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Ostomy Care Today

Having started in nursing in the 1960s, I have seen many changes in ostomies and ostomy care. There is a history of colostomies being done in the generally as a last resort. One doctor performed a colostomy on a 3 day old infant with imperforate anus and reportedly this person lived to age 45. In the 1900s, surgeons began to treat rectal cancer with resection and permanent colostomy.

Today, we see a sharp decrease in permanent colostomies and more primary reconnections of the intestine. Loop ileostomies are frequently done temporarily to protect lower surgical sites. Newer surgical techniques and the intestinal stapling device have enabled surgeons to resect lower in the rectum and reconnect the bowel.

Today, many continent procedures are done. Several attempts were made to make colostomies continent without success. A magnetic method was used with mixed success and numerous complications. Irrigation and diet are used now to regulate temporary continence of the colostomy. There is also a plug system used by some ostomates for temporary continence. Surgeons began performing ileostomies in the 19th century, and today we have several continent procedures for certain individuals. These include the Koch Pouch and the Barnet Continent Ileal Loop. These are internal systems which require catheterization.

In the scope of urinary diversions, several procedures were tried including hooking ureters directly to skin. The most success has been with intestinal conduits, called various names including Bricker’s Loop, ileal conduit, or colon conduit. Many people improperly call them ileostom them ileostomies. Also, many today, opt for continent urostomies which need to be catheterized every 3-4 hours. These include the Kock urostomy, Gilchrest, the Indiana, Miami, or Florida pouches.  Surgeons have also created a neobladder with fairly good success in men.

Today, we have seen a proliferation of laparoscopic surgeries. The first laparoscopic colectomy was done in 1991. The development of interostomal therapy nurses (Ostomy nurses) has enhanced the lives of most ostomates. Most hospitals, some nursing homes, and home care agencies have specialists to help patients manage their ostomies.

What are the biggest concerns I hear for persons with ostomies?

  1. Can I still do everything I did before? Generally, yes. You can play, shower, bathe, swim, play sports with few restrictions.
  2. What about odor? Modern pouches are odor proof. Hand in hand with odor, people ask about gas. Certain foods are gas producing, as well as using straws, gum and smoking.
  3. What about sex? The risks and options should have been discussed before surgery. Communication with your partner is the key to a successful marriage.
  4. Can I do everything? There may be some restrictions depending on the type of surgery. Those with ileostomies have to be careful of dehydration and of possible food blockage, especially from high fiber foods. Major rules are, chew your food well and drink plenty of liquids, unless restricted.Certain foods may discolor feces or urine.
  5. Will medication affect my ostomy? Many medications not only color feces or urine, but may affect the output. Some, such as pain meds, tend to constipate, while others will loosen. Some ileostomates may see time-release capsules or enteric coated tablets come through the pouch.
  6. What appliance should I use? There are one piece and two piece pouches to choose from and there are close ended pouches, generally for colostomies. There are urostomy pouches with a spout which can be attached to drainage bags or bottles. There are high output pouches, convex pouches, and wafers, solid wafers or those with flexible tape.

If you wish to try samples of pouches, call your medical supply company or check with your ET Nurse.

Via: Lolly McClure, RN, BA, CWOCN
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