Understanding the different types of stomas can empower individuals who are preparing for or recovering from stoma surgery.
Gaining knowledge about what to expect can ease anxiety and provide clarity, helping people feel more confident in managing their stoma. This information is equally valuable for those supporting a loved one with a stoma, offering insight into their care and needs. After all, knowledge is power!
Here’s a helpful guide to the different types of stomas, breaking down the anatomy, purpose, and surgical methods for each.
What is a colostomy?
A colostomy is formed when a section of the colon (large bowel) is brought to the surface of the skin on the stomach. A colostomy produces a semi-formed/formed stool as the faeces have had time to travel through the colon undergoing water absorption.
Some colostomies are temporary, often performed to allow the bowel to rest and heal following infections, injuries, or certain cancers. These temporary colostomies can typically be reversed at a later date through an additional surgery, where the bowel is reattached.
In contrast, some colostomies are permanent. These are usually necessary for more serious or irreversible conditions, such as the removal of the rectum due to disease or when the muscles controlling elimination are no longer functioning. For individuals with a permanent colostomy, reversal is not an option.
What are the types of colostomy surgeries?
End Colostomy: This is formed when one end of the colon is pulled through and sewn to your abdomen. This can be either permanent or temporary. The other part of the diseased bowel is usually either removed or allowed to heal before being joined back up together further down the line.
Loop Colostomy: This is formed when a looped portion of your colon is pulled through to your abdomen. An incision is then made in the loop and sewn to your stomach using a special stoma rod to keep it above surface level. A loop colostomy is usually a temporary measure performed in an emergency operation and will be reversed a few months down the line (dependent on the surgeon and hospital).
What is an Ileostomy?
A portion of the ileum (small intestine) is brought to the surface of the skin on the stomach. The waste from the ileum is more of a liquid output, an ileostomy tends to produce more frequent, watery output and therefore can be a little bit more difficult to manage than a colostomy.
What are the different types of ileostomies?
End ileostomy: This is formed when all or part of the large bowel and or the rectum are removed. Part of the small bowel is brought out to the surface of the abdomen to create a stoma. An end ileostomy can be temporary or permanent. Temporary ileostomies may be reversed further down the line, but again this needs to be discussed with your surgeon to see if this is a possibility and whether you are healthy enough to have the surgery done.
Loop ileostomy: This is created to protect a surgical join in the large bowel or to divert the flow of stool from an obstruction. It is formed when a loop of the small bowel is brought to the surface of the abdomen and opened to form a stoma. This can be temporary or permanent. A loop can also be formed to protect the join following reconstruction surgery, such as an ileo-anal pouch. A loop ileostomy has two openings; only one of these will pass stool, the other may pass mucus.
If part of the bowel becomes diseased a long-term permanent ileostomy is created. The diseased part of the bowel and anus will be removed or permanently rested. In this case the ileostomy is considered permanent and is not ever expected to be closed (removed).
What are the types of ileostomy surgeries?
There are three types of ileostomy surgeries and talking them through with your surgeon and stoma nurse will help you decided which is the most appropriate for you are your situation, taking into consideration your age, general health, and disease process.
Standard or Brooke ileostomy: This is the most common type of ileostomy surgery. The end of the ileum is pulled through the abdominal wall and is turned back and sutured to the skin, leaving the smooth rounded inside out ileum as the stoma. The stoma is usually in the lower right-hand side of the abdomen.
Continent ileostomy: A continent ileostomy is a different type of standard ileostomy, you don’t need to wear an external pouch with this kind of ileostomy. It is created by looping part of the ileum back on itself that a reservoir or pocket is formed inside the abdomen. A nipple valve is made from part of the ileum, a few times a day a catheter can be inserted to drain the waste out of the reservoir inside your abdomen.
Ileo-anal reservoir (J-pouch or pelvic pouch): The ileo-anal reservoir or pelvic pouch made from the ileum and the rectum and placed inside the body of the pelvis. Other names for this include J-pouch, W -pouch and S-pouch depending on the surgical procedure. The pouch is connected to the anus. Waste passes into the pouch, where it is stored. When an urge is felt, the stool is passed through the anus, out of the body. The sphincter muscle around the anal opening must be intact to keep the pouch from leaking. In most cases at least tow surgeries are required to make the ileo-anal reservoir or pelvic pouch.
What is a urostomy?
A urostomy is formed when your bladder is removed due to disease such as bladder cancer. A stoma is made from the urinary tract (usually from the ureters, which connect the kidneys to the bladder) to divert urine into a stoma pouch outside the body. A small piece of your bowel will be pulled through an incision made through your abdomen and sewn to your stomach to form a stoma. The ureters will then be detached from the bladder and attached to the piece of bowel to form the urostomy.
What are the types of urostomy surgeries?
Ileal conduit:
The most commonly formed surgery for urinary diversion is called an ileal-conduit with urostomy formation. It is still one of the most used techniques for the diversion of urine after a patient has had their bladder removed.
This is when the surgeon takes a 12-14cm section of the small bowel (ileum) to form the ileal-conduit. The remaining bowel is reconnected for normal function to continue. The kidneys produce urine, which passes down into the ureters. The ureters are then detached from the bladder and stitched into the conduit. One end of the conduit is closed, and the open end is brought out onto the abdominal wall to create a stoma. There is no muscle to control urination so you will need a urostomy pouch to collect the urine. This pouch covers your new stoma and adheres to your abdomen.
During the operation, fine tubes called “stents” are inserted into the kidneys via the ureters. These assist free drainage of the urine until healing has taken place. These stents either fall out or are removed approximately 10 days after surgery. These will be monitored by your stoma care nurse, once you are home from hospital.
Continent urinary diversion:
Continent urinary diversion such as the creation of a neobladder or mitrofanoff reservoir is classed as urinary reconstruction and is an alternative to ileal conduit surgery. To undergo these two surgeries, there must be low risk of cancer recurrence.
Following either surgery you are taught how to self-catheterise as this will be required on a long-term basis to drain the urine. Therefore, you must have good dexterity and a clear understanding of what is required for a prolonged period of time. You may also experience some level of urinary incontinence (dribbling) for the first 6 months and need to wear a pad.
For a neobladder procedure, your surgeon uses a larger piece of your intestine to create something like a substitute bladder. It is attached to the urethra so you can pass urine like you used to, but you won’t have the normal muscle reflexes that kick in when the bladder is full. You may need to self-catheterise to empty the bladder completely.
A reservoir is created from a section of your intestine into a holding pouch inside your abdomen. There is a small, continent opening (stoma) on the surface of the abdomen, through which you insert a catheter to drain this internal reservoir about 6 times per
How does a stoma work?
When the bowel moves, wind and faeces are re-routed and come out through the colostomy or ileostomy (stoma) rather than the anus. For a urostomy, the urine flows from your kidneys through the ureters and the piece of bowel, and out of your body through the urostomy (stoma) bypassing the bladder.
There is no control over when this happens and therefore a pouching system called a stoma pouch/bag attaches to the stomach covering the stoma, to collect waste product. These stoma pouches have a skin friendly adhesive on the back to help firmly attach to your skin.
