Types of Colostomies and Pouching Systems - American ...

A colostomy can be short-term (temporary) or life-long (permanent) and can be made in any part of the colon. The different types of ... TheAmericanCancerSocietyishereto supportUkrainianpatients withcancer,caregivers,andclinicians. CloseCriticalAlertBanner Search prod Verenespañol | Downloadthistopic[PDF] ColostomyGuide WhatIsaColostomy? TypesofColostomiesandPouchingSystems CaringforaColostomy Treatment&Support TreatmentsandSideEffects TreatmentTypes CancerSurgery Ostomies ColostomyGuide TypesofColostomiesandPouchingSystems Acolostomycanbeshort-term(temporary)orlife-long(permanent)andcanbemadeinanypartofthecolon.Thedifferenttypesofcolostomiesarebasedonwheretheyarelocatedonthecolon. Temporarycolostomies Certainlowerbowelproblemsaretreatedbygivingpartofthebowelarest.It’skeptemptybykeepingstoolfromgettingtothatpartofthebowel.Todothis,ashort-term(temporary)colostomyiscreatedsothatthebowelcanheal.Thishealingprocessusuallytakesafewweeksor months,butmaytakeyears.Intime,thecolostomywillbereversed(removed)andthebowelwillworklikeitdidbefore–thestoolwillexitfromtheanusagain. Permanentcolostomies Whenpartofthecolonortherectumbecomesdiseased,along-term(permanent)colostomymustbemade.Thediseasedpartofthebowelisremovedorpermanentlyrested.Inthiscase,thecolostomyisconsideredpermanentandisnotexpectedtobeclosedinthefuture. Transversecolostomies Atransversecolostomyisoneofthemostcommontypes.Thereare2typesoftransversecolostomies:thelooptransversecolostomyandthedouble-barreltransversecolostomy.Thetransversecolostomyisintheupperabdomen,eitherinthemiddleortowardtherightsideofthebody.Thistypeofcolostomyallowsthestooltoleavethebodybeforeitreachesthedescendingcolon.Someofthecolonproblemsthatcanleadtoatransversecolostomyinclude: Diverticulitis.Thisisinflammationofdiverticula(littlesacsalongthecolon).Itcancauseabscesses,scarringwithstricture(abnormalnarrowing),orruptureofthecolonandinfectioninseverecases. Inflammatoryboweldisease Cancer Obstruction(blockage) Injury Birthdefects Ifthereareproblemsinthelowerbowel,theaffectedpartofthebowelmightneedtimetorestandheal.Atransversecolostomymaybeusedtokeepstooloutoftheareaofthecolonthat’sinflamed,infected,diseased,ornewlyoperatedon–thisallowshealingtotakeplace.Thistypeofcolostomyisusuallytemporary.Dependingonthehealingprocess,thecolostomymaybeneededforafewweeksormonths,butpossiblyforyears.Ifthecolonhealsovertime,thecolostomyislikelytobesurgicallyreversed(closed).Youwillhavenormalbowelfunctionafterit'sreversed. Apermanenttransversecolostomyismadewhenthelowerportionofthecolonmustberemovedorpermanentlyrested,orifotherhealthproblemsmakethepatientunabletohavemoresurgery.Thecolostomyisthenthepermanentexitforstoolandwillnotbeclosedinthefuture. Looptransversecolostomy(Figures2and3):Theloopcolostomymaylooklikeoneverylargestoma,butithas2openings.Oneopeningputsoutstool,theotheronlyputsoutmucus.Thecolonnormallymakessmallamountsofmucustoprotectitselffromthebowelcontents.Thismucuspasseswiththebowelmovementsandisusuallynotnoticed.Despitethecolostomy,therestingpartofthecolonkeepsmakingmucusthatwillcomeouteitherthroughthestomaorthroughtherectumandanus.Thisisnormalandexpected. Double-barreltransversecolostomy(Figures4and5):Whencreatingadouble-barrelcolostomy,thesurgeondividesthebowelcompletely.Eachopeningisbroughttothesurfaceasaseparatestoma.The2stomasmayormaynotbeseparatedbyskin.Here,too,oneopeningputsoutstoolandtheotherputsoutonlymucus(thissmallerstomaiscalledamucusfistula).Sometimestheendoftheinactivepartofthebowelissewnclosedandleftinsidethebelly.Thenthere’sonlyonestoma.Themucusfromtherestingportionofthebowelcomesoutthroughtheanus Changesinthenewlyformedtransversecolostomy Rightaftersurgery,yourcolostomymaybecoveredwithbandagesoritmayhaveaclearpouchoverit.Thetypeofpouchusedrightaftersurgeryisusuallydifferentfromthoseyou’lluseathome.Beforeyoulookatyourcolostomyforthefirsttime,keepinmindthatitmaybequiteswollenaftersurgery;theremayalsobebruisesandstitches.Whileastomanormallyismoistandpinkorredincolor,itmaybedarkeratfirst.Yourstomawillchangealotasitheals.Itwillgetsmallerandanydiscolorationwillgoaway,leavingamoistredorpinkstoma.Thismaytakeseveralweeks. You’llsoonnoticethat,althoughyoucanusuallytellwhenyourcolostomyisgoingtopassstoolorgas,youcan’tcontrolit.Yourcolostomydoesnothaveavalve-likesphinctermusclelikeyouranusdoes.Becauseofthis,you’llneedtowearapouchoveryourcolostomytocollecttheoutput.Yourostomynurseordoctorwillhelpyoufindapouchingsystemthat’srightforyou.  Thisisalsodiscussedinmoredetailbelowin"Choosingacolostomypouchingsystem." Managingatransversecolostomy Whenacolostomyismadeintherighthalfofthecolon(neartheascendingcolon),onlyashortportionofcolonleadingtoitisactive.Thestoolthatcomesoutofatransversecolostomyvariesfrompersontopersonandevenfromtimetotime.Afewtransversecolostomiesputoutfirmorpaste-likestoolatinfrequentintervals,butmostofthemmoveoftenandputoutsoftorloose,oatmeal-likestool. It’simportanttoknowthatthestoolcontainsdigestiveenzymes(chemicalsmadebythebodytobreakdownfood).Theseenzymesareveryirritating,sothenearbyskinmustbeprotectedwithaskinbarrier. (See"Protectingtheskinaroundthestoma"underCaringforaColostomy formoreonthis.) Tryingtocontrolatransversecolostomywithspecialdiets,medicines,enemas,orirrigationsusuallydoesn’tworkandisnotusuallyadvised.Inmostcases,apouchingsystemiswornoveratransversecolostomyatalltimes.Alightweight,drainablepouchholdstheoutputandprotectstheskinfromcontactwiththestool.Thepouchdoesn’tusuallybulge,andit’snoteasytoseeunderyourclothes. Bowelmovementswithatransversecolostomy Atransversecolostomywillputoutstoolnomatterwhatyoudo.Keepinmindthesepoints: Therightpouchingsystem(alsocalledanappliance)foryouisonethatwillkeepyoufromsoilingyourclothing. Thefirmnessofyourstoolisaffectedbywhatyoueatanddrink. Gasandodorarepartofthedigestiveprocessandcannotbeprevented.Buttheycanbecontrolled.Yourpouchwillhelptocontrolodors. Emptythepouchwhenit’sabout1/3to1/2fulltokeepitfromleakingorbulgingunderyourclothes.It'sbesttoarrangeaspaceinyourbathroomathome,andtofindabathroomwhenyou'reout,whereyoucanemptyyourpouch. Changethepouchsystembeforethere’saleak.It’sbesttochangeitnomorethanonceadayandnotlessthanonceevery3or4days. Theostomyoutputcanirritateyourskin.Youcanhelppreventskinproblemsbyhavingacorrectlyfittedpouchsystemandbyusingspecialmaterialsforostomycare. Ascendingcolostomy Theascendingcolostomyisplacedontherightsideofthebelly.Onlyashortportionofcolonremainsactive.Thismeansthattheoutputisliquidandcontainsmanydigestiveenzymes.Adrainablepouchmustbewornatalltimes,andtheskinmustbeprotectedfromtheoutput.Thistypeofcolostomyisrarebecauseanileostomyisoftenabetterchoiceifthedischargeisliquid. (Formoreonthis,see Ileostomy:AGuide.) Caringforanascendingcolostomyismuchlikecaringforatransversecolostomy(asdiscussedabove). Descendingandsigmoidcolostomies Locatedinthedescendingcolon,thedescendingcolostomy(Figure6)isplacedonthelowerleftsideofthebelly.Mostoften,theoutputisfirmandcanbecontrolled. Asigmoidcolostomy(Figure7)isthemostcommontypeofcolostomy.It’smadeinthesigmoidcolon,andlocatedjustafewincheslowerthanadescendingcolostomy.Becausethere’smoreworkingcolon,itmayputoutsolidstoolonamoreregularschedule.  Boththedescendingandthesigmoidcolostomiescanhaveadouble-barrelorsingle-barrelopening.Thesingle-barrel,orendcolostomy,ismorecommon.Thestomaoftheendcolostomyiseithersewnflushwiththeskinorit’sturnedbackonitself(liketheturned-downtopofasock). Youwillnoticewithadescendingorsigmoidcolostomy: Thestoolisfirmerormorelikepaste.Itdoesn’thaveasmuchoftheirritatingdigestiveenzymesinit. Stooloutputmayhappenasareflexatregular,expectedtimes.Thebowelmovementwilltakeplaceafteracertainamountofstoolhascollectedinthebowelabovethecolostomy.Twoor3daysmaygobetweenmovements Spillingmayhappenbetweenmovementsbecausethere’snomuscletoholdthestoolback.Manypeopleusealightweight,disposablepouchtopreventaccidents Feelingtheneedtoemptythebowel(reflex)willhappenquitenaturallyinsomepeople.Othersmayneedmildstimulation,suchasjuice,coffee,ameal,amildlaxative,orirrigation.  Bowelmovementswithadescendingorsigmoidcolostomy Abowelmovementthroughacolostomyhappensnaturallylikeanormalmovementthroughtheanus.But,unliketheanalopening,thecolostomydoesnothavenervesorasphinctermusclethatcanhelptostopthepassageofstool. Youmustwearapouchtocollectanythingthatmightcomethrough,whetherit’sexpectedornot.Manylightweightpouchesarehardtoseeunderclothes.Theysticktotheskinaroundthecolostomyandmaybewornallthetime,oronlyasneeded. Forsomepeople,eatingcertainfoodsatcertaintimescanmakethebowelmoveatatimethatworksbestforthem.Somepeopleuseonlythismethodtokeepbowelmovementsonaregularschedule,whileothersuseitwithirrigation. Constipationorloosestool Manypeoplethinkthatyoumusthaveabowelmovementeveryday.Intruth,thisvariesfrompersontoperson.Somepeoplehave2or3movementsaday,whileothershaveabowelmovementevery2or3daysorevenlessoften.Itmaytakesometimeaftersurgerytofigureoutwhat’snormalforyou. Whilemanydescendingandsigmoidcolostomiescanbetrainedtomoveregularly,somecannot.Training,withorwithoutstimulation,islikelytohappenonlyinthosepeoplewhohadregularbowelmovementsbeforetheybecameill.Ifbowelmovementswereirregularinearlieryears,itmaybehard,orimpossible,tohaveregular,predictablecolostomyfunction.Spasticcolon,irritablebowel,andsometypesofindigestionaresomeconditionsthatcausepeoplewithcolostomiestocontinuetohaveboutsofconstipationorloosestool.  Closingorreversingacolostomy Ifyou’regoingtohaveyourcolostomyclosed,thesurgeonmightmentionplansto“takeitdown”or“reverseit”inafewweeksormonths,butsometimesthedoctordoesn’tsayanythingaboutit.It’sbesttotalktoyoursurgeonaboutthesethingsbeforeyouleavethehospitalsoyouknowwhattheplansareandwhentoseethesurgeonagain.Ifyou’reathomenowanddidn’tgetinstructions,callthedoctor’sofficeorclinicandfindoutwhatthedoctorwantsyoutodo.It’syourjobtostayintouchwiththedoctor. Manythingsmustbetakenintoaccountwhenthinkingaboutclosingacolostomy,suchas: Thereasonyouneededthecolostomy Whetheryoucanhandlemoresurgery Yourhealthsincetheoperation Otherproblemsthatmayhavecomeupduringoraftersurgery Choosingapouchingsystem Decidingwhatpouchingsystemorapplianceisbestforyouisaverypersonalmatter.Whenyou’retryingoutyourfirstpouchingsystem,it’sbesttotalkwithanostomynurseorsomeonewhohasexperienceinthisarea.Thereshouldbesomeoneinthehospitalwhocangetyoustartedwithequipmentandinstructionsaftersurgery. Asyou’regettingreadytoleavethehospital,besureyouarereferredtoaWoundOstomyContinencenurse(WOCNorWOCnurse,alsocalledanostomynurse),aclinic,anostomymanufacturer,orachapteroftheUnitedOstomyAssociationsofAmerica.Evenifyoumustgooutoftowntogetsuchhelp,it’sworthwhile,asyouwanttogetagoodstartandavoidmistakes.Evenwithhelp,youmayhavetotrydifferenttypesorbrandsofpouchingsystemstofindtheonethatbestsuitsyou.(See GettingColostomyHelp,Information,andSupport.) Therearemanythingstothinkaboutwhentryingtofindthepouchingsystemthatwillworkbestforyou.Thelengthofthestoma,abdominalfirmnessandshape,thelocationofthestoma,scarsandfoldsnearthestoma,andyourheightandweightallmustbeconsidered.Specialchangesmayhavetobemadeforstomasnearthehipbone,waistline,groin,orscars.Somecompanieshavecustom-madeproductstofitunusualsituations. Agoodpouchingsystemshould: Staysecure,withagoodleak-proofsealthatlastsforupto3days Beodor-resistant Protecttheskinaroundthestoma Benearlyinvisibleunderclothing Beeasytoputonandtakeoff Allowyoutoshowerorbathewiththepouchon,ifyouwishtodoso Typesofpouchingsystems Pouchescomeinmanystylesandsizes,andanostomynursecanhelpyouchoosethebestoneforyoursituationandlifestyle.Theyallhaveacollectionpouchtocollectstooldrainagethatcomesoutofthestomaandanadhesivebarrier(calledaflange,skinbarrier,orwafer)thatprotectsthesurroundingskin.Thereare2maintypesofsystemsavailable: One-piecepoucheshavebothapouchandskinbarrierattachedtogetherinthesameunit.Whenthepouchisremoved,thebarrieralsocomesoff. Two-piecesystemsaremadeupofaskinbarrierseparatefromapouch.Whenthepouchistakenoff,thebarrierstaysinplace. Somepouchingsystemscanbeopenedatthebottomforeasyemptying.Othersareclosedandaretakenoffwhentheyarefull.Stillothersallowtheadhesiveskinbarriertostayonthebodywhilethepouchmaybetakenoff,washedout,andreused.Pouchesaremadefromodor-resistantmaterialsandvaryincost.Theycanbeeitherclearoropaqueandcomeindifferentlengths. Figures8through15showsomeofthedifferentkindsofpouches,plusothersuppliesthatmaybeneeded,suchasflanges,clips,andbelts(tohelpholdthepouchinplace). Theopeningoftheskinbarrierorwaferofthepouchneedstofityourstoma.Theopeningshouldbenomorethan1/8inchlargerthanthestoma.Dependingonthepouchdesign,youmayneedtocutaholeoutforyourstoma,orthewafermaybesizedandpre-cut.Thesizeoftheholeisimportantbecausethewaferisdesignedtoprotectthenearbyskinfromthestomaoutputandbeasgentletotheskinaspossible. Keepinmindastoma'ssizecanchangeifitbecomesswollenorforotherreasons.Forexample,aftersurgery,yourstomamaybeswollenforabout6to8weeks.Duringthistimethestomashouldbemeasuredaboutonceaweek.Ameasuringcardmaybeincludedinboxesofpouches,oryoucanmakeyourowntemplatetomatchyourstomashapeandgetthebestfit. Stomacap Ifyourcolostomyputsoutstoolatregular,expectedtimes,youmaybeabletouseastomacoverinsteadofalwayswearingapouch.Youcanplaceneatly-foldedgauzeortissue,dabbedwithasmallamountofwater-solublelubricantoverthestoma,andcoveritwithapieceofplasticwrap.Thiscanbeheldinplacewithmedicaltape,underclothes,oranelasticgarment.Plastic,ready-madestomacaps(Figure16)arealsoavailable. Writtenby References TheAmericanCancerSocietymedicalandeditorialcontentteam Ourteamismadeupofdoctorsand oncologycertifiednurseswithdeepknowledgeofcancercareaswellasjournalists,editors,andtranslatorswithextensiveexperienceinmedicalwriting. InitsoriginalformthisdocumentwaswrittenbytheUnitedOstomyAssociationofAmerica(1962-2019).IthassincebeenmodifiedandupdatedbytheAmericanCancerSocietyusingthefollowingsources. Berti-HearnL,ElliottB.Colostomycare:Aguideforhomecareclinicians. HomeHealthcareNow. 2019;37(2):68-78.Accessedat https://journals.lww.com/homehealthcarenurseonline/FullText/2019/03000/Colostomy_Care__A_Guide_for_Home_Care_Clinicians.2.aspxonOctober2,2019. ColwellJC,McNicholL,BoariniJ.NorthAmericaWound,Ostomy,andContinenceandEnterostomalTherapyNursescurrentostomycarepracticerelatedtoperistomalskinissues.JWoundOstomyContinenceNurs.2017;44(3):257-261. Hollister.Typesofostomies.Accessedathttps://www.hollister.com/en/ostomycare/ostomycareprofessionalresources/resourcesforyourpatients/ostomyresourcesonOctober2,2019. Hollister.Understandingyourcolostomy.Accessedathttp://www.hollister.com/~/media/files/pdfs-for-download/ostomy-care/understanding-your-colostomy_923054-0917.pdfonOctober2,2019. UnitedOstomyAssociationofAmerica(UOAA).Colostomyguide.Accessedathttps://www.ostomy.org/wp-content/uploads/2018/03/ColostomyGuide.pdfonOctober2,2019. UnitedOstomyAssociationofAmerica(UOAA).Newostomypatientguide:Colostomy,ileostomy,urostomy,continentdiversion.Accessedathttps://www.ostomy.org/wp-content/uploads/2018/05/All-In-One-New-Patient-Guide_2018.pdfonOctober2,2019. References InitsoriginalformthisdocumentwaswrittenbytheUnitedOstomyAssociationofAmerica(1962-2019).IthassincebeenmodifiedandupdatedbytheAmericanCancerSocietyusingthefollowingsources. Berti-HearnL,ElliottB.Colostomycare:Aguideforhomecareclinicians. HomeHealthcareNow. 2019;37(2):68-78.Accessedat https://journals.lww.com/homehealthcarenurseonline/FullText/2019/03000/Colostomy_Care__A_Guide_for_Home_Care_Clinicians.2.aspxonOctober2,2019. ColwellJC,McNicholL,BoariniJ.NorthAmericaWound,Ostomy,andContinenceandEnterostomalTherapyNursescurrentostomycarepracticerelatedtoperistomalskinissues.JWoundOstomyContinenceNurs.2017;44(3):257-261. Hollister.Typesofostomies.Accessedathttps://www.hollister.com/en/ostomycare/ostomycareprofessionalresources/resourcesforyourpatients/ostomyresourcesonOctober2,2019. Hollister.Understandingyourcolostomy.Accessedathttp://www.hollister.com/~/media/files/pdfs-for-download/ostomy-care/understanding-your-colostomy_923054-0917.pdfonOctober2,2019. UnitedOstomyAssociationofAmerica(UOAA).Colostomyguide.Accessedathttps://www.ostomy.org/wp-content/uploads/2018/03/ColostomyGuide.pdfonOctober2,2019. UnitedOstomyAssociationofAmerica(UOAA).Newostomypatientguide:Colostomy,ileostomy,urostomy,continentdiversion.Accessedathttps://www.ostomy.org/wp-content/uploads/2018/05/All-In-One-New-Patient-Guide_2018.pdfonOctober2,2019. LastRevised:October16,2019 AmericanCancerSocietymedicalinformationiscopyrighted material.Forreprintrequests,pleaseseeourContentUsagePolicy. ColostomyGuide WhatIsaColostomy? TypesofColostomiesandPouchingSystems CaringforaColostomy MoreInTreatment&Support UnderstandingYourDiagnosis TreatmentsandSideEffects Survivorship:DuringandAfterTreatment FindingandPayingforTreatment CaregiversandFamily ChildrenandCancer EndofLifeCare PatientProgramsandServices BackToTop Close * Close Imageof Previous Next Close Close SelectAHopeLodge