Overview

What is an ostomy?

An ostomy is surgically created opening in which the small or large intestine is brought out through an opening in the abdominal wall. The end of the intestine is everted and connected to the abdominal skin.  Waste material passes out of the intestine into a pouching system, which is attached to the skin around the ostomy or stoma. A pouching system must be worn at all times. Because there is no sensation in the ostomy opening, there will be no feeling when the stool passes from the stoma.

There are several different types of ostomies. An ileostomy  is an opening into the small intestine (ileum). A colostomy is an opening into the the large intestine (colon).

An ostomy may be temporary or permanent. A temporary or permanent ostomy may be required when the gastrointestinal tract needs to heal from disease or injury. 

How does an ostomy function?

An ostomy diverts waste material from a diseased or removed section of the GI tract to an opening in the skin (a stoma). 

After surgery, it may take several days for your ostomy to start functioning. It will then produce gas and liquid output, with volume gradually increasing as the body resumes a normal process of digestion. During this time, the texture of output changes from liquid to a pasty stool.  

Normal excretion from an ileostomy has liquid to pasty output with number of bowel movements varying in frequency. Normal excretion from a colostomy has pasty to semi-solid consistency, with bowel movements occurring in a more regular pattern. Because there is no sensation in the ostomy, there will be no feeling when the stool passes from the stoma. A pouching system is worn to collect output. 

Is there a difference between the terms "ostomy" and "stoma?"

An ostomy is a surgically created opening. The opening itself is called a stoma.

Why might someone have an ostomy?

There are several reasons that a person might need to have an ostomy created. In some instances, patients with inflammatory bowel disease (ulcerative colitis and Crohn's disease) or colorectal cancer may require ostomy surgery. Other indications for stoma creation include diverticulitis, trauma and ischemic disease.

Will people know I have an ostomy?

With good self-management, wardrobe choices and pouching systems, people will rarely (if ever) notice your ostomy.  Many people find that wearing snug fitting garments over the pouch conceals it by allowing the contents of the pouch to be equally distributed. There are wraps and other clothing options that can provide a flat profile. Your ostomy nurse will discuss options with you. 

A correctly applied pouching system will contain the odor of the stool; no odor will be present until the pouch is opened. An odor exists when the pouch is emptied, but that takes place in the washroom. If you are concerned about odor when emptying your pouch, you can place an odor eliminator inside the pouch.

How should I talk about my ostomy with others?

If and when you share information about your ostomy is your choice. Since your ostomy will be concealed under clothing and you will not have a limit on activities, other people will not know you have an ostomy unless you share that information. Some people feel they have no reason to discuss their ostomy; others provide friends with an explanation of what an ostomy is and why the surgery was performed. Learn more about discussing your ostomy with others.

Learn more about discussing your ostomy with others.

What is a stoma?

A stoma is a surgically-created opening into the small intestine (ileostomy) or large intestine (colostomy). The stoma protrudes through the abdominal wall to the outer surface of the skin and is visible. Stool exits the body from the stoma and is collected by a pouching system attached to the skin around the stoma.

What does a stoma look like?

Stoma

A stoma is round or oval, red and moist, and has a texture similar to the inside of the mouth. A stoma is edematous (swollen) for the first few weeks after ostomy surgery, as the tissue heals. Over time, it will change and shrink to a permanent size, which varies from patient to patient. The permanent stoma should maintain protrusion or upright position above the skin level.

How is a stoma made?

Ileostomy

An ileostomy is created from a section of the small intestine called the ileum and is surgically moved through the abdominal tissue to a previously marked site on the skin. The three types of ileostomy include: end, loop, end-loop.

Colostomy

A colostomy is created from a section of the large intestine or colon, is surgically moved through the abdominal tissue to a previously marked site on the skin.  There are four areas of the colon that a colostomy can be created from: ascending, transverse, descending, and sigmoid.  There are three types of colostomies: end, loop, end-loop.

Are there different types of stomas?

There are three types of stomas:  1) end stoma with or without mucous fistula, 2) loop stoma, and 3) end/loop stoma. 

A surgeon decides which stoma to create based on each patient's disease, type of surgery that  is required, the patient's physical condition, and the overarching goals of health care and maintenance.

The basic principles of ostomy care and stoma management are the same for all types of stomas. There are differences with respect to the type and frequency of stoma output, stoma construction and patient preference for a particular pouching system.

Does a stoma hurt?

No, there is no sensation of any kind in a stoma. This is because no nerves are present in the tissue.

Is there a leakage problem with a stoma?

The pouching system may leak if there are issues with application, utilizing a system not correctly fitted or because of changes in the stoma function or the skin around the stoma. Learn more about stoma leakage issues and solutions.

​Does a stoma bleed?

Minor temporary bleeding is normal and no cause for alarm. A stoma may bleed if it is grazed, bumped or rubbed. Learn more about stoma bleeding and solutions.

Will having an ostomy change my lifestyle?

To live with a stoma, some adjustments are needed, and new skills must be acquired. Specifically, you will need to learn how to apply and empty the pouching system. Once you acquire these skills and move toward healing, you will return to your normal lifestyle. 

Learn more about living with an ostomy. Or, read patient stories.

What is a pouching system?

Pouching System

A pouching system consists of an odor-proof pouch that collects and contains output from the stoma, and an adhesive (called a skin barrier) that attaches to the skin around the stoma. The skin barrier will protect the skin around the stoma and adhere the pouch to the skin. The bottom of the pouch has a tail, which can be opened to drain collected stool, but otherwise stays sealed with an integrated pouch closure. 

How does a pouching system work?

An opening is made in the skin barrier of the pouching system that matches the size and shape of the stoma. For example, if the stoma is round-shaped, the opening is round; if the stoma is oval-shaped, the opening is oval. When the skin barrier is applied it should fit to the skin stoma junction providing skin protection.  As the stool drains from the stoma it will pass over the skin barrier into the pouch and be contained in the pouch until emptied.  There are many types of pouching systems available. The ostomy nurse will help you find the best, most secure fit. 

View a demonstration of how to change and empty a pouching system.

What are the different types of pouching systems? 

There are two basic types of pouching systems: one-piece and two-piece. Each has unique features and benefits. You may decide to use both at different times, to suit your changing needs. 

One Piece Pouching System

A one piece pouching system consists of the pouch and the skin barrier.  The skin barrier is attached to the pouch as one piece. 

 

 

A two-piece pouching system consists of a pouch and a separate skin barrier, which features a flange or a landing zone. The pouch can be attached and detached to the flange as needed. The skin barrier is placed on first and the pouch snapped and/or attached to the skin barrier. 

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Two Piece Pouching System

Are there any challenges I might encounter with an ostomy? 

It's important to remember that there is a learning curve when acquiring any new skills, such as applying and emptying a pouching system. One challenge after surgery is that the opening in the skin barrier needs to be altered as the stoma size and shape changes. Our nurses recommend that the stoma be measured every two weeks for the first 6 weeks after surgery to determine when to change the skin barrier opening.

Leakage of the stool onto the skin under the adhesive seal is another issue some patients encounter. This may occur as a result of an incorrect fit of the pouching system (not matching the stoma size or shape, not matching the shape of the skin barrier to the shape of the skin around the stoma), not changing the pouching system on a consistent basis, or lack of knowledge about stoma care. 

Learn more about common stoma problems.

Learn more about living with an ostomy.

Get care— schedule an appointment with an Ostomy nurse.