Colostomy and ileostomy are the medical interventions that are performed to improve the quality of life of any individual. The basic aim of both surgeries is to divert the route of bodily waste material towards the stoma- an opening created outside the abdomen.

These two procedures are performed for several different reasons. However, both procedures are quite similar and many individuals are concerned about which one is worse and has more complications.

In this article, we will discuss some basic understanding of colostomy and ileostomy, why and how they are performed, and which one is worse. So let’s start!

WHAT IS STOMA AND OSTOMY?

A stoma is a hole that is created to bring the part of an internal organ (small or large intestine) outside the skin or abdomen. The purpose of stoma is to re-route or divert the way of waste product.

Whereas ostomy is a surgical procedure in which a stoma is created to bring bodily waste or fluids outside the body through a stoma. The bodily waste could be urine or feces. Ostomy surgery includes colostomy (part of the colon is brought outside the skin), ileostomy (part of the ileum is brought outside the skin), or urostomy (part of the urinary tract is brought outside the skin)

WHAT IS COLOSTOMY?

A colostomy is a surgical procedure in which a portion of the colon (large intestine) is brought through the abdominal wall to create an opening called a stoma. This procedure is often done when there is a disease, injury, or other medical condition that prevents normal passage of stool through the rectum. The stoma allows feces to bypass the part of the colon where the issue is and exit the body through the abdominal wall into a disposable bag or pouch.

WHY IT IS PERFORMED?

Colostomies are typically performed for various reasons including:

bowel obstruction typically obstruction in the colon which cannot be cleared
inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease
Diverticulitis is the inflammation or infection of small pouches that can form in the walls of colon
Colorectal cancer

IS IT PERMANENT OR TEMPORARY?

Whether colostomy is permanent or temporary it all depends upon the underlying disease condition. Colostomy could be temporary when the main purpose of surgery is to give rest to the colon rectum or anus so that they can properly heal after surgery. For instance, in the case of an anal fistula, a temporary colostomy is performed to give time to the anus to heal properly.

However, permanent or lifetime colostomy is performed when the large part of the colon, rectum, or anus is removed due to any disease condition. Since the large part is removed so there isn’t any possibility of using a normal route for defecation. Therefore, a permanent colostomy is performed. For instance, in the case of colon cancer when a big part of the colon is removed due to cancer cells, a permanent colostomy is performed.

EFFECT ON STOOL:

A colostomy doesn’t produce any prominent effect on the stool. The consistency of stool remains the same as it was before surgery, instead, it will be more formed. How formed the stool is depends upon the location of the colostomy in the colon. If the colostomy is done in the last part of the colon, the stool will be more formed as it has to pass more through the colon. Whereas, the stool will be less formed when a colostomy is performed in the starting part of the colon.

Since a stoma of colostomy lacks any nerve endings, therefore, Individuals with a colostomy won’t have control over when stool exits the body through the stoma. Despite this lack of control, the ostomy bag typically requires fewer emptying sessions throughout the day compared to an ileostomy.

The appearance of a stool after a colostomy can be greatly affected by diet, and it may seem like a person might have a functioning colon. However, if only a small portion of the colon remains, there could be more noticeable variations. In such cases, stool might be less formed and more susceptible to changes in color, consistency, and smell based on dietary factors.

Read here: What is a colostomy bag and how does it work

WHAT IS ILEOSTOMY?

An ileostomy is a surgical procedure in which a portion of the ileum (the lowest part of the small intestine) is brought through the abdominal wall to create an opening called a stoma. This surgical intervention is typically performed when there is a need to divert the flow of stool away from the colon and rectum. The stoma allows waste to exit the body and be collected in an external pouch or bag.

Usually, there are two types of ileostomy

End ileostomy: In this procedure, a portion of the small intestine is separated from the colon and brought outside to create a stoma.

Loop ileostomy: in this procedure, a loop of intestine is pulled through the incision to form a stoma.

WHY IT IS PERFORMED?

An ileostomy is typically performed for various reasons, which include:

Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis
Any surgery to the digestive tract that requires rest.
Colorectal cancer
any injury or trauma to the bowel
or any obstruction in the small intestine that cannot be treated.

IS IT PERMANENT OR TEMPORARY?

Just like colostomy, ileostomy can be permanent or temporary depending upon the underlying disease condition.

Sometimes temporary ileostomy is performed when the main purpose of surgery is to give rest or break to the colon to get recover from any diseased condition. For- instance in case of colon surgery or any inflammation of the colon, a temporary ileostomy is performed. The duration of a temporary ileostomy is from 6 months to 1 year. Once your intestine has healed properly, you will have another surgery called anastomosis in which two ends of the intestine are rejoined together. In this surgery, the stoma will be closed and you will be able to pass the tool from the normal route.

However, permanent ileostomy is performed in conditions when the small intestine or the initial part of the colon is damaged seriously. It is also recommended in colorectal cancer when it has metastasized to surrounding tissues. Permanent ileostomy can’t be reversed which means you will have to live with ileostomy all through your life.

EFFECT ON STOOL:

Chyme (food with enzymes and acid) enters from the stomach to the small intestine for further digestion and absorption. The chyme at this stage is liquid as it has more enzymes, gastric acid, and water content. Water and some nutrients are usually absorbed in the colon. Since in ileostomy, we are bypassing the colon, the stoma output in ileostomy would be more liquid. Apart from this, it will be more acidic than the output of colostomy.

Since the stoma of colostomy lacks any nerve endings, Individuals with an ileostomy won’t have control over when stool exits the body through the stoma. Despite this lack of control, the ostomy bag typically requires several emptying sessions throughout the day compared to colostomy.

So stool consistency in ileostomy would be liquid and frequency would be more. Also, it would be more affected by your diet.

HOW COLOSTOMY & ILEOSTOMY ARE PERFORMED:

To start the procedure first of all general anesthesia is given to the patient. This means that throughout surgery patient will remain unconscious.

The procedure of colostomy and ileostomy can be carried out using any one of the two techniques that are:

Open technique: here surgeon will cut the abdomen to reach the desired part of the intestine.

Laparoscopic technique: in this technique, two or three small cuts are made in the abdomen, through which tools and an endoscope are inserted into the abdomen to perform the surgical procedure.

Usually, surgeons prefer to use an open technique to do colostomy or ileostomy surgery.

After this, the diseased part of the bowel is removed which is called bowel resection. And it depends upon the reason for doing the procedure.

To make an end colostomy or ileostomy, the doctor brings one end of the colon or ileum (the small intestine) to the surface of the belly and stitches it to the skin, creating a stoma. The other end of the colon or ileum is closed up with stitches or staples.

Sometimes a tube called a drain pipe is placed in the abdomen to drain the infectious fluid. if this pipe is not placed, it will be difficult for the wound to heal properly. Also, a special medical device called an ostomy bag is placed around the stoma to collect the stools through the stoma.

WHAT DO YOU EXPECT AFTER SURGERY?

Once the surgery is performed, you will be kept in the recovery room until you become conscious. You will have to stay in the hospital for a few days to get prompt medical attention. During your period in the hospital, you will be given liquid food only. Solid food will be started slowly and gradually.

In the early days of surgery, a stoma looks like the inner lining of our buccal cavity. It will be soft and moist but since it lacks nerve endings so, it won’t feel any touch or pain.

Your surgeon or stoma nurse will attach an ostomy pouch to hold bodily waste that is excreted by the stoma. They will guide you to manage your life with an ostomy pouch.

If the colostomy or ileostomy is temporary, your healthcare team will talk to you about how long you need to have it.

LIFE WITH STOMA:

Living with a stoma needs certain modifications in our daily life. You can live your life to the fullest as you used to do before surgery but there are certain things that you must have to incorporate in order to maintain your health and the health of your stoma:

Maintain a proper care routine for your stoma:

Stoma is a sensitive part. So it’s really important to keep it neat and clean, as it is exposed to body waste daily. So there are chances of infection or inflammation of the skin around the stoma. Gently clean the stoma with warm water and soap.

Ensure to take enough fluid: since your colon is responsible for reabsorbing water. There are chances of dehydration after colostomy or ileostomy surgery. Therefore, in order to maintain good hydration status, make sure to drink enough fluids.

Healthy diet: Take a healthy diet and switch to a low fiber diet. Avoid food that may cause flatulence or stomach disturbance.

COMMON PROBLEMS WITH STOMA:

GAS:

Certain foods and beverages can lead to the production of gas. Managing gas can be challenging and may result in awkward situations. To control gas, try to have regular meals and chew your food slowly. Foods such as beans, broccoli, and onion should be avoided as they produce gas.

ODOUR:

Certain foods can lead to unpleasant smells from the pouch or ostomy appliance. Consider restricting the intake of odor-causing foods like onions, cabbage, garlic, fish, eggs, and fried foods. Apart from this, add yogurt and buttermilk to your diet. You can also use ostomy deodorants in the pouch to get rid of unpleasant smells.

CHOCKED STOMA:

It has been observed that sometimes the intestine near the stoma becomes narrow due to obstruction which is caused by certain foods. This condition may further progress towards swelling and irritation of the stoma.

One can get rid of it by consuming more fluids and limiting foods that can block the stoma such as popcorn, seeds, and skin of fruits/vegetables like strawberries and lady’s finger.

COLOSTOMY VS ILEOSTOMY. WHICH ONE IS WORSE?

There are numerous similarities between colostomy and ileostomy. The choice of permanent or temporary ostomy pouch is there in colostomy and ileostomy surgery. More or less, both surgeries have the same reason. Even the surgical procedure of colostomy and ileostomy is quite similar.

However, it is hard to decide which one is the worst. To be honest experience of both would be daunting for anyone. Be it a patient of colostomy or ileostomy, everyone has to face more or less similar challenges, except the fact that complications are more associated with ileostomy than colostomy. The reason is in ileostomy less digested or less formed stool is excreted via stoma. Therefore, ileostomy requires more care. Ultimately, the goal of both colostomy and ileostomy is to enhance the quality of life for individuals facing specific health challenges.