Anatomy of a Stoma

The body needs to elim­i­nate waste. It’s a process most peo­ple take for granted: we eat, the intestines extract nutri­ents and water from the food, and the left­over mate­r­ial is removed, usu­ally into a toi­let. But this seem­ingly sim­ple process is essen­tial for health and life. If the sys­tem stops working—for instance, if part of the intes­tine becomes inflamed or blocked—the body needs another way to remove its waste. Mod­ern medicine’s answer to this prob­lem is the stoma, a surgically-created open­ing in the abdomen for the body’s dis­charge of waste.

The def­i­n­i­tion of an Ostomy is the sur­gi­cal pro­ce­dure used to cre­ate the stoma. A sur­geon makes a cut into the patient’s abdomen, removes the dis­eased or injured area of intes­tine, and draws the free end of the intes­tine out through the abdom­i­nal open­ing, where it can heal to the skin. This cre­ates a new open­ing from the intestines, called a stoma. The stoma refers specif­i­cally to the pro­trud­ing area of bowel. The stoma opens directly into the intestines, so the inner, mucus-covered lin­ing of the intes­tine is visible.

The large intes­tine is an organ about five to six feet long. It is located in the abdomen, where it loops from the lower right abdomen, up over the small intestines, and down to the lower left abdomen. There it con­nects to the rec­tum, which releases waste from the body through the anus. The large intestine’s pri­mary func­tions are to extract water from, move, and store the body’s waste mate­r­ial after the small intes­tine extracts nutrients.

Types of Ostomy Surgery

There are sev­eral dif­fer­ent kinds of Ostomy surgery, named for the organ or area being oper­ated on.

• Colostomy: surgery where part of the colon is brought through the abdomen to cre­ate a stoma. Ascend­ing, trans­verse, and descend­ing colostomies refer to the area of the colon brought to the sur­face of the abdomen.

• Ileostomy: surgery where the low­est part of the small intes­tine, the ileum, is brought through the abdom­i­nal wall to cre­ate a stoma. An ileostomy com­pletely bypasses the colon for stool elimination.

• Urostomy: surgery where a small sec­tion of small or large bowel is used as a con­nec­tor between the uri­nary tract and the stoma. This allows urine to be elim­i­nated from the body with­out being stored in the bladder.

• Per­ma­nent ver­sus Tem­po­rary: Ostomy surg­eries can be tem­po­rary (usu­ally per­formed to allow regions of the bowel to heal) or per­ma­nent (usu­ally per­formed with loss of the rectum.)

• J-Pouch: Also known as the ileoanal reser­voir, this is a two-step pro­ce­dure. A tem­po­rary ileostomy is fol­lowed by a sec­ond surgery where the end of the small bowel is used to cre­ate a reservoir—the “J-Pouch”—and then con­nected to the anus. This surgery per­mits con­trol of waste elim­i­na­tion and pre­vents the need for a per­ma­nent ileostomy.

Ostomy Sup­port

The United Ostomy Asso­ci­a­tions of Amer­ica, Inc. (www.uoaa.org) and the United Ostomy Ass of Canada (http://www.ostomycanada.ca/) pro­vides infor­ma­tion, sup­port and advo­cacy for peo­ple who require Ostomy surgery. They also host dis­cus­sion boards where osto­m­ates can find oth­ers for advice, encour­age­ment, and cama­raderie. Visit their web­site for guide­books and brochures cov­er­ing colostomy, ileostomy, Urostomy, j-pouches, and more.