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ileostomy vs. colostomy - how do the drs. decide?

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ileostomy vs. colostomy - how do the drs. decide?

Postby pearlgirl » Tue Mar 04, 2008 6:54 pm

I'm pretty familiar with the differences between an ileostomy and a colostomy, but can anyone fill me in about what decides which you will need?

My husband will be having his second lower anterior resection (after chemo and radiation - it's a ways off yet) and was told he'd need a temporary ostomy. One doctor said "ostomy", another said "ileostomy", and I believe yet another said "colostomy".

I'm just thinking, with a surgical site that low in the bowel, why would an ileostomy be performed, if there is still lots of colon left to use for a colostomy?
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Postby CRguy » Tue Mar 04, 2008 7:40 pm

I am NOT a SurgOnco so check with them but I would surmise :

after chemoradiation the colon doesn't heal as well or as quickly and you are more prone to pelvic abscesses ( on this I AM an expert of sorts !!!) so even though you colostomize the remaining colon there could be a higher chance of complications. Also they would likely have to do a separated colostomy where the distal part (lower) is completely detached from the upper proximal part. the reattachment later can also be more problematic.

with ileostomy, especially a temporary loop ileo you do not completely separate the lower and upper sections of ileum and less damage up front means less damage to repair later. This also gives the entire colon a good rest and chance to heal. I recall somewhere the complication rates for loop ileos are way less than for colostomies, so the docs are just stacking the odds in hubby's favor by trying to reduce the potential complications.

In his specific case there may also be case specific reasons why one over the other if the colon has already had one surgery.

in general the small intestine heals faster and better than the large (colon)
at least in my experience.....your mileage may vary !!
hope this helps

cheers and good luck, whatever the procedure.
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Postby pearlgirl » Wed Mar 05, 2008 10:48 am

Very plausible explanations. Thanks!
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Postby CRguy » Wed Mar 05, 2008 8:51 pm

You are most welcome, glad it helped.
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Re: ileostomy vs. colostomy - how do the drs. decide?

Postby garbovatwin » Sat Jun 13, 2009 5:42 am

Is the daily action of an ileostomy different than that of a colostomy?
I would assume the texture if you will of the full bag is somewhat different?

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Re: ileostomy vs. colostomy - how do the drs. decide?

Postby NWgirl » Sat Jun 13, 2009 12:46 pm

Garbovatwin - the ileostomy uses the small intestine - so the output tends to be more liquid. Mine varied from total liquid to a toothpaste like consistency - how's that for TMI!!! :-) When you're on chemo and/or radiation, it really does a number on what comes out - whether you're pooping into a bag or out your bottom.

With a colostomy, you're using the colon for the ostomy part. Since one job of the colon is to absorb fluids, the output is more solid. I've never had a colostomy so I can't share all the gorey details of exactly what that output is like.

I know you have concerns about what your future may hold as far as a potential ostomy. If you haven't browsed the UOAA (United Ostomy Associates of America) chat group, definitely check it out sometime. I think if most people have a choice - as far as a permanent ostomy, they would opt for a colostomy as it is a little less maintenance. Also, with the ileo being more liquid, if that liquid output gets on your skin, it burns like crazy. The reason it would get on your skin is usually a problem with getting a good seal on your appliance. Some people, however, don't have a choice and end up with a permanent ileostomy due to problems with their colon. Here's a link to the UOAA web-site....

http://www.uoaa.org/forum/viewforum.php?f=2
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Re: ileostomy vs. colostomy - how do the drs. decide?

Postby Lee » Sat Jun 13, 2009 1:06 pm

garbovatwin wrote:Is the daily action of an ileostomy different than that of a colostomy?
I would assume the texture if you will of the full bag is somewhat different?

jA


I had rectal cancer and have a permanent colostomy today. I can go from harder stools to softer stools in 10 mins. Generally my out put is similar to what most people do in the toilet, it just takes me longer. And I generally go every other day, similar to what I was doing prior to my diagnoses.

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surgery - August 2004/hernia repair 2014
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Re: ileostomy vs. colostomy - how do the drs. decide?

Postby garbovatwin » Sun Jun 14, 2009 6:47 am

Thank you NwGirl and Lee for your iput.

jA
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