t think it is just Ostomies that can cause minor issues. One issue with having an ostomy is Skin Irritation, it is most likely caused by the output from your stoma or even an allergic reaction the bag,creams or powders. This is all very minor and can be fixed easily. Other problems are Hernias and Prolapse of the Stoma, is serious, these issues may need surgery to be fixed. Also, Weight loss and Weight gain, can affect how the ostomy and stoma is.

Relationship Concerns-

Patients may fear that their social life may change and that others may not accept them as how they were before the surgery. One of the main concerns is how to tell others about the surgery, who to tell and when.

Patients should be prepared to explain their surgery with a few  brief statements such as, “An ostomy is a surgical procedure for the diversion of the bowel”

They should understand that they do not have to tell everyone  about the surgery. Be selective about who and how much to tell. It may  be only to friends who will be supportive throughout the rehabilitation  process.

Returning to the work place may present a concern about restroom  facilities, interaction with co-workers, and feelings of being watched.

In this situation, it is best to tell a few co workers or your boss of your surgery and that you may have to take bathroom breaks at times to empty the bag. Let them know the things you can and can’t do and information that needs to be known in case of an emergency.

Sexuality issues are common concerns for the new ostomate. Linked  closely to our feelings of sexuality is how we think about ourselves and  our body image.

Any sexuality concerns should be discussed between the patient  and his partner. It is likely that the partner will have anxieties due  to a lack of information. An intimate relationship is one in which it  matters how well two people can communicate about the most personal of  human functions, that is, bodily elimination and sex.

Ostomy surgery may present more concerns for single individuals.  When to tell depends upon the relationships. Brief casual dates may not  need to know. If the relationship grows and leads to intimacy, the  partner needs to be told about the ostomy prior to a sexual  experience.

PHASES OF PSYCHOLOGICAL ADAPTION-

Almost every patient goes through four phases of recovery following an  accident or illness that results in loss of function of an important  part of the body. The patient, along with the family, goes through these  phases, varying only in the time required for each phase. People may  experience the various phases of adaptation in a different order and at  varying rates. Some people may skip certain phases entirely and some may  move up and down at different times.

These phases are shock, denial, acknowledgment and resolution.

1. Shock or Panic

Usually occurs immediately after surgery. The patient is unable to  process information and may be tearful, anxious and forgetful. This  phase may last from days to weeks.

2. Defense/Retreat/Denial

This phase may last for weeks or months and delays the adaptation  process. During this phase, the individual denies or minimizes the  significance of the event and defends himself against the implications  of the crisis. You may note the avoiding of reality and  “wishful” thinking.

3. Acknowledgment

As the patient moves to the next step of acknowledgment, he begins to  face the reality of the situation. As you give up the existing old  structure, you may enter into a period, at least temporarily, of  depression, of apathy, of agitation, of bitterness, and of high  anxiety.

4. Adaptation/Resolution

During this phase, the acute grief begins to subside. The patient copes  with their situation in a constructive manner and begins to establish  new structures. They develop a new sense of worth. This phase may take  one to two years.

With the aid of an ostomy nurse and the ostomy visitor, you learn about  living with a stoma.

So there you have it, I think I have included everything I can possibly think of. But one last note,

Having an Ostomy will take time to get use to, it will involve a lot of learning and adjusting with your life. Once you have recovered from the surgeries and you have learnt how to look after yourself and your bag, you will have a 100% normal happy active life. Having an Ostomy is a big deal and it is a very big surgery, but if you are terribly ill or hurt and at the point where your only option is an ostomy, it seems less of a big deal, you get use to the idea and you get use to having an Ostomy.

Having an ostomy has not changed my self-esteem or how I think of myself. I love who I am and how my Ostomy has changed myself and my life. So I hope anybody who thinks bad of the ostomy or thinks they are an ugly disgusting idea, I hope you understand what they truly are. They are a life saver for many people.

If you are somebody with an ostomy, I hope you are hell proud of your ostomy, who you are and what you have overcome. Ostomies are a beautiful thing and it’s about time the rest of the world thought the same.

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