Ostomy: Life after colostomy or ileostomy

If you have a serious medical condition that affects your gastrointestinal (GI) tract, you may need an ostomy. An ostomy can be life-changing, and in some cases, lifesaving. It's estimated that up to one million Americans currently live with one.

What is an ostomy?

Ostomy is a medical term for a surgery that changes the way urine or stool leaves the body. This article will focus on ostomy procedures related to stool.

Briefly, during an ostomy procedure, the surgeon connects the small or large intestine to a stoma, or opening, in the abdominal wall. This allows waste to exit the body while bypassing part of the digestive tract. Instead of leaving the body through the anus, stool collects in a special pouch placed inside or right outside the abdomen. An ostomy may be temporary or permanent.

Who might need an ostomy?

An ostomy may be needed if an injury or illness prevents waste from exiting the body. For example:

• cancer, including colorectal cancer
• trauma from an accident
• inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis
• bowel obstruction
• infection
• fecal incontinence (an inability to control your bowel movements)
• diverticular disease.

In some cases, ostomy may be reversed once treatment for the underlying condition is complete or an injury has healed.

Types of ostomies

There are two main types of ostomies: a colostomy and an ileostomy. Your surgeon will recommend one or the other depending on which part of your intestine is affected.

Colostomy

During this surgery, diseased or damaged portions of the colon, or large intestine, are removed, and the remaining portion is diverted through an opening in the abdominal wall.

Ileostomy

With this surgery, diseased or damaged portions of the ileum, or small intestine, are removed and the remaining part is redirected to an opening in the abdominal wall.

What to expect after surgery

A nurse will go over everything you need to know about post-surgical care — including how your ostomy bag works — before you leave the hospital. You will be in the hospital for anywhere from three to 10 days after the procedure. You'll usually be sent home once stool begins to exit your body through your stoma.

You'll experience many changes after surgery, including the following:

Changes in bowel movements. You may find that your bowel movements are looser and less formed. This should improve with time, as your digestive tract heals.

Excess gas. It's normal to be gassier after ostomy surgery. Avoiding the following can help:

• drinking from a straw
• chewing gum
• drinking soda
• eating gas-producing foods like eggs, cabbage, onions, baked beans, fish, and dairy products.

You may also need to temporarily limit high-fiber foods like raw fruits and vegetables, nuts, and seeds. You'll be able to gradually reintroduce these foods after a few weeks.

Dehydration. Up to 30% of patients become dehydrated after ostomy surgery. It's the most common cause of hospital readmission. In general, it's recommended that adult men drink 13 cups of fluid a day, and adult women 9 cups. You'll need to increase that by about 2 to 3 cups per day after surgery. The best fluid choices are water, broth, and Pedialyte.

Managing your ostomy bag and caring for your skin

A common problem with ostomy bags is leakage of body waste. A study published in the journal Nursing Open found that about 14% of ostomy patients report leakage at least once a week. You can help reduce the chance of this happening by carefully following the care instructions provided by your nurse.

For example, you'll need to empty your ostomy bag when it's one-third full (usually five to eight times a day). In addition to reducing the risk of leakage, this will help to prevent unpleasant odors. You'll go to the bathroom and empty the pouch's contents into the toilet, then clean the bottom of the pouch with toilet paper. You will also need to change your pouch every three days or so. You can shower or bathe either with or without your ostomy bag.

The skin around your stoma can become irritated from the ostomy bag. To help prevent this, your ostomy pouch comes with a skin barrier. Also called a wafer, this barrier sticks to the skin and helps keep the ostomy bag in place. It's very important that the skin barrier is the right size. If it's too small, or too large, it can injure the stoma, cause skin irritation, or cause an unpleasant odor. Your nurse can help you determine if your skin barrier fits properly.

You should replace the skin barrier whenever you change your ostomy bag. Clean around your stoma with warm water and a washcloth, dry the skin, then apply the new skin barrier. Pastes and powders are also available over the counter to make the skin barrier easier to apply and to help prevent irritation.

Common challenges and solutions

Here are some common challenges you may encounter after your ostomy — along with solutions to make them more manageable.

Odor. Ostomy pouches are designed to contain odors. But odors are normal when the pouch is being emptied. Ostomy pouch deoderants and room sprays can help neutralize unpleasant odors during emptying.

Travel. You can still hit the road (or a train, or a plane) with an ostomy bag. Bring twice the number of supplies that you normally need. Pack some with you, and some in another place like your suitcase in case one gets lost. You can also download a TSA Travel Communication Card, and a Restroom Access Communication Card, to discreetly let airport and airplane staff know you have an ostomy.

Trouble absorbing medications. Because an ostomy shortens the duration of the digestive process, it may be harder to absorb medications after ostomy surgery, especially if you take enteric-coated pills or time-release capsules. Tell all your doctors and your pharmacist if you have had ostomy surgery. They can make sure you get medications in the form you need, whether they are prescription or over the counter. Let them know immediately if you see any full or partially digested pills in your ostomy bag.

Anemia. It may be harder to absorb nutrients such as vitamin B₁₂ from food after ostomy surgery. As a result, you can develop anemia, a condition where your body can't produce enough red blood cells and that can make you feel very tired. Ask your doctor whether you should take a vitamin B₁₂ supplement.

Sex. You may feel self-conscious about having sex after your ostomy. Open communication with your partner is key. You may want to simply start with kissing and cuddling. Intercourse won't injure your stoma, but a side lying position may be most comfortable. Sometimes, men experience temporary problems with erection. Women may notice vaginal dryness. There are medication options to help with both.

Exercise and other physical activies. People who have an ostomy can do all the activities they did before surgery, from biking and skiing to jogging or gardening. If you play contact sports, you may want to purchase a stoma guard. Also talk to your doctor about stomach strengthening exercises, to reduce the risk of developing a hernia.

If you are a swimmer, you may worry that your ostomy bag will leak in the water. Ostomy pouches are specially designed to prevent that from happening. If you are still worried, you can apply waterproof tape to the pouch for added security. You may also want to empty your pouch before you dive in.

Although the idea of having an ostomy pouch can take some getting used to, and despite the need to deal with certain challenges, research suggests that most people enjoy the same quality of life after the procedure that they had before their ostomy.

Support and resources for living with an ostomy

These resources can make it easier to live with an ostomy:

United Ostomy Associations of America. This nonprofit organization provides informational materials on life with an ostomy, as well as support groups.

Wound, Ostomy and Continence Nurses Society (WOCN). This website provides resources for patients and families. It can help you find an ostomy nurse to help with ostomy care, as well as adjusting to life with an ostomy.