A comprehensive guide to the different types of ostomies, including colostomies, ileostomies, and urostomies.
Do you know your ostomy types? There are three kinds of bowel or bladder ostomies, and with this handy guide, you can brush up on each one – including the multiple sub-types. But first, let’s cover the basics.
Ostomy surgery is a surgical operation that redirects body wastes through a new outside opening, called a stoma. The stoma is a new exit point created to divert feces or urine. In some cases, multiple stomas are created to divert both. The term “ostomy” is used interchangeably by patients to refer to their medical condition, their stoma, and/or the appliance used to collect waste.
Intestinal ostomies are most often performed in conjunction with: tumor removal; to permit repair of bowel injuries; congenital defects; or as a last resort, treatment in medically unmanageable cases of inflammatory bowel diseases. Indications for urinary diversion include: tumor removal; congenital or nerve defects; or injuries that take away voluntary bladder control.
Types of Ostomies
There are three types of bowel or bladder ostomies, along with multiple sub-types:
Colostomy – a stoma is formed from the large intestine (various types below):
- Transverse: Loop and Double Barrel
Ileostomy – a stoma is formed from the small intestine:
Urostomy – a stoma is formed from the urinary tract (also called ureterostomy):
- Ileal Conduit
A colostomy is constructed from the large intestine (colon). Any inactive parts of the large intestine are left to heal or fully removed. The large intestine is nearest to the finish line of the digestive system, so output is more fully formed than it is with an ileostomy.
Because digestion occurs throughout the colon – and the majority of nutrition is absorbed through the small intestine – a colostomate may be able to live relatively comfortably without their large intestine. This may include fewer dietary restrictions or changes, and a measure of control over the timing of bowel movements.
The higher in the intestinal tract the stoma is made, the less time the body has to process digested materials. Below is the list of different colostomies, from highest (closest to the small intestine) to the lowest (closest to the rectum.)
An ascending colostomy is created in the ascending colon. This type of colostomy is close to the small intestine (ileum). Not much large intestine is left to absorb nutrients or store waste in the body, and waste discharges somewhat continuously. The output is concentrated with digestive juices that are very irritating to the skin.
A transverse colostomy is created in the transverse colon. The stoma is normally formed in the upper abdomen, either in the middle or a little to the right side of the body. The output from a transverse colostomy may vary, depending on how far away from the small intestine the opening is made.
To create this type of colostomy, a loop of the transverse colon is lifted through the abdomen. The colon is given a small split on the side facing out, and a rod placed underneath for support (the rod may be removed after a few days, when support is no longer needed). Although this may appear to be one large stoma, it is actually two: one opening for the normal discharge of waste, and the other (disconnected portion) for the drainage of mucous as the intestine heals.
This colostomy is similar to loop colostomy, except there is no connection between the two ends of intestine. In this type of procedure, a loop of transverse colon is lifted through the abdomen and separated completely. Two different openings (barrels) are created which may or may not be separated by skin.
Descending Colostomy and Sigmoid Colostomy
A descending colostomy is located in the descending colon (further from the small intestine). A sigmoid colostomy is located in the sigmoid colon, nearly at the end of the digestive tract. Because these colostomies are located so far down the intestinal tract, discharge is likely to be semi-solid to firm and digestive enzyme content is low. As a result, bowel movements can often be regulated through irrigation, and output is less likely to irritate the skin.
An ileostomy is the formation of a stoma from the small intestine (ileum). Ileostomy surgery may be necessary when the entire large intestine (colon) needs to be removed, placing the stoma higher up in the digestive tract. The discharge from an ileostomy is continuous due to the shortened intestinal tract. Stool is very soft, wet and less digested, due to its proximity to the stomach. Output from an ileostomy contains high levels of rich digestive enzymes which can seriously damage the skin. The stomas are generally small in size (one inch in diameter) since they are constructed with the small intestine.
In an end ileostomy – also called a standard diverting ileostomy – the end of the ileum is brought out through the abdomen and forms the stoma. In these cases, the colon and rectum may be partially or completely removed.
In a loop ileostomy, a loop of the small intestine is lifted through the abdomen to form the stoma. In loop ileostomies, the colon and rectum are not necessarily removed and may be left in the body to heal, allowing possible future reattachment.
A urostomy diverts urine away from the bladder. This may be needed because the bladder has been removed, or if the bladder is not functioning due to: bladder cancer; spinal cord injury; bladder malfunctions; or congenital birth complications such as spina bifida.
The most common type of urostomy is an ileal conduit (a “pipeline” created for the urine to flow through), which is constructed from a 6 to 8-inch section of the small intestine. One end of the conduit is connected to both ureters – the thin tubes which release urine from the kidney – and the other end forms the stoma. The conduit has no storage capacity and is not considered a substitute bladder. Because it cannot hold volume, the urine flows almost continually out of the stoma.
A bilateral urostomy does not utilize a conduit, so it does not usually require removal of a piece of the small intestine. Instead, the ureters are brought directly to the surface and used to create two stomas, one on either side of the body. There is no storage capacity with a bilateral urostomy, therefore the urine flows almost continually.
Also known as a Kick or Indiana pouch, in some cases, an internal pouch can be constructed just under the skin from a piece of the small intestine or bowel. It functions to collect waste within the body from the small intestine or ureters, rather than having a constant flow of output. The waste is drained at intervals by pushing a catheter through the stoma into the pouch to drain the waste. Because the output can be contained, this procedure is known as a continent ostomy. There are two types.
In a continent ileostomy procedure, a loop of the small intestine is constructed into a pouch within the abdominal cavity. Waste from the small intestine collects inside the Kock pouch until a convenient time to drain it. A one-way nipple valve is created in the pouch to prevent leakage.
Similar to the continent ileostomy, the internal pouch is constructed from a portion of the small or large bowel. In the continent urostomy, a nipple valve is needed at both ends of the pouch: one to prevent the urine leaking out the stoma, and at the other end to prevent urine flowing back up into the ureters which could cause urinary tract infections.
Do You Know Your Ostomies?
Knowing the different types of ostomies is obviously important – not only for effective wound care, but for positive results in the areas of patient and family education. So we’re curious … were you already familiar with all the ostomy types listed here, and which ones have you treated the most? Have you noticed a difference in the way ostomy patients react and manage their stomas and appliances, and do you have any stories to share on the subject? We’d love your feedback – please leave your thoughts or comments below.
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Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.