Types of Ostomies
The main types of ostomies are colostomy, ileostomy, and urostomy, each with distinct configurations (end or loop) designed for specific clinical indications and with different management requirements. 1, 2
Main Types of Ostomies
Colostomy
- Definition: A stoma created from a portion of the colon
- Characteristics:
- Most common type of enteral stoma
- Typically red and minimally raised above skin surface
- Usually produces formed stool (once daily)
- Appliances typically changed every 6-7 days
- Common locations: Sigmoid, descending, or transverse colon
- Indications:
- Colorectal cancer
- Diverticulitis with perforation
- Trauma
- Crohn's disease
- Fecal diversion (for incontinence, sacral wounds, spinal cord injury) 1
Clinical Pearl: The right side of the colon is usually avoided for colostomy creation due to its large diameter and liquid effluent, which can lead to leakage problems. 1, 2
Ileostomy
- Definition: Stoma constructed from the terminal ileum
- Characteristics:
- Created close to ileocecal valve to maximize nutrient absorption
- Produces liquid effluent
- Requires emptying 3-4 times daily
- Wafer typically changed every 4 days
- Has a small spout (about 25mm) protruding from abdominal wall
- Indications:
Important Consideration: Ileostomies are easier to construct and reverse but are associated with more dehydration and skin excoriation than colostomies due to the enzymatic content of the liquid output. 1
Urostomy (Ileal Conduit)
- Definition: A urinary diversion that passes urine through a stoma
- Characteristics:
- Small spout (about 25mm) protruding from abdominal wall
- Passes urine and small amounts of mucus
- Uses drainable bag with bung or tap 3
Stoma Configurations
End Ostomy
- Definition: Created when intestine is divided and proximal end is brought out as stoma
- Characteristics:
- Distal end remains within abdomen
- Easier for patients to pouch
- Lower risk of prolapse compared to loop ostomies
- Indications:
Special Variant: Mucus fistula - rarely, the distal end is also brought out through a separate incision, creating two stomas. Generally avoided due to management difficulties but may be necessary with risk of leak, distal obstruction, or poor tissue integrity. 1, 2
Loop Ostomy
- Definition: Created by bringing continuous piece of intestine through abdominal wall and opening anterior wall
- Characteristics:
- Results in two intestinal openings side by side in same skin aperture
- Proximal end (draining stool) is typically made dominant
- Higher risk of prolapse than end ostomies
- Indications:
Management Considerations
Common Complications
Skin breakdown and leakage:
- Risk factors: obesity, placement in skin crease, loop configuration, liquid effluent
- Prevention: preoperative marking by stomatherapist
- Treatment: barrier powder + skin sealant, corticosteroid spray for persistent dermatitis 2
High-output stoma (>1.5 L/day):
- Management includes hydration, antimotility medications, and bulking agents 2
Appliance Selection
- Different appliances are required based on stoma type:
Practice Point: Adequate stomal care significantly improves clinical outcomes and reduces hospitalizations, directly impacting patient morbidity, mortality, and quality of life. 2
Historical Context
Ostomy support and management has evolved significantly from early rubber appliances that were bulky and difficult to manage to today's modern, specialized appliances designed for specific types of stomas. The first organized ostomy support group was formed in 1950, leading to the eventual development of the United Ostomy Association and specialized enterostomal therapy. 5, 6