When should someone have a colostomy?

The artificial anus for colon cancer patients

 

Information on the author and / or the specialist advisor can be found at the end of the article.

Stomas help colon cancer patients

For many patients, living with colon cancer also means living with an artificial anus. It is estimated that around 150,000 people in Germany have an ostomy. What initially poses a great challenge can nowadays be integrated very well into everyday life thanks to modern aids (ostomy supplies) and with the help of routine and tips - especially from those affected. Many of the fears of ostomy patients turn out to be unfounded. We want to take a closer look at our main topic, take away fears and provide practical help.

What is an artificial anus?

The creation of an artificial anus, also known as a stoma or anus praeter, often affects people with colon and especially rectal cancer. Around 70 percent of all ostomate wearers have cancer, and around every tenth patient with rectal cancer is affected. But an artificial anus can also be necessary for other intestinal diseases such as severe inflammation of the intestinal mucosa.

The word "stoma" comes from the Greek and means mouth, mouth or opening. It not only designates an artificial anus (large intestine exit = colostoma, small intestine exit = ileostoma), but also other artificial exits, such as those of the bladder (urostoma) or the windpipe (tracheostoma) - therefore the name of the affected organ is placed in front of the medically correct designation , even if only the short form “stoma” is often used in everyday life. The word “anus praeter”, on the other hand, leaves no doubt: “Anus” is Latin and describes the lower opening of the intestine, the anus. "Anus praeter" is the artificial anus.

When and why is a stoma necessary?

In the case of advanced or deep-seated tumors in the rectum, the sphincter muscle at the lower end of the colon may also have to be removed in order to destroy all cancer cells. Without a functioning sphincter muscle, the stool can no longer be held back - it would therefore constantly flow out of the intestine. To avoid this, the anus is closed and the intestine is drained through a surgically created small opening in the abdominal wall, usually in the lower left area. The exit point is provided with an odor-proof collection bag in which the stool collects and which - similar to a plaster - adheres securely to the skin around the stoma. In many cases, an ostomate can use Thickintestinal stoma (Colostoma) also use irrigation: with an enema with water over the stoma - usually every 24 or 48 hours - the intestine is stimulated to rapidly empty the intestinal contents. Since the intestine is then empty, there is usually no need for a bag for one or two days. The stoma can be covered with a small, flat "stoma cap" (similar to a plaster).

A stoma doesn't have to be permanent

There are various reasons for creating an artificial anus. Therefore it does not have to be final in every case. For example, when removing parts of the rectum and a suture connection in the rectum, it is common today to protect this suture by temporarily creating an anus praeter (also known as a transient or temporary stoma). In most cases this is an exit from the small intestine (ileostomy). When the healing of the intestinal suture is complete (after about 6 weeks), this anus praeter can be moved back under the abdominal wall in a small operation. The bowel evacuation then takes place naturally again. However, problems with or during defecation over a shorter or longer period are not uncommon. That is why timely measures to promote continence - even before relocation - are important for the later quality of life.

Another possibility of an only temporary artificial anus is in emergency operations, due to a ruptured bowel or an inflammatory bowel disease. This can lead to peritonitis, so that a direct reunification of the intestinal ends with the risk of a seam leak with serious consequences. Here, a temporary artificial anus is used to give the inflamed area enough time to heal. The connection of the two ends of the intestine with a suture ("reconnection operation") can be carried out in a further operation. Afterwards, the bowels are emptied naturally again.

After the operation

After the stoma has been surgically applied, it will be checked daily during the first postoperative days. As a rule, this is done by a specially trained nurse (stomatotherapist) in addition to the doctor. The amount and type of excretion are carefully observed, and the position of riders and pins used during the operation, the blood flow to the stoma and the condition of the skin around the stoma are documented. The patient has the opportunity to ask questions and familiarize himself with the new situation. This phase also checks how the patient reacts to the chosen ostomy system. A product change can be made if necessary.

Practical tips for use

As soon as the postoperative phase is over, patients should learn how to care for the stoma in the practice as early as possible. After all, this care has to be carried out daily from now on. The ostomy supply is individually adapted in the clinic. Here it is also clarified whether a one-piece or a two-piece supply is the right one (one-piece: adhesive surface and bag are firmly connected to one another; two-piece: adhesive surface - also known as a base plate - and bags are separated and are connected to one another by a locking ring system or adhesive surfaces) In certified colon cancer centers, a stomatotherapist is always on hand to provide instructions for self-care. If there is an increased need for care, it is advisable that relatives or caring staff are instructed and adjusted to the individual situation.

How often a complete ostomy appliance is changed cannot generally be said. That depends on the supply system itself and on individual conditions (e.g. the nature of the skin). The best time to change an ostomy is before breakfast. During this period, the body produces fewer excretions, which makes the switch easier. All materials that are required should be placed ready to hand and ready for use beforehand. Depending on whether it is a one-part or two-part supply, in addition to the bags or the base plate plus bag, these also include compresses, disposal bags, possibly scissors to cut the hole opening in the adhesive surface as well as skin protection paste, skin protection rings and modeling strips for additional sealing and supply.

Once everything has been prepared, the old restoration is carefully removed from top to bottom. The peeling should not be violent so that the very sensitive skin around the stoma is not additionally stressed. The detached adhesive surface of the old ostomy should be examined to see what could be improved. A heavily softened or stool-soiled protective skin surface could, for example, indicate that the supply has been left on the skin for too long and should be changed earlier the next time. The stoma and skin are then cleaned with water (if necessary with pH-neutral soap), whereby the stoma itself should only be dabbed so that the sensitive mucous membrane does not bleed. Compresses or other suitable soft and non-linting material are suitable for this. Then everything is carefully patted dry.

The skin around an intestinal stoma is cleaned in a circular manner from the outside in. Hair on the abdominal skin in the area of ​​the adhesive surface of the ostomy supply must be carefully removed with a disposable razor on a regular basis. The stoma itself can be covered with a compress to avoid injury. If the skin is cared for and dry, a new ostomy can be attached from the bottom up. In this way, the skin protection surface can be attached exactly to the lower edge of the stoma. The skin is tightened by hand in order to obtain a smooth attachment surface.

Who helps?

Even before the operation, the doctor will explain in detail the reason for creating an anus praeter and how to deal with it. Nevertheless, many questions do not arise until after the operation and can and should then be discussed and clarified.

There are so-called stomatotherapists so that those affected receive the right support and advice. They are specially trained to help patients with an ostomy. Stoma therapists are usually nurses with additional training. Further care at home to learn how to be self-sufficient is also possible. The best way to discuss any additional support you need at home is with your doctor.

The tools are offered by many different manufacturers. Which supply items are best suited for an ostomy wearer must be decided individually. Product samples provided free of charge can help. Sometimes it can take time and you will try different products from different manufacturers until you have found “your” stoma supply.

Ostomy nutrition

When the body has recovered from the operation and the digestive system has smoothly re-started, a special diet is not required, basically what you can eat is what tastes good. Of course, attention must be paid to the individual tolerability of the food, as is the case with "healthy people". Flatulence can be uncomfortable for ostomate wearers, and accordingly many sufferers tend to be reluctant to eat flatulent foods. But: It's worth trying!

It is important for those affected with an ileostomy (small intestine exit) that they drink enough, as a lot of fluid is excreted with the bowel movement. You should also cut fibrous foods into small pieces first and not eat them in large quantities at once, in order to avoid an ostomy blockage caused by fibers tangled in the small intestine. It should also be chewed very well.

 

Exercise and the stoma

No longer being able to swim or go to the sauna - that's an old wives' tale. There are no hygienic concerns with a securely adhering ostomy. Ostomy bags are waterproof in both directions and can hardly be seen or not at all under cleverly chosen swimwear, especially for women. Men who do not like high-cut swimming shorts sometimes also use so-called swimming and bathing belts, which keep prying eyes away and protect the stoma, especially during more demanding water sports. In the sauna, the ostomy bag can be covered with a towel. Water, heat and movement cannot harm modern supply systems!

After consulting your doctor, nothing stands in the way of active leisure activities. Doctors usually advise against doing sports that use abdominal muscles to reduce the risk of an ostomy rupture. For some sports, aids such as belts can be useful, which secure the bag even when you move around.

Since sport and exercise increase physical well-being, patients with an ostomy should not do without it.

Sexuality and Family Planning

An artificial anus is not an obstacle to intimacy and sexuality. Pregnancy is also not a fundamental problem for women with an ostomy.

However, many ostomates report sexual disorders. These can have physical causes, such as pain or surgical scars. If the nerves that are important for an erection could not be spared during the operation of a man, it is possible that impotence is a consequence. Your doctor will also know what can be done and what aids are available.

On the other hand, there may be psychological causes, such as depressive moods or the feeling of being physically disfigured and unattractive. Casual intimacy always has something to do with self-esteem. Therefore, a stoma can affect it too. However, it does not have to be the end of a fulfilling sex life. Sufferers should try to talk openly about it with their partner.

From a purely physical point of view, the same applies to sports: the abdominal muscles should not be overexerted, belts, mini bags or ostomy caps can be a solution if you have concerns about the ostomy bag.

Contact with other affected persons

If you get involved in the new situation, you quickly become a true expert on your own subject. For the well-informed patient, a stoma usually means hardly any restrictions in everyday life.

Anyone who feels the need to get together with people who are similar can get in touch with the Deutsche ILCO e.V. (ILCO is made up of the first letters for ileum = small intestine and colon = large intestine). The independent self-help organization of ostomies (with colostomy, ileostomy or urostomy - regardless of the underlying disease), colon cancer sufferers (with or without stoma) and their relatives is the point of contact for those affected and interested. In addition to almost 300 self-help groups throughout Germany, the ILCO also offers free information material and a lobby group. Members also receive the ILCO-PRAXIS membership magazine every three months with extensive information and reports from those affected. There are also separate meetings and a closed Facebook group for young ostomists.

Link tips:

www.ilco.de
Website of the Deutsche ILCO e.V., a self-help organization by and for ostomists, people with colon cancer and relatives. The site offers, for example, information on stoma and colon cancer, experience reports, news, recommendations for literature, the option to order free brochures, addresses of advice centers and rehabilitation clinics and links to other organizations.

www.ilco.de/forum
Internet forum of the German ILCO for the exchange of experiences between ostomists, colon cancer sufferers and relatives.

https://www.facebook.com/DeutscheILCO.de/
Information page of the German ILCO on Facebook

www.stomawelt.de
Website of an ostomy wearer with lots of practical information and a forum for exchange for those affected and interested. The list of links contains, among other things, 13 manufacturer addresses where you can get information about ostomy products.

www.kaengurufreunde.de
The forum community for ostomists with an artificial urostomy (urostomy), tracheotomy (tracheostomy), with hereditary or non-hereditary colon cancer or chronic inflammatory bowel disease, as well as for relatives and everyone who is interested in the topic of stoma.

(yia / red / jk)

 

Swell:
[1] Guideline Program Oncology (Ed.): S3 Guideline Colorectal Carcinoma, Version 1.0 - June 2013. Available online at: http://leitlinienprogramm-onkologie.de/uploads/tx_sbdownloader/LL_KRK_Langfassung_1.1.pdf

[2] H.-J. Pout. K. Höffken, K. Possinger (Eds.): Compendium Internal Oncology, Springer Verlag 2006

[3] Pietzonka, Veronika: Caring for a stoma properly. Published in: Heilberufe. The care magazine. Springer Medicine 2016, issue 68 (6).

[4] German ILCO e.V. Federal Association

Technical advice: Deutsche ILCO e.V.

Last content update on: 01/26/2018

Further basic information on colon cancer:

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Last accessed on: May 21, 2021 10:57 p.m.