Different Types of Ostomies

There is a lot of misunderstanding surrounding the different types of ostomy surgeries that some people who suffer from a form of inflammatory bowel disease have to undergo. I have found this to be the case with some patients, certain physicians, and also the general public.

In my experience, a “colostomy” seems to be the catch all phrase for every type of ostomy which isn’t accurate and what has led me to want to clarify some of the terminology in layman’s terms for anyone who may be interested in learning more about this topic.

Let’s break it down.

What is an ileostomy?

An ileostomy is when a piece of your small intestine is brought out of your abdomen so waste can be collected in an appliance or bag. Usually, a person who has an ileostomy has had a total colectomy, which means they have had their entire large intestine (also known as your colon) removed. The piece of your small intestine that protrudes out is known as a stoma, which some people say looks a little like a rose bud.

There are two types of ileostomies.

The first one is called a loop ileostomy, which many people call a temporary ostomy. In this case, the stoma that protrudes out of a person’s stomach is from closer to the ileum. The surgeon will create this “loop” which will divert stool away from a person’s rectum and anus with the option of having it reversed.

The second type of ileostomy is called an end ileostomy, or a permanent ileostomy. In this surgery, the end of a person’s small intestine makes up the stoma. Most of the time, this operation is performed when there is no intention of having it reversed. Meaning, either the person has too many anal fissures, fistulas, or inflammation that would not allow the reversal procedure (also known as a Takedown) to be successful.

Whether the person still has their rectum and anus with an end ileostomy is very individual. Some patients prefer to keep their options open in the hopes that if medical technology should advance, they would still have what is necessary for them to eliminate stool from their body the more traditional way. Once you remove the rectum and anus, the only other option a patient has is a continent ileostomy (also known as a Kock pouch or BCIR pouch) which I will explain later on in the article.

However, if there is severe damage to the rectum or anus and/or surrounding areas, which is common with a disease like IBD, leaving options open isn’t always ideal. I do know of people who do the best they can with it, while still suffering with leakage and other issues, until they can mentally accept life with an ostomy forever. It is all an individual process that is unique to everyone, much like inflammatory bowel disease.

What is a colostomy?

Colostomy surgery is performed when the surgeon either needs to remove part of your large intestine or there is a reason needed to divert stool away from the rectum/anus. In this case, the stoma (part of intestine that protrudes out of the abdomen) is made up of a person’s large intestine.

A colostomy is different than an ileostomy for a number of reasons. First, a person who has a colostomy may need to irrigate in order for waste to come out into their appliance. If this is the case, a person may not need to wear an appliance (or bag) over their stoma all of the time like someone who has an ileostomy does. This is not the case for everyone with a colostomy, but some of the time. The stoma, in general, is also much larger since it is made out of the large intestine. Second, the consistency of the stool is much thicker than with an ileostomy given water can be absorbed.

Whether a person who has a colostomy still has their rectum and anus left in is dependent on the situation. I would imagine if there is severe disease and the intent is for the colostomy to be permanent, those things might be removed in order to avoid future problems and the need for more surgery. On the other hand, if a colostomy is created temporarily in order to allow certain parts of the body to heal before being reconnected (and therefore, eliminating stool like a “normal” person) the rectum and anus would remain left inside the body.

What is a continent ileostomy?

A continent ileostomy is one of the least popular types of ostomies. It is not indicated for people who have Crohn’s Disease, although there are those patients who have one and do well, similar to a Jpouch operation.

This type of surgery is also known as a Kock Pouch and a BCIR pouch. This type of ostomy has a lot of cosmetic benefits since the patient does not need to wear an appliance. The surgeon will create a pouch inside where waste is held in by a valve, made out of the patient’s small intestine. On the surface, a person’s abdomen looks like they have an inverted stoma, which allows for insertion of a catheter in order to eliminate waste. The valve is supposed to hold waste inside the body until the person is ready to empty the contents. A bandage of some kind usually covers this type of stoma.

However, given you are asking the body to do what it is not designed to do, it can cause complications. While complications can obviously occur with people who have a different type of ostomy, ileostomies and colostomies are more about diverging stool away from an area that is compromised, as opposed to in this case when you are asking part of your small intestine (the valve) to hold in waste, which it is not designed to do.

I hope this helps to clarify some of the questions so many of us have about the different types of ostomies. Feel free to post any comments or questions you may have as well.

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