Having an ostomy can save one’s life or improve your quality of life. Ostomies can be temporary or permanent, emergent or planned. Health conditions that require ostomy placement vary as well as the type of ostomy created and where the ostomy is placed. Let’s explore the details.
It is a diversion of the normal flow of waste in the digestive or urinary tract. The diversion surgery pulls a portion of the intestine to the surface of the abdomen, allowing waste to leave the body. The portion of the intestine exposed on the abdomen (stomach) can be either the large intestine (colon), known as a colostomy, or the small intestine, known as an ileostomy and is called a stoma. The stoma does not have a sphincter muscle to hold the waste in so controlling output is impossible. The waste is managed by placing a pouching system around the stoma and emptied as needed
The most common cause of colostomy placement is perforation of the colon. The number 1 cause of perforation is diverticulitis. The most common area of diverticulitis is the sigmoid colon which is found in the left lower abdomen. These stomas are usually temporary and can be surgically reversed between 3 and 6 months. Perforation of the colon can be caused by other conditions and can also be reversed in time.
Rectal or anal cancer is another health condition that may require a stoma. If the cancerous tumor is found in the lower portion of the rectum, usually a colostomy is placed permanently. Again, these stomas are usually placed in the left lower abdomen. Obstruction in the colon may result in a colostomy. If the obstruction is higher up in the colon, the colostomy will be placed along the tract of the colon above the obstruction. These stomas can be placed on the lower right abdomen or along the upper abdomen on the right or left side. The age of the patient, along with their health status will determine if the ostomy will be temporary or permanent
A common cause of ileostomy placement is again rectal cancer. These patients most commonly will be treated with chemotherapy and radiation first, then move on to surgery to remove the tumor with a temporary ileostomy placed while they heal. The reversal is usually done 3-6 months later. The next most common reason for ileostomy placement is ulcerative colitis (UC). If UC does not respond to medical treatment, surgery to remove the entire colon is usually effective. With a total colectomy, an ileostomy is placed. This can be permanent. Some patients may choose to have an additional surgery where the ileum (last portion of the small intestine) is used to create a J-Pouch. Once healed, the ileostomy is reversed. Obstruction of the small bowel can often be treated conservatively with bowel rest, no eating, and decompression. If these methods do not resolve the obstruction, surgery is the next step, sometimes leading to a stoma.
All these reasons for needing an ostomy often lead the patient to ask “Why me?” Most of these events are unplanned or the patient is given a diagnosis like cancer that changes their life. Many have difficulty accepting having a stoma even if it’s temporary. But there is a population of patients that plan to get an ostomy because it improves their quality of life.
Crohn’s disease is an inflammatory bowel disease that can affect the entire digestive tract. It is most common in the small intestine and the rectum. The most common symptoms are abdominal or rectal pain, cramping, and frequent diarrhea. Crohn’s disease patients often limit social activities because they need a bathroom close by. Most will tell you they know where every public restroom is along their route to work or where they shop. In fact, some will not shop at retailers that do not allow the use of a restroom. Many will become incontinent of stool with time, especially those that have rectal Crohn’s disease. As they limit social activity, their quality-of-life diminishes. They go out less, travel less, and feel the loss of social contacts as they isolate themselves.
Think of all the work situations that are limited to patients with Crohn’s. Jobs can be difficult if you cannot get to a bathroom in a timely fashion. For instance, a cashier at the supermarket, a telephone operator, a bus driver, or landscaper, just to name a few. Some feel their employers monitor time spent in the bathroom.
A person living with these challenges looks at having an ostomy as an improvement in their quality of life. A stoma gives them freedom lost from Crohn’s isolation. They feel liberated and able to participate in society again. They are not tied to a bathroom and can travel, feeling secure. They can choose employment opportunities that were otherwise lost to them.
Where some find having an ostomy a life sentence, others feel blessed to “get their life back.” Some are happy to be alive with a stoma rather than choose a shortened life without one. All ostomates have challenges along the way and most are happy to share their personal experiences by offering support to those in need.
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