Ostomies: Types and Pouching Systems
- Publish Date: 2015/10/06 - (Rev. 2017/07/17)
- Author: Thomas C. Weiss
- Contact : Disabled World
Outline: Information regarding the most common specific types of ostomies and one or two-piece pouching systems.
The terms, 'ostomy,' and, 'stoma,' are general descriptive terms that are often times used interchangeably, although they have different meanings. An, 'ostomy,' refers to the surgically created opening in a person's body for the discharge of body wastes. A, 'stoma,' is the actual end of the ureter or small or large bowel that may be seen protruding through the person's abdominal wall. The most common specific types of ostomies are presented below.
An ostomy pouching system or colostomy bag is defined as a prosthetic medical device that provides a means for the collection of waste from a surgically diverted biological system (colon, ileum, bladder) and the creation of a stoma. Pouching systems are most commonly associated with colostomies, ileostomies, and urostomies.
- Loop Colostomy: A loop colostomy is usually created in the transverse colon; one stoma, two openings. One discharges stool, the other discharges mucus.
- Ascending Colostomy: An ascending colostomy is fairly rare opening in the ascending portion of a person's colon. It is located on the right side of the person's abdomen.
- Temporary Colostomy: A temporary colostomy permits the lower part of a person's colon to rest or heal. It may have one or two openings; if there are two openings, one of them will discharge mucus.
- Transverse Colostomy: A transverse colostomy is the surgical opening created in a person's transverse colon, resulting in one or two openings. It is located in the person's upper abdomen, middle, or right side.
- Permanent Colostomy: A permanent colostomy usually involves the loss of a portion of the person's colon, most commonly the rectum. The end of the remaining portion of the colon is brought out to the abdominal wall to form the stoma.
- Sigmoid or Descending Colostomy: A sigmoid or descending colostomy is the most common type of ostomy surgery, in which the end of the descending or sigmoid colon is brought to the surface of the person's abdomen. It is usually located on the lower-left side of the abdomen.
- Ileostomy: An ileostomy is a surgically created opening in the small intestine, commonly at the end of the person's ileum. The intestine is brought through the abdominal wall to form a stoma. Ileostomies can be temporary or permanent and might involve removal of all or a portion of the person's entire colon.
- Colostomy: A colostomy is the surgically created opening of the colon, resulting in a stoma. A colostomy is created when a part of the person's colon or rectum is removed and the remaining colon is brought to the person's abdominal wall. It might be further defined by the portion of the colon involved and/or its permanence.
- Indiana Pouch: The ileocecal valve that is usually between the large and small intestines is relocated and used to provide continence for the pouch which is made from the person's large bowel. With a Kock pouch version, which is similar to that used as an ileostomy alternative, the pouch and a, 'nipple,' valve are both created from the person's small bowel. In both procedures, the valve is located at the pouch outlet to hold urine until a catheter is inserted.
- Continent Urostomy: There are two main continent procedure alternatives to the ileal or cecal conduit, although others do exist. In both Indiana and Kock pouch versions, a reservoir or pouch is created inside the person's abdomen using a portion of either the small or large bowel. A valve is constructed in the pouch and a stoma is brought through the person's abdominal wall. A catheter or tube is inserted a number of times each day to drain urine from the reservoir.
- Orthotopic Neobladder: An orthotopic neobladder is a replacement bladder made from a section of intestine that substitutes for the bladder in its usual position and is connected to the urethra to permit voiding through the usual channel. Like the ileoanal reservoir, this is technically not an ostomy because there is no stoma. Candidates for neobladder surgery are people who need to have their bladder removed, yet do not need to have the urinary sphincter muscle removed.
- Urostomy: 'Urostomy,' is a general term for a surgical procedure which diverts urine away from a defective or diseased bladder. The ileal or cecal conduit procedures are the most common urostomies. Either a section at the end of the person's small bowel or at the beginning of the large intestine is surgically removed and relocated as a passageway for urine to pass from the person's kidneys to the outside of their body through a stoma. It might include removal of the diseased bladder.
- Continent Ileostomy: In this surgical variation of the ileostomy, a reservoir pouch is created inside the person's abdomen with a portion of the terminal ileum. A valve is created in the pouch and a stoma is brought through the person's abdominal wall. A catheter or tube is inserted into the pouch a number of times each day to drain feces from the reservoir. The procedure has generally been replaced in popularity by the ileoanal reservoir. A modified version of this procedure called the, 'Barnett Continent Intestinal Reservoir (BCIR) is performed at a limited number of facilities.
- Ileoanal Reservoir: Ileoanal reservoir is now the most common alternative to the more conventional ileostomy. Technically, it is not an ostomy because there is no stoma. In this procedure, the person's colon and the majority of their rectum are surgically removed and an internal pouch is formed out of the terminal portion of the person's ileum. An opening at the bottom of this pouch is attached to the anus such that the existing anal sphincter muscles may be used for continence. The procedure should only be performed on people with ulcerative colitis or familial polyposis who have not previously lost their anal sphincters. Along with the, 'J,' pouch there are, 'S,' and, 'W,' pouch geometric variants. It is also referred to as, 'ileoanal anastomosis,' 'pull-thru,' 'endorectal pull-thru,' 'pelvic pouch,' and, 'ileal pouch anal anastomosis (IPAA).'
Pouching System Types
Pouching systems can include a one-piece or two-piece system. Both kinds include a skin barrier/wafer or, 'faceplate,' as well as a collection pouch. The pouch attaches to the person's abdomen by the skin barrier and is fitted over and around the stoma to collect the diverted output, either urine or stool. The barrier/wafer is designed to protect the person's skin from the stoma output and to be as neutral to the person's skin as possible. What follows are descriptions of pouch systems.
- Urinary Pouching Systems: Urostomates may use either one or two-piece systems. The systems; however, also contain a valve or spout which adapts to either a leg bag or to a night drain tube connecting to a drain-able bag or bottle.
- Two-Piece Systems: Two-Piece systems allow changing pouches while leaving the barrier/wafer attached to the person's skin. The barrier/wafer is part of a, 'flange,' unit. The pouches include a closing ring that attaches mechanically to a mating piece on the flange. A common connection mechanism consists of a pressure fit snap ring.
- One-Piece Systems: One-Piece systems consist of a skin barrier/wafer and pouch joined together as a single unit. The systems provide greater simplicity than two-piece systems, although they require changing the entire unit, to include the skin barrier, when the person changes their pouch. Both two-piece and one-piece pouches can be either drainable or closed.
- Colostomy and Ileostomy Pouches: These pouches may be either open-ended, requiring a closing device, or closed and sealed at the bottom. Open-ended pouches are called, 'drainable,' and are left attached to the person's body while emptying. Closed end pouches are most commonly used by colostomates who can irrigate or by people who have regular elimination patterns. Closed end pouches are commonly discarded after a single use.
- Irrigation Systems: Some colostomates can, 'irrigate,' using a procedure analogous to an enema. The procedure is done to clean stool directly out of the person's colon through the stoma. It requires an irrigation system, consisting of an irrigation bag with a connecting tube or catheter, a stoma cone, as well as an irrigation sleeve. A lubricant is sometimes used on the person's stoma in preparation for irrigation. After irrigation, some colostomates may use a stoma cap, a one or two-piece system which simply covers and protects the stoma. The procedure is usually done to avoid the need to wear a pouch.
The above are the major types of pouching systems; there are also a number of styles. For example; there are flat wafers and convex shaped ones. There are very flexible ones and fairly rigid ones. There are barriers with and without adhesive backing and with and without a perimeter of tape. Some manufacturers have introduced drainable pouches with a built-in tail closure that does not require a separate clip. The decision as to what type of system to choose is a personal one aimed at each person's needs. There is no right or wrong choice, although each person must find the system that performs best for them.
Larger mail-order catalogs illustrate the styles and types from all or the majority of suppliers. If a person has any trouble with their current pouching system, it is important for them to discuss the issue with an ostomy nurse or other health care provider to find a system that works better. It is not uncommon to try several types until the best solution for the person is found. There is no reason to remain with a poorly performing or uncomfortable pouching system.
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