Differences Stomas

Differences between Stomas

 

 

Ileostomy

Colostomy

Urostomy

Stoma

Small, because the small intestine is used. The stoma will “work” and pulse in and out when outputting, due to the peristalsis that moves the contents of the small intestine along.

Large, because the colon is used. There is no peristalsis of the large intestine.

Small, because the last part of the Ileal Conduit 4/5"which joins the colon is used to form the Stoma.The Uriters from the kidneys are connected to the internal end of this conduit where they drain. There is some peristalsis.

Position

Usually on the right, but can be on the left if is has been repositioned. It will always be in the Abdominal External Oblique Muscle.

Usually on the left. Can be on the right if most of the colon has been re-sected. It will always be in the Abdominal External Oblique Muscle.

Usually on the right of the abdomen, but maye be repositoned on the left if a repair has to be undertaken or a hernia.

Output

Output liquid, to semi-solid (consistency of yoghurt or custard)

semi-solid, to almost 'normal'. This depends largely on the amount of colon left intact.

Liquid only [Urine]

Output frequency

Almost constantly, more so right after eating.

1 - 3 times/day, depending on how much of the colon is left intact.

Constant, with intermittent spurts, no control or feeling of urine passing.

Pouches

Drainable pouches with a closure at the bottom, so that they can be emptied repeatedly.

Usually closed pouches. Drainable pouches can be used in cases of diarrhoea, or when travelling

Drainable pouches, option of one or two piece system, must have a tap for emptying. Essential to use night drainage bags, connects easily to stoma pouch with an extension tube.

Frequency of pouch changes

Differs from user to user. Some change daily, others use 1 pouch for several days. This could also depend on health insurance!

The pouch is removed and discarded once there is a motion, and a new one affixed. A colostomist with no underlying problems may well revert to bowel habits which were routine before acquiring a stoma.

The Urine pouches and flanges can be worn for 3/4 days [some use them longer] without problems. A night drainage can be used for 7 days [some use for longer] should be washed out on a daily basis, steralisation with milton or vinegar is optional for some.

Emptying the pouch

As output is almost constantly, emptying will occur several times/day. Most ileostomists have to get up once or twice at night to empty as well.

With regular bowel movement, emptying is not necessary. When using a closed pouch, it is changed after a bowel movement.

Constant output means the bag will need to be emptied regularly. This will take place at approx. 2 hour intervals day and night.The obvious use of a night bag will relieve the problem of getting up in the night.

Stoma cap

Due to constant output not recommended, but can be used at a quiet stoma time for intimacy or bathing.

Very regular colostomists can use a stoma-cap instead of a pouch, eg. For swimming.

Not an option for Urostomates. However there is a Mini Bag with tap available from coloplast ref14206 could be an option for swimming or intimacy, will give about 1/2 hour wearing time [estimated].

Irrigation

Due to constant output not recommended.

Some colostomists can irrigate to regulate their bowel movements, eg. When there will be no time or room to change a full pouch. Always contact your stoma-care nurse to check if this is an option for you!

Not an option for Urostomates.

Skin problems

Skin problems can occur, due to the liquid output that can be very aggressive to the skin. Liquid output can eat away the adhesives. Also, allergies to certain adhesives can occur.

Skin problems occur in principal only when there has been a leak. Also, allergies to certain adhesives can occur.

All these can also be problems to Urostomates especially leaks as liquid will find the smallest gap. Barrier creams or sprays can help.

Noise

Farting noises when gas passes, squelching noise sometimes when stoma is active.

Farting noises when gas passes.

Noises are not a Urostomy problem, multi chamber bags stop the sloshing of urine in the bag.

Gas

Passing gas is usually moist. This will cause filters to block, and pouch will fill with air. Releasing is possible through the closure at the bottom of the pouch.

Passing gas is usually dry, but pouch can still fill up with air if filter blocks. Releasing the air can be a problem when using a closed pouch, and a 1-piece system.

There is no gas produced from Urine

Food

You can eat as you are used to, however caution is recommended when eating fibrous foods, nuts etc. As they do not get digested in the small intestine, there is a chance for blockage! Contact your stoma-care nurse when you are in doubt.

Diet is almost normal. Most colostomists try and avoid foods that cause lots of gas (cabbage, etc); see above (Gas).

Any diet that was acceptable before surgery should be acceptable after unless there are other reasons for avoidance.

Blockages

Most blockages are caused by adhesions always present after abdominal surgery, but can be caused by badly chewed or fibrous food.

Most blockages are caused by adhesions always present after abdominal surgery, but can be caused by badly chewed or fibrous food.

Adhesions can occur after any surgery, but are not the norm. The passing of urine through the conduit will more than likely produce Mucus which can cause blockages to the night bag with non return valve fitted.

Smell

Smells differ, depending on what you eat, but on average a bit stronger than normal. There should be no, or barely any smell when pouch and filter are functioning normally. Smells can be indication of a leak if they occur other than when emptying!

Smells differ, depending on your diet, but on average quite 'normal'. There should be no, or barely any smell when pouch and filter are functioning normally. Smells could be an indication of a poor filter, or a leak.

If cleanliness is maintained then urine in a fresh state does not smell, only when it becomes stale or lack of hygiene will cause problems.

Leaks

Due to the more runny output leaks are most likely to start as a trickle between skin and flange. A tickly feeling under the wafer could be an indication!

In case of pancaking (see below) or excess gas (see above) the pouch can become overfull quickly. Output will find a path or least resistance, which usually means lifting the flange off the skin.

Leaks can arise, and do with a urostomy. Don't let the bag overfill

Pancaking

Happens rarely, only if the output is semi-solid, and sticks around the stoma. As a result, output will not be able to find it's way down into the pouch, with chance of a leak (see colostomist, Leaks)

If pouch vacuums, or output sticks around the stoma. As a result, output will not be able to find it's way down into the pouch, with chance of a leak (See above)

Pancaking cannot happen with a urostomy.

Dehydration

As liquids are mostly absorbed in the colon (which has been removed) and due to the mostly liquid output, one should take care to drink more than normal. 1,5 - 2 ltrs/day is recommended to prevent dehydration.

Due to the more solid output, sufficient liquids should be consumed to keep the output in a more managable consistency.

Liquid intake is a must for Urostomates 2 litres or more a day are recommended not only for hydration, but helps prevent Urinary Tract Infections and keeps the kidneys active.

Salt absorption

As salts are absorbed by the colon (which has been removed) ileostomists are likely to need extra salts. Contact your stoma-care nurse or dietician.

Depending on how much of the colon is left intact, salt absorption is more normal. Be sure to have regular check-ups with your family doctor for (blood) levels.

Not a requirement.

Vitamin B12

Vitamin B12 is absorbed in the ileum (connection between small intestine, and colon) Depending on where your stoma is in relation to your ileum, Vitamin B12 may have to be taken. Check regularly with your family doctor for (blood) levels.

This again seems to depend on how much colon one has left. Checks may have to be made over time to ensure balance is OK.

As the Final part of the Ileum has been used to form the Stoma It may be that we are not absorbing Vitamin B12 however i don't know of anyonebing tested ?

Iron

There is some evidence that ileostomists have difficulty absorbing iron, and may need extra.

There should be no difference to someone with normal bowel function.

Not a standard requirement and normal balanced diet should be enough to cover.