Atoq wrote:I totally agree that living with a ileostomy would not be a problem at all for me, but it is a big decision . . I have reversal scheduled in a week. But I wondered if a permanent ileostomy means that the colon is removed or is is it possible to keep it disconnected?
All the best
Claudia
Claudia:
Your question is one that surfaces over time as new members come and go and is a good question to review anew.
Most/all members here with an ileostomy have what is called a “loop ileostomy.” A loop ileostomy is formed by bringing a segment of the middle section of small intestine (jejunum) up and onto the surface of the abdomen, making a lengthwise slit of approximately 4 inches along the length of small intestine, rolling back the edges at both ends of the slit, thereby forming two stomas in close approximation. The stoma that connects to the functioning upstream small intestine is called the “active” or “working” stoma. The stoma that connects to the disconnected and resting remainder of intestinal tract is called the “non-working” or “mucus” stoma.
An end ileostomy is formed by bringing up the terminal end of the small intestine (the ileum) onto the surface of the abdomen, rolling the intestinal tissue back upon itself like a turtleneck sweater. An end ileostomy has only one stoma, an active/working stoma. The residual downstream intestinal tract is either: 1. Surgically removed. Either as a total colectomy (retaining a rectal stump or rectal cuff + anal sphincters) or as a total
proctocolectomy (removal of rectum and removal of anal sphincters with surgical closure of one’s backend, ie “Barbie butt”); 2. Downstream intestine is retained in situ.
A loop ileostomy is higher maintenance to care for and generally causes people more grief than an end ileostomy. Because the loop ileostomy is sited higher up along the length of small intestine, the fecal material had a higher water content - the fecal output is a thin liquid and of high volume output per unit time. A loop ileostomy, because of its dual stomas, is also more challenging to contain with an ostomy pouching system. The ostomy wafer plate needs to be larger to accommodate the two stomas and is more cumbersome. Asthetically, the loop ileostomy is larger and more noticeable than an end ileostomy, and can cause people more emotional angst.
A loop ileostomy is usually placed as a temporary measure, but it
can remain as a permanent ostomy when circumstances dictate (ex. a person is medically frail or compromised and not a strong candidate for additional surgery to undergo a reversal or create an end ileostomy). That said, a loop ileostomy is not a first choice when making a decision for a permanent - its’ high volume output leaves the person at risk for recurrent dehydration; the resting remainder of intestinal tract is prone to disuse colitis, an inflammatory condition.
There are all sorts of ostomies based on the site/location along the digestive tract - loop ilesostomy, end ileostomy, ascending colostomy, transverse colostomy, sigmoid colostomy. Any ostomy can be temporary. Any ostomy can be permanent. It is oft said among ostomy veterans: “Any ostomy is permanent until it is
successfully reversed.” Meaning: There is no guarantee that an ostomy can be 100% successfully reversed. Only time will tell how well function is restored following a reversal (rectal sensitivity and pelvic floor coordination and anal sphincter control are most problematic).
So, yes . . . A loop ileostomy can begin as a temporary option and be retained as a permanent option if need be. However, a loop ileostomy is more challenging to maintain than an end ileostomy or variable site colostomy and, therefore, is not an ideal permanent ostomy.
People have temporary and/or permanent ostomies for many different reasons. Ulcerative colitis and Chron’s disease are a common finding in young people finding severe symptom relief in an ostomy; automobile accidents that cause pelvic injuries; chronic constipation due to nerve damage and severe slowing of intestinal motility; pelvic floor prolapse; diverticular disease.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.