Treatment and Medication

One of the possible outcomes of surgery is an ostomy. An ostomy surgery is performed to create a stoma (opening) from an end of your intestine inside your body to the outside surface of your abdomen. An external bag is attached to the stoma to collect waste. In some cases, an internal pouch can also be attached to your digestive system.

In IBD, an ostomy is a surgically created opening of the bowel (large intestine or small intestine) on the abdomen. This opening can be of different shape and height. 

The ostomy is pink to red, appears shiny because it is an inner lining of the organ, called mucosa, and is insensible to touch because there is no nerve ending on it. Since you cannot feel it, the opening is not expected to cause pain.

The ostomy is also highly vascularized, meaning that it has a lot of blood vessels. Due to this, it could easily bleed when you rub it. You should therefore be careful when you are caring for it as you might not notice that you are bleeding if you are unable to feel it in the first place.

An ostomy on the small intestine is called an ileostomy while that of the large intestine is called a colostomy. 

Ileostomy

Ileostomies are usually located at the right side of the bowel. The stools that come from the ileostomy are liquid to pasty because the water has not been absorbed yet but instead will be reabsorbed in the large intestine. Ileostomies are surgically made to protrude the abdomen so that the liquified stools are not in contact with your skin.

This passage of stool is also fast. People with ileostomies should be mindful that it will not take long after eating to pass stool. It is also important to inform your pharmacists that you have an ileostomy because some medications are coated with products that will be digested in the large intestine. 

Colostomy

Colostomies could be created at different sites of your bowel. It could be made on the ascending colon, transverse colon, or at the end of the colon depending on the disease. 

As such, the consistency of your stools will also depend on the location from which it comes out of. For example, if your colostomy is at the beginning of your colon, your stools will be more liquid. The further we go along the bowel, the pastier or almost-solid they will become. It could therefore be possible that people who have colostomies at the end of their colon could have the same type of fecal elimination as they had before the surgery. 

In contrast to ileostomies, since the stool are more solid in this case, the colostomy is not made to protrude the abdomen by much and therefore the height of the opening will be smaller.

A pelvic pouch is a surgically constructed reservoir made with a part of the small intestine after the resection of the large intestine (part or total removal of the colon), in the case of ulcerative colitis. 

Your surgeon will start by removing your colon and then after some time, the end of the small intestine will be used to create a reservoir or pouch. The pouches could be in the shape of the letters J, S, or W depending on your unique case. 

Some surgeons will choose to create a temporary ostomy for a few weeks (e.g. 3 to 5 weeks) before reconnecting all the digestive system to the anus through the pelvic pouch. From there, you would then be able to pass stool like you would usually do before surgery.

Surgeons will create temporary ostomies when:

• There is a need to put part of the bowel to rest.

• In some situations, until the patient’s health condition has improved. 

• The rectum is still in place (e.g. after a trauma, after a pelvic pouch construction) such that it is expected that the digestive system will eventually be able to be connected to the anus. This temporary ostomy could be in place for a few weeks, months, or even years.

• An ileoanal anastomosis (J-pouch surgery) or pelvic pouch needs to be protected. 

Surgeons will opt to create permanent ostomies when:

• There is no possibility to reconnect the bowel.

• The rectum has been removed and then there would no way to reconnect the digestive system to the anus. 

The pouch should be emptied when it is one-third full because it could make you uncomfortable as it would bigger under your clothes and because it would produce a weight that would tear the pouch if you allow more waste to be collected.

However, there is no need to clean inside the pouch because you could interfere with the waterproof coating that is on the pouch, causing the stools to come out when you put it back on. Typically, a person with an ileostomy may empty their pouch 5 to 6 times a day while a person with a colostomy may empty it only once a day. 

The pouching system, found between the skin and the pouch, is usually changed every 5 to 7 days, depending on the type of ostomy. Sometimes with an ileostomy, there are more enzymes (proteins) in the liquified stools and these could affect the skin barrier. 

You should also change the pouching system when there is a leakage of stools or odor. If your skin is itchy or burning, this could mean that there is not enough protection around the ostomy and the system then needs to be changed to prevent leaks. 

Check out our national GoHere™ Washroom Access Program to learn about our locator app to identify the nearest available washroom to you, our access card to easily show proof of medical need, and which businesses offer accessible washrooms to better plan your trips. 

If you need assistance, search our directory for services and programs, like ostomy clinics, supplies and ET nurses, in your community or online and register for our peer support events to share your experience and receive guidance from our mentors.

Replacing the ostomy bag

Your healthcare provider or ET nurse will tell you how often the bag needs to be replaced. You should replace the bag when it is one-third to one-half full, to avoid having difficulties pulling it off. 

Here are a few steps to follow when replacing your ostomy bag:

• Prepare the new bag and barrier using the instructions provided with the bag.

• Remove the bag you are currently wearing. Gently peel away the barrier and lift the bag while pressing down on your skin below it. Try not to irritate your skin. If the bag is sticking to your skin, use an adhesive remover. Drain or dispose of the bag.

• For a drainable bag, you can open one end and empty it. For a closed bag, you would simply dispose of it and replace with a new one. Putting the pouch in a Ziplock bag will help reduce odour. 

• Clean your skin and stoma with a wet face cloth or wipe, or clean it in the shower. If you use soap, rinse well. 

• Let your skin dry and look for irritation. If your skin is irritated, be extra gentle. You can try sprinkling ostomy protective powder on the skin, then blot it off.

• Measure the size of your stoma if your doctor has requested this.

• Put the new bag on following the manufacturer’s instructions. Position the opening in the barrier around the stoma. Apply the sticky side to your skin and press it down.

• If you develop severe abdominal cramping, little or no waste in the bag, or if your stoma becomes pale, dusky or blue, or swells or bleeds, call your doctor.

Irrigating a colostomy

Irrigation is a procedure where you stimulate and flush your intestines at a regular time each day. This helps control when you pass stool.

This should be done under the supervision of your health care team or ET nurse, who will provide you with detailed instructions.

Watch this video from our Gutsy Learning Series webinar to learn more about what are ostomies and pelvic pouches, how to prepare for an ostomy surgery, different ostomy products and how to care for them, including managing odor and leaks and going about your daily activities, from an enterostomal therapy (ET) nurse.

For more helpful tips and advice about living with an ostomy and support, please visit Ostomy Canada. Crohn's and Colitis Canada is not affiliated with Ostomy Canada. These resources should not be used a replacement to seeking advice from your healthcare providers.