With a number of intestinal diseases, passage of stools and their outward release by a natural way is impossible. Then the doctors resort to colostomy.
Colostomy - what is it and how to live with it?
Colostomy is a kind of artificial anus that doctors make in the abdominal wall. A hole is made on the peritoneum, and the end of the intestine is sewn into it( usually thick).Fecal masses, passing through the intestine, reach the opening and enter the bag attached to it.
Photo of Colostomy of the rectum
If the lower intestinal tract can not be restored, then a constant colostomy is performed. Healthy people can easily control the processes of intestinal emptying. This is ensured by the smooth operation of sphincters.
In patients with colostomy, the feces come out through an artificially formed anal anus in the form of semi-shaped or formed masses, without interfering with intestinal activity.
Indications for colostomy
Colostomy may be temporary or permanent. Children often spend a temporary stoma.
In general, indications for colostomy are as follows:
- Incontinence of anorectal type;
- Corking of the intestinal lumen with tumor formation;
- Traumatic damages of colonic walls like gunshot or mechanical wounds;
- Severe cases of colonic pathologies such as diverticulitis or ischemic colitis, cancer or peritonitis, polyposis and ulcerative colitis, abscesses of intestinal walls with perforation, etc.;
- Recurrent cases of cancer in the urodynamic tissues and uterus, cervical canal or rectum;
- The presence of severe forms of postprojective proctitis, especially this occurs after radiotherapy for cervical canal cancer;
- If there are internal fistulas from the rectum to the vagina or bladder;
- As preoperative preparation for the prevention of seam divisions and their suppuration;
- With anomalies of a congenital nature such as Hirschsprung's pathology, meconial obstruction of the newborns or atresia of the anus canal, etc.( if there is no possibility of radical intervention);
- In case of rectosigmoid resection, if the seams are unsuccessful after the operation.
Types of the stoma
According to the localization, the colostomas are classified into several types: transverse, ascending and descending.
- Transverse colostomy.
Transversostom is formed in the upper abdomen, in the transverse colonic region.
To avoid nerve damage, the transverse stoma is located closer to the splenic left bend.
The transverse colostomy is shown with intestinal obstruction or oncopathologies, traumatic injuries and diverticulitis, congenital colonic abnormalities.
These colostomas are usually set temporarily for the duration of treatment. On a permanent basis, transverse stoma is needed when removing the lower intestinal region.
Stomas of the transverse type are divided into two types: single-barreled and double-barreled.
- The single-aisle or the terminal stoma is a longitudinal incision of the large intestine, therefore only one opening is removed to the surface. This technique is usually performed forever and is used for radical ectomy of the descending colonic department.
- Double-barreled colostomy involves the removal of the intestinal loop with a transverse incision on it in such a way that 2 holes of the intestine are removed on the peritoneum. After one stroke, excreta is excreted, and through the other, medications are usually administered.
The lower part of the intestine can continue to produce mucus that will exit through the resulting hole or anus, which is the norm option. Such transversostomy is usually done for a certain time.
- Ascending colostomy or ascendant.
Similar stoma is located on the ascending colonic segment, so on the peritoneum it is localized on the right side. This site is located in the early intestinal part, therefore, the excreted contents will be an alkaline, liquid and rich residual digestive enzymes.
Therefore, the kalospriemnik need to be cleaned as often as possible, and the patient should drink more to avoid dehydration, since thirst is characteristic for an ascendant. Ascending colostomy is usually a temporary therapeutic measure.
- Descending and sigmoid method of colostomy( descendostoma and sigmistoma).
These varieties are stabbed on the left side of the peritoneum in its lower part, actually at the end of the colon. Therefore, masses emerge from it in terms of their physicochemical properties similar to ordinary feces.
A distinctive feature of such a colost is the patient's ability to regulate defecation processes. This is due to the fact that in these parts of the intestine there are nerve endings, which make it possible to control the process of stool output. Such localization by the colost allows them to be installed for a long time and even for a fixed period.
Advantages and disadvantages of
The procedure is often of vital importance, providing the patient with a normal life after a radical surgery intervention for sigmoid or rectal cancer.
This fact is the main undeniable advantage of the artificially created anus.
In addition, modern bandages, kalopriememniki and other devices allow you to live comfortably even with constant colostomy.
There are certainly drawbacks to the methodology. Perhaps the main one is the psychological factor, which often causes a deep depression of the patient. But even with this, doctors have learned to fight - they conduct explanatory work with patients, talk about proper care for stoma, clarify important nuances, talk about sensations, etc.
For many, the smell may seem another drawback. But the problem is completely solved, because modern kalopriemniki equipped with magnetic caps, filters against odor, there are specialized deodorants on sale. Therefore, today such accessories can solve the problem of skin irritation and frequent replacement of the kalospriemnika.
Types of the
intake hoods The hoods are one- and two-component. Two-component ones are equipped with ostrich bags and a self-adhesive plate, which are connected by a special flange. But such kalopriemniki inconvenient in that they can provoke irritation of the skin. Therefore, during their operation, the plate can be replaced every 2-4 days, and the sac can be replaced daily.
If there is a feeling of itching and discomfort, it is recommended to immediately unfasten the plate. Undoubted advantage is the equipment of a kalospriemnika special filter, eliminating gases and smells.
The drainage bag must be emptied when it is filled by 1/3, for this purpose slightly bend over the toilet and open the drainage hole, after which the stool bag is washed and dried. Before reusing the bag, check the drainage hole so that it is closed.
How to take care of an ostomy at home?
Colostomy requires very careful care, which begins on the first day after surgery. First, the patient is trained by a nurse who changes the kalopriemniki and rinses the stoma. In the future, the patient already independently changes the stool bags and processes the orifice of the stoma.
The whole process runs in several algorithms:
- First eliminate feces;
- Then, with the boiled hot water, rinse out the outlet, thoroughly wash the skin around it, then dry it with gauze napkins;
- Treat the skin surface with Lassar paste or Stomaghesive ointment, then gauze impregnated with petroleum jelly is applied around the stoma, and the top is covered with a sterile bandage and cotton wool. On top, the treatment site is closed with a gauze dressing, which is changed every 4 hours.
- When the stoma heals and finally forms, you can use the kalopriemnikami. The final formation and healing is not indicated by the mouth protruding above the skin and the absence of an inflammatory infiltrate. Only with such a clinical picture is it possible to use a calico.
- The change of fecal sacs is recommended in the evenings or in the morning. First, carefully remove the used feces receiver, then remove the stool remnants and wash the stoma. Then, treat the mouth and skin around the ointment or paste, and then fix the calorimeter again.
Usually, for pasting the receiver, a paste of Koloplast containing a small amount of alcohol is used. The product does not cause irritation even to damaged injuries and inflammation of the skin, and also improves fixation of the device.
Some patients prior to gluing the absorber handle the skin with a special protective film, which protects the skin from inflammations and irritations.
Food
There is no special specialized diet for colostomized patients, therefore the patient is not expected to make any significant changes in the diet after the surgery.
With colostomy, the only thing to consider is the effect of each product on the digestive process.
- Products that promote gas production, which include eggs and beer, carbonated drinks and cabbage, mushrooms and legumes, onions and chocolate, for obvious reasons, it is recommended to limit.
- A noticeable increase in the smell of intestinal gas products such as garlic and eggs, spices and fish, onions and cheese.
- Salad and yoghurt, cranberries and spinach, parsley, etc., have the opposite effect.
The right combination of products avoids many unpleasant situations. In addition, it is recommended with special thoroughness to chew food, eat more often and slightly.
You can lightly press the stoma to prevent unwanted gas leakage. Colostomized patients should also monitor the consumption of laxative and fixing products to avoid such trouble as diarrhea or constipation.
Types of operations
The location of the colostomy is determined by the doctor, taking into account the specific clinical picture of each patient.
To significantly complicate the installation of an ostomy on the intestine, there may be scarring or scars, since it is necessary to take into account the condition of the fatty tissue and the muscle layer, which, with the formation of folds, can eventually displace the colostomy.
Patients may need an operation to superimpose or close the colostomy, as well as the surgeon's intervention with a reconstructive and restorative purpose. Each of the interventions has its own individual characteristics, requiring a different approach to the patient.
Overlay of
The colostomy procedure is performed under general anesthesia under sterile operating conditions.
- First, the surgeon cuts the rounded portion of the subcutaneous tissue and skin at the site of the supposed location of the ostium's mouth.
- In the second stage of the operation, the muscles are divided in the direction of the fibers. To avoid compression on the gut, the hole is made large enough. In addition, the probability of the patient gaining excess weight in advance if the ostomy is superimposed on a long term is taken into account in advance.
- The intestine is then looped outward and a necessary incision is made on it.
- The gut is sewn to the muscle tissue of the peritoneum, and its edges are attached to the skin.
Unfortunately, it has not yet been possible to devise drainage facilities in the stomatal cavity, since the immune system includes protective functions and actively resists foreign materials, provoking dystrophy and inflammation of tissues.
Only surgical suturing of the intestinal margin to the skin favorably heals, although it would be much easier to use special tubes that emanate from the lumen of the gut and are exposed to the outside.
Closure of
The operation to close the stoma on the intestine is called bell colostomy.
Temporary colostomy is usually closed after 2-6 months after application. This operation is the elimination of an artificially created anal opening.
Obligatory condition for the closure of the operation - the absence of obstructions in the lower intestine to the anus.
Approximately a centimeter from the edge of the stoma, the surgeon cuts the tissues, slowly disconnecting the adhesive elements. Then the bowel is taken out and the edge with the hole is excised. Then sew both ends of the intestine and return it back to the peritoneum. Then, with the help of contrasting, the joint is tested for tightness, after which the wound is sewn layer by layer.
Reconstructive surgery
Usually, such interventions are assigned to patients with temporary colostomas applied for the time of treatment of the underlying areas of the gut. Many patients believe that after a dental closure the intestinal functions are completely restored, which is not entirely true.
Dasha, with the full success of reconstructive surgery, the lack of a certain area in the intestine can not but affect its further functionality.
The best time to close the stroma is the first 3-12 months after surgery. This is the only way to count on the successful healing of intestinal tissues without consequences for the body. In fact, the reconstructive-reconstructive operation is the closure of the stoma or bell-colostomy, the description of which is presented above.
Diet after operations of
After a recovery operation or closing of the stoma, a strict diet should be followed, so that the digestive processes can be quickly restored.
Dietary diet is reduced to the exclusion of products like:
- Burning seasonings or spices like curry, chili peppers, etc.;
- Excessive number of soda, kvass or beer;
- Gas-forming products such as kidney beans, garlic or cabbage, etc.;
- Fatty foods;
- Foods provoking irritation of intestinal tissues, such as currants or raspberries, grapes or citrus.
If necessary, the physician prescribes individual restrictive prescriptions in the patient's diet.
Complications of
Colostomy is a serious surgical procedure that can cause many complications.
- Specific selection. This mucus is produced by the intestinal tissues as a lubricant to facilitate the passage of stool. Normally, the consistency of the secretions can be a sticky or sticky egg-like egg. If there are purulent or bloody impurities in the mucus, this may indicate the development of an infectious process or damage to intestinal tissues.
- Blockage of the estuar orifice. Usually, this phenomenon is the result of sticking up food particles and is accompanied by watery stools, swelling of the stoma, flatulence or nausea and vomiting symptoms. If there are suspicions of the development of such a complication, it is recommended to exclude hard food, periodically massage the abdominal area near the mouth of the stoma, increase the amount of fluid consumed, take hot baths more often, which helps relax the abdominal muscles.
- Paralytic hernia. A similar complication involves bulging the intestines through the peritoneum muscles, and near the mouth of the stoma there is a pronounced subcutaneous bulge. Avoid the hernia will help special support bandages, weight control and refusal to lift and dragging weights. Usually hernias are eliminated by conservative methods, but sometimes you can not do without surgical intervention. Unfortunately, there is always the possibility of re-forming the hernial process.
You can avoid such troubles, most importantly, strictly follow the doctor's recommendations, especially dietary intake and hygienic requirements for the maintenance of the colostomy.
Video tells how to care for a colostomy: