An Overview Of Ileostomy

An ileostomy refers to a surgically created bowel diversion that connects to an opening in the abdomen or an internal pouch inside the abdomen.

During the surgical procedure, the surgeon disconnects the ileum from the colon and pulls it out through a cut in the abdomen to create a stoma. It necessitates the patient to wear an ostomy bag over the stoma to manage stool evacuations after surgery.

The surgeon may alternatively choose to create an internal pouch using tissues from the large and small intestines. With this internal reservoir, the patient doesn’t need to wear an ostomy bag.

When does an ileostomy become crucial?

Damage or loss of function in the colon due to an underlying health condition or injury is the reason you may need an ileostomy. This bowel diversion may also be a part of the bowel cancer treatment, in which the removal of the entire or some of the colon becomes necessary.

Conditions that may prompt your doctor to choose to give you an ileostomy may include the following.

• Ulcerative colitis
• Crohn’s disease
• Bowel cancer

People whose digestive conditions are treatable through ileostomy surgery are generally aged between 15 and 30 years. Patients who receive an ileostomy as a part of the bowel cancer treatment are mostly aged between 60 and 70 years.

Other reasons that may necessitate an ileostomy include the following.

• Bowel obstruction
• An injury to the colon
• Familial adenomatous polyposis

What are the types of ileostomy?

Three main types of ileostomy include the following.

• Loop ileostomy
• End ileostomy
• Continent ileostomy

A loop ileostomy is when the surgeon pulls a loop of the small intestine out through a cut in the belly. This procedure is generally a part of the treatment that involves the removal of the rectum. Alternatively, a loop ileostomy may be aimed at resting the diseased section of the bowel until it recovers from an underlying condition. A loop ileostomy may also help treat bowel cancer.

The procedure involved in the creation of an end ileostomy generally aims at aiding the treatment that involves the removal of the colon and rectum. The surgeon, during the procedure, disconnected the ileum from the colon and pulls it out through a cut in the belly. An end ileostomy is generally permanent. With this ileostomy, you are going to have to wear an ostomy bag over your stoma the entire time. You may also ask your surgeon to give you a j-pouch, also known as the ileoanal reservoir. This reservoir connects with the anal canal, enabling you to pass out stools through your anus.

The third kind of ileostomy is the continent one, which involves the creation of an internal reservoir that connects with an opening in the belly. This internal reservoir consists of tissues from the small and large intestine, and it connects to an opening in the abdomen by means of a valve made of living tissues from the ileum. The significant benefit of having a continent ileostomy is that it gives the patient control over when to evacuate stools.

What kind of ileostomy you need depends on the condition of your bowel. You may discuss it with your doctor.

The Complications Of Colostomy

Colostomy is a technique for an opening in the abdomen and it could cause about 40% of complications due to the technique.

Edema:
All the stomata are edematized right away after the intervention because of the bowel manipulation. However, the edema will diminish gradually during the next weeks as well as the size will be built in six weeks. It is crucial to observe the progress, and the size should be regularly measured so that the edge opening is correctly cut.

Necrosis and Ischemia:
It generally manifests in the first 24 hours after the operating period, and might even appear during the operating before the end of intervention. The mucosa on the stoma could change color from the reddish to grayish blackish. The ischemia could be superficial to the mucosa or extending into the peritoneal cavity, and it will determine the following action.

Mucocutaneous Separation:

Mucocutaneous separation occurs if there is a splitting of the suture line, which affixes the stoma on the surface of the abdomen as well as leaves the cavity in the wound. Mucocutaneous separation could be treated by using stoma pastes as well as an adhesive washer.

Stenosis:
Stenosis happens when the stoma opening becomes narrow, and it occurred probably because of the establishment of the non-elastic tissue after the retraction, necrosis and mucocutaneous separation. Stenosis is typically characterized by abdominal pain as well as the difficulty in expelling stool. In general, the treatment for stenosis includes instructing the patients to keep the stools soft through diet and using faecal softening drugs like lactulose, and also introducing a dilator to the stoma lumen in order to keep it permeable. The long-term treatment for stenosis might require the patient to have surgical reshaping the stoma.

Infection:

Infection is among the most frequent complications of Colostomy. It has clinical pain in the stomal area with the signs of inflammation. Infection could occur more frequently with the interventions performed urgently because of the lack of colon preparation.

Retraction:
Retraction is called, due to sinking of the stoma down below the level of skin. It is often caused by the excessive bowel tension, generally because of the lack of mobilization, while also in many occasions the patient’s gaining weight could favor it the same as postoperative ileus, hyperpressure abdominal pain, and peristomal septic complications. When the degree of retraction gets important, it could also have stenosis with an ostomotic mouth, which could cause difficulty to pass stools that require a surgical reconstruction.

Evisceration:
Evisceration is a complication that has a low incidence. If the hole in the abdominal wall is too big related to the diameter of stoma, either because of an internal abdominal hyperpressure, or because the wall of abdomen is hypoplastic, one of those bowel loops could come out of the hole.

Prolapse:
Prolapse is the over-exteriorization of the colon because of the puffiness resulting from the increase of the intra-abdominal pressure or from the incorrect fixation of colon. The size could vary and reach up to 15-20 millimeters. It could occur suddenly, but in most of the cases, it appears progressively. The factors that could increase the chance for a prolapse include age, the existence of disease before the ostomy, the bowel movements, and all conditions that could increase the intra-abdominal pressure such as cough.

 

Ostomy and Convexity

Ostomy bags with convexity refers to the outward faceplate of skin for maximum seal. The convexity is defined as an upward bell shape into the skin. 

Why Convexity in Ostomy appliances?
Uneven seals, weirds shapes, and even leaks are somewhat common in the peristomal skin of ostomy appliances. A convexity introduced into the skin adds a stronger seal. The resulting outward curve means the ostomy bag is pressed firmly into the peristomal skin for the best seal possible.

Convex ostomy bags do not have a clear or single inventor. Rather, the convex shape is more so a trend in the ostomy industry. In the late 1980s and early 1990's, manfuactorers began to expriment with additional seals, adhesives, rings, and shapes for those with irregular body shapes or poorly contrsucted stomas. During this time, several manufacturers began to release products with convex skin barriers capable of use for 1 and 2 piece systems.

What is a convex pouching system? 

Flat pouching systems lay flat on the stomach around a stoma. Comparatively, the convex punching system differs in that it faces outward towards the skin. This is accomplished by the use of skin barriers, faceplate, ring(s), or some combination thereof. This means the stoma sticks out better and empties more efficiently into the punching system.

You may still be wondering what exactly this convex shapes means in terms of advantages. It means urine and leakages happen less often. It also means you can feel more secure, and your skin is irritated less often.

Convex products should also be used in some specific scenarios and may not be for everyone. For instance, if you have common leaks, then you should consider getting a consultation for a convex-shaped system. A convex shape can also be used to increase wear time due to the increased comfort and conforming style of the convex shape.

Different types of convex systems.

• There are several different types of convex system which vary according to material, method of sizing, and method of producing the convex shape.
• First up, there are "fit-to-convex" systems that allow for cutting the barrier to the specific fit of the stoma. This is especially helpful if your stoma is not round. This method also is used for one or two pouch systems. 
• Secondly, there is the pre-cut convex system that uses a precut shape and style. These often come in many different options for all sorts of stoma shapes and needs. The advantage here is that the barrier is already designed for you and reduces the needed time and energy to find a perfect fit. The disadvantage then is, of course, this style may not be an ideal fit like you can achieve with the "fit-to-voices" system. 
• Finally, a convex insert is a series of pre-cut rings for use in a two pouch system. These rings can be useful for people who want a system with increased support and rigidity. Otherwise, there are also ostomy belts and girders that provide additional support around the barrier as well.

 

Why use an Ostomy Skin Barrier for Peristomal Skin Irritation Prevention?

Peristomal skin is a very sensitive part that most patients get much concerned about. High levels of cleanliness should be observed lest residues of urine and stool get stuck, thus causing some skin irritation and contamination, which increases the perils of getting stoma complications and infections. 

Ostomy skin barriers are very effective in reducing the incidences of infections and contaminations. Research shows that many of the complications linked to stoma are caused by leakages making the discharge getting into contact with the skin. That is the reason why the ostomy skin barrier is highly recommended to attach the ostomy pouch.

Patients who get skin complications around the stoma tend to experience suboptimal-barrier adhesion, constant leakage, and extended peristomal skin destruction. Hence, it is critical to maintain a healthy peristomal-skin to seal the area between the peristomal and the barrier. Similarly, a well-sealed region ensures no leakages take place, and the peristomal skin is healthy.

How Does Ostomy Skin Barriers Aid in Skin irritation prevention?
When using an ostomy skin barrier, a seal gets formed around the stoma. Upon the attachment of the pouch, any effluents from the body system are prevented from getting into contact with your skin. The skin barrier can be separated from the pouch to form a two-part system or can be conjoined with the pouch to create a one-piece system ostomy bag.

Why should you opt for Ostomy Skin Barrier?

• Aids in ensures that discharge odors do not leak
• No friction gets caused around the stoma region of the skin.
• Its adhesiveness does not get interfered with by the body moisture or any wetness. This feature is essential for those patients who have a high perspiration rate.
• It ensures protection of the peristomal skin from any contamination as a result of stool or urine.
• The effectiveness of the system does not get interfered with upon the distorted shape of the stoma. The original size of the stoma continues getting smaller upon the diminishing of the post-surgery swelling. Therefore the patients should do the necessary resizing. 
• It causes no injury to the skin when removing because it has a painless peel off.
  
  
  

The ostomy skin barrier has a custom cutting. Hence, it offers precise sizing to fit properly to reduce the amount of time spent on changing the gadget. To last long and have an extended wear time, minimized skin irritation and leakages result from a fitting device. Additionally, it also means that you visit your physician less often. However, custom cutting is not suitable for a fresh stoma after surgery; instead, it should last for at least eight weeks after the stoma stabilizes and shrunk to act helpful.

What are the available common types of Skin Barriers possible?
The type of skin barrier that a patient opts for is dependent on stoma contour and personal preferences. The following are the commonly used skin barriers.

• Skin barriers that are flexible to adapt well to skin curves and folds.
• Moldable wafers that get manipulated to fit well with body contours of the patient.
• Inward skin protruding barriers with a convex shape to fit retracted and flat stomas.
• Pre-cut barriers: They are standard for patients with well marked-stoma
• Cut-to-fit barriers: They are designed for patients with irregular shape stomas or those whose stoma-size is reducing in size.