Hygiene - Ostomy care: Nursing skills

An ostomy is a surgically created opening used to connect an internal organ to the abdominal wall, through which waste products, like intestinal contents, are eliminated. The opening that can be seen on the body surface is called a stoma, and it’s usually connected to an ostomy pouch, also called a bag or appliance, where stool and flatus collect. An ostomy can be permanent or temporary, and it can be necessary because of fecal incontinence, an intestinal tumor, bowel trauma, and a bowel inflammatory disease. In these circumstances, part or all of the intestine is removed, and the remaining part of the intestine is brought up through the abdominal wall to allow for elimination of waste products.

Now, depending on how much bowel is removed, an ostomy can be either an ileostomy or a colostomy. With an ileostomy, a part of the small intestine is connected to the abdominal wall. An ileostomy can be permanent when the entire large intestine is removed or temporary when it’s done to allow the large intestine to heal after trauma or surgery. With a colostomy, only part of the large intestine is removed, and the remaining part is connected to the abdominal wall. Remember that, normally, in the small intestine, the nutrients are pretty liquid because most of the water is reabsorbed in the large intestine. So, with an ileostomy, the feces are liquid, and they flow at a fairly constant rate. With a colostomy, on the other hand, feces have a different consistency depending on the location of the colostomy.

So, if nearly all the large intestine was removed and the colostomy is near the beginning, feces are more liquid. If the colostomy is near the end of the digestive tract, feces are more solid. Like ostomies, ostomy appliances also come in different shapes and sizes. There are drainable appliances, also called “open-end” appliances which are sealed with a clip or a Velcro-type system at the bottom, so they can be drained and reused. Then there are closed-end, or disposable appliances which can be removed and replaced or emptied and rinsed when full. Additionally, some appliances are pre-cut, so they come in different sizes to match the various stoma sizes.