Because of Spina bifida and
incontinency it might be possible that surgery is needed to solve the problems
with incontinency. A ostomy is one of the solutions which are possible.
One this page I'll explain the different types of ostomies. I also give some information about the (im)possibillities with sex.
Types of Ostomies and Continent Procedures
The terms ostomy and stoma are general descriptive terms that are often used interchangeably though they have different meanings. An ostomy refers to the surgically created opening in the body for the discharge of body wastes. A stoma is the actual end of the ureter or small or large bowel that can be seen protruding through the abdominal wall. The most common specific types of ostomies are described below.
created opening of the colon (large intestine) which results in a stoma.
A colostomy is created when a portion of the colon or the rectum is
removed and the remaining colon is brought to the abdominal wall. It may
further be defined by the portion of the colon involved and/or its
Living with a
Ostomy is, as the name suggests, one intended for a limited amount
of time only. However, it can also refer to an ileostomy or colostomy if
the lower part of the rectum and all of the anus are not removed, thus
leaving it open for the patient to be reconnected again in the future. A
Urostomy is considered temporary if the bladder is not removed.
Temporary ostomies are usually given in emergency situations (ie car
accidents) or during the first stage of J Pouch surgery. Most often they
are performed simply to allow the bowel time to rest and hopefully heal
before being reconnected again.Allows the lower
portion of the colon to rest or heal. It may have one or two openings
(if two, one will discharge only mucus). If the surgeon must cut out a
section of diseased colon, then they may decide to do a double-barrel
ostomy. As for the loop ostomy, there are two stomas but they are
completely separated (ie the bowel is cut completely in half). Both the
functional and non-functional stomas are bought through the abdominal
wall. The second stoma, as per the loop ostomy, secretes mucous and you
can quite often get away with just a piece of gauze covering it rather
than a bag (although of course, a bag must be worn over the main stoma).
If you are to have this type of surgery, make sure that your surgeons
locates the two stomas away from each other. This makes them much easier
to care for rather than having to worry about the one wafer appliance
having to cover both stomas.
Another temporary ostomy procedure is the Hartmann's Pouch procedure. This surgery leaves you with only one stoma and the non-functional end of the bowel simply stitched or stapled shut and left inside you until reconnection can take place.
|Permanent Colostomy||Usually involves the loss of part of the colon, most commonly the rectum. The end of the remaining portion of the colon is brought out to the abdominal wall to form the stoma.|
|The most common type of ostomy surgery, in which the end of the descending or sigmoid colon is brought to the surface of the abdomen. It is usually located on the lower left side of the abdomen.|
|Transverse Colostomy||The surgical opening created in the transverse colon resulting in one or two openings. It is located in the upper abdomen, middle or right side.|
|Loop Colostomy||Usually created in the transverse colon. This is one stoma with two openings; one discharges stool, the second mucus.|
|Ascending Colostomy||A relatively rare opening in the ascending portion of the colon. It is located on the right side of the abdomen.|
created opening in the small intestine, usually at the end of the ileum.
The intestine is brought through the abdominal wall to form a stoma.
Ileostomies may be temporary or permanent, and may involve removal of
all or part of the entire colon.
Living with an
|Ileoanal Anastomosis||This is now the
most common alternative to the conventional ileostomy. Technically, it
is not an ostomy since there is no stoma. In this procedure, the colon
and most of the rectum are surgically removed and an internal pouch is
formed out of the terminal portion of the ileum. An opening at the
bottom of this pouch is attached to the anus such that the existing anal
sphincter muscles can be used for continence. This procedure should only
be performed on patients with ulcerative colitis or familial polyposis,
and who have not previously lost their rectum or anus. It is also called
J-pouch, pull-thru, endorectal pullthrough, pelvic pouch, or a
combination of these terms.
|Continent Ileostomy||This surgical
variation of the ileostomy is also called a Kock pouch. A reservoir
pouch is created inside the abdomen with a portion of the terminal
ileum. A valve is constructed in the pouch and a stoma is brought
through the abdominal wall. A catheter or tube is inserted into the
pouch several times a day to drain feces from the reservoir. This
procedure has generally been replaced in popularity by the ileoanal
pouch. A modified version of this procedure called the Barnett Continent
Ileal Reservoir is performed at a limited number of facilities.
|Urostomy||This is a general
term for a surgical procedure which diverts urine away from a diseased
or defective bladder. The ileal or cecal conduit procedures are the most
common urostomies. Either a section at the end of the small bowel
(ileum) or at the beginning of the large intestine (cecum) is surgically
removed and relocated as a passageway (conduit) for urine to pass from
the kidneys to the outside of the body through a stoma. It may include
removal of the diseased bladder.
Living with a
|Continent Urostomy||There are two main continent procedure alternatives to the ileal or cecal conduit (others exist). In both the Indiana and Kock Pouch versions, a reservoir or pouch is created inside the abdomen with a portion of either the small or large bowel. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted several times daily to drain urine from the reservoir.|
|Indiana Pouch||The ileocecal valve that is normally between the large and small intestines is relocated and used to provide continence for the pouch which is made from the large bowel. With a Kock Pouch version, which is similar to that used as an ileostomy alternative, the pouch and a special "nipple" valve are both made from the small bowel. In both procedures, the valve is located at the pouch outlet to hold the urine until the catheter is inserted.|
Types of Pouching Systems
Pouching systems may include a one-piece or two-piece system. Both kinds include a faceplate/flange (barrier or wafer) and a collection pouch. The pouch (one-piece or two-piece) attaches to the abdomen by the faceplate/flange and is fitted over and around the stoma to collect the diverted output, either stool or urine. The barrier is designed to protect the skin from the stoma output and to be as neutral to the skin as possible.
|Can be either open-ended, requiring a closing device usually called a clamp or tail clip; or closed and sealed at the bottom. Open-ended pouches are called drainable and are left attached to the body while emptying. Most commonly, closed end pouches are used by colostomates who can irrigate (see below), or by patients who have regular elimination patterns. Closed end pouches are usually discarded after one use.|
|Two-Piece Systems||Consist of a separate flange and pouch. The pouch contains a closing ring which mechanically attaches to a mating piece on the flange. The most common closure is a pressure fit snap ring, very similar to that used in TupperwareTM.|
|One-Piece Systems||As the name implies, are those in which the wafer and pouch are assembled together in one piece and not separate.|
|Both two-piece and one-piece pouches can be either drainable or closed.|
|Irrigation Systems||Some colostomates can "irrigate," using a procedure analogous to an enema. This is done to clean stool directly out of the colon through the stoma. This requires a special irrigation system, consisting of an irrigation bag with a connecting tube (or catheter), a stoma cone and an irrigation sleeve. A special lubricant is sometimes used on the stoma in preparation for irrigation. Following irrigation, some colostomates can use a stoma cap, a one- or two-piece system which simply covers and protects the stoma. This procedure is usually done to avoid the need to wear a pouch.|
|Urostomates can use either one or two piece systems. However, these systems also contain a special valve or spout which adapts to either a leg bag or to a night drain tube connecting to a special drainable bag or bottle.|
are the major types of pouching systems. There are also a number of
styles. For instance there are flat faceplates and convex shaped ones.
There are fairly rigid and very flexible ones. There are faceplates with
and without adhesive backing and with and without a perimeter of tape.
The decision as to what particular type of system to choose is a
personal one geared to each individual's needs. There is no right or
wrong choice, but each person must find the system that performs best
for him or her.
The larger mail-order catalogues will illustrate the types and styles from all or most of the suppliers. If you have any trouble with your current pouching system, discuss the problem with an ostomy nurse or other caregiver and find a system that works better for you. It is not uncommon to try several types until the best solution is found. Free samples are readily available for you to try. There is no reason to stay with a poorly performing or uncomfortable pouching system.
Types of Accessories
You may need or want to purchase certain pouching accessories. The most common items are listed below.
|Convex Inserts||Convex shaped plastic discs that are inserted inside the flange of specific faceplates.|
|Ostomy Belts||Belts that wrap around the abdomen and attach to the loops found on certain pouches. Belts can also be used to help support the pouch or as an alternative to adhesives if skin problems develop. These usually add a measure of security.|
|Pouch Covers||Made with a cotton or cotton blend backing, easily fit over the pouch and protect and comfort the skin. They are often used to cover the pouch during intimate occasions.|
|Wipes and powder help protect the skin under the wafer and around the stoma from irritation caused by digestive products or adhesives. They also aid in adhesion of the wafer.|
|Skin Barrier Paste||Paste that can be used to fill in folds, crevices or other shape or surface irregularities of the abdominal wall behind the wafer, thereby creating a better seal.|
|Tapes||Tapes are sometimes used to help support the flange or wafer (faceplate) and for waterproofing. They are available in a wide range of materials to meet the needs of different skin sensitivities.|
|Tape Remover||Tape remover is helpful in cleaning the adhesive that might stick to the skin after removing the tape or faceplate, or from other adhesives.|
Concerns about Surgery
Fear of loss is normal and facing any loss is difficult. What are patients giving up by having this operation? Is there any gain? How changed will they be? Such thoughts may lead to weeping or depression, or they may be denied.
It is important to understand the impact of the ostomy surgery on the patient’s change in self-image and how they perceive themselves. It may be accepted as the lesser of two evils, or they may refuse to acknowledge its existence, or may hold onto the belief that it is a temporary situation.
Within the rehabilitation process there are times that patients should have the opportunity to express or deny their feelings, about their surgery, the changes in their body or their self-image.
Patients should begin to assist the ostomy nurse with caring for the ostomy as soon as possible. Becoming involved in this process will begin to build confidence and help the patient to regain control of his situation.
Returning to the work place may
present a concern about restroom facilities, interaction with
co-workers, and feelings of being “watched.”
Sexuality issues are common
concerns for the new ostomate. Linked closely to our feelings of
sexuality is how we think about ourselves and our body image.
B. Phases of
These phases are shock,
denial, acknowledgment and resolution.
With the aid of an ostomy nurse and the ostomy visitor, you learn about living with a stoma.
Good ostomy management is the key to establish confidence during lovemaking. The pouching system should be free of odor and leakage. Pouches should be emptied prior to lovemaking and some ostomates may wish to avoid eating or drinking anything that may give trouble. Consider opaque pouches and/or pouch covers to enhance intimacy.
If the pouch or other stoma covering seems to be in the way during intercourse, experiment with different positions.
In addition to good ostomy management, preparation for sex is the same as it is for the non-ostomate: cleanliness, appealing nightclothes, privacy and a loving attractive manner.
Many sex problems that male ostomates experience after surgery may stem from psychological factors. It is often difficult to determine the difference between psychological and physical factors. If sexual difficulty should be experienced, careful consideration of any psychological issues may help resolve the cause.
Most of the following concerns apply primarily to the immediate post-operative period.
|Serious anxiety or fear about one's ability to perform sexually, the attractiveness of his altered body, the possibility of odor, and the security of his pouch or other stoma covering.|
|Failure because of attempting intercourse before strength returns following the operation.|
|Depression which many patients suffer following major surgery.|
|Medication, sedative or other.|
It is important that the new male ostomate and his partner understand that impotence is not unusual and is usually temporary because of the foregoing reasons.
A cooperative partner is one who takes the ostomy for granted with warmth, tenderness, and patience. They engage in activities that provide both partners with maximum enjoyment. In some cases this may require that previous sex patterns may need to be changed. Any changes should be pleasing and acceptable to both lovers.
The presence of a stoma on the abdomen is quite a change in one's anatomy and can make the ostomate self-conscious and may pose a psychological barrier in sexual relations. There should be some communication with one's partner that intercourse will not harm it.
The ostomate should be relaxed and unworried. This may be difficult the first time, but subsequent encounters are likely to become easier. If the partner expresses concern about hurting the stoma or dislodging the pouch, one should not misinterpret it as rejection.
|It is important that the male and his mate
understand that failure to achieve and/or sustain an erection can happen,
but in most cases the condition is temporary and potency will return in a
few months. Be patient, do not panic.
|This does not mean that the couple should
avoid making love. There is much more to sex than erections and orgasm. Love
play, or pleasuring each other, is delightful.
|There are many ways a man can satisfy his
partner sexually up to and including orgasm. There is masturbation, manual
stimulation, oral-genital sex, stuffing the flaccid penis into the vagina
and moving the pubis without thrusting.
|Uninhibited communication between both partners is the key to finding the best technique.|
The nature and extent of ostomy surgery in some instances may cause sexual impairment of a physical or organic nature. This is because of the location of the prostate glands and the nerves serving them in the case of urostomy surgery. When the rectum is removed in ileostomy or colostomy surgery, it is because of the location of the nerve system serving the genitals.
The types of sexual impairment that may result from removal of the bladder or the rectum are:
|Impotence. Inability to achieve
and/or sustain an erection.
Inability to have an orgasm or the lessening of the quality and intensity
Inability to ejaculate.
|Sterility. Inability to produce sperm for impregnation of the female.|
Medical professionals should address any sexual difficulty, first with the ostomy surgeon and/or the WOC(ET) or ostomy nurse. Referral may be made to a urologist, therapist or counselor, and they may recommend new advances in medical and surgical interventions.
and the Female Ostomate
After surgery, while you are recovering and learning to manage your ostomy, you may not experience any sexual feelings for days, weeks, or even months. On the other hand, you may begin to focus on sexual feelings while still in the hospital. You need to let your partner know what to expect from you about intimacy and sex.
Women recovering from ostomy surgery worry about many things: How they will look to themselves and if they will still be attractive to others, will there be pain, how to manage the pouch before, during and after sex. Remind yourself that your lovableness and self-worth do not depend on a body part.
If the rectum has been removed, the whole position and structure/size of your vagina may feel different. Be aware that for some women it is either uncomfortable and/or painful. Your vagina may feel too small or too tight. You may not come to orgasm the first time if things are too strange and different.
An intimate relationship is one in which it matters how well you can communicate about this intimate experience. Your partner will take the cue from you. But do not forget that your partner's feelings are real, too, and they should not be denied any more than your own.
The longer you lived with the conditions of disease process, the longer you adjusted your sexual activities to the limitation they placed on you. This will now change with some caring and sharing on both your parts. A helpful task for you now is to sort through these limitations to determine if they were from the illness or "ancient history" experiences.
Pain blocks good sexual feelings. Remember that the rectal-genital area consists of soft tissue that is rich in blood vessels and nerves; tissues like this bruise and swell easily when traumatized. They take time to heal. Another source of pain is lack of lubrication.
Most women who have experienced painful post-operative intercourse say that the pain diminishes with time, hormonal creams or lubricants, relaxation, gentle thrusting, and manual stimulation.
|Desire. Sometimes you may experience
little or no desire for sex. Illness and medical treatments often lower
sexual desire as do pain, medication and just plain not feeling well. A
change in body image and lowered self-esteem interfere with sexy feelings.
Fatigue, depression, anxiety or anger is likely to dampen desire.
|Loss and Grief.
Ostomy surgery means a major change in your body. Even if your surgery
has brought an end to years of illness and discomfort, or has been to cure a
life-threatening disease, it still represents the loss of a natural body
function. Not infrequently, grief is experienced as anger or fear.
Body image is the way we see ourselves in the mirror and like to imagine
our appearance. Although the change seems so great to oneself, most others
do not see the ostomy as changing in any major way the person they love.
Harmony within oneself precedes harmony in a relationship.
Drugs taken during illness and surgery may affect sexual behavior. Each
person reacts individually to medication. Anesthesia can leave a person
feeling off center for quite some time.
|Surgical Procedures. If the rectum has been removed along with the colon, there may be a different sensation in the vagina during intercourse since part of its supporting structure is gone. In some women the angle of the vaginal barrel changes penetration, and orgasm may be harder to achieve. The uterus may change position, leading to difficulties in conception. If radiation therapy has been received, there may be vaginal tenderness and dryness.|
It is your right to share or not to share information about your body. Sharing information about your ostomy may not be easy. If you find someone with whom you want to share a sexual relationship, then you need to decide when and how much you want to share about your operation.
Many a loving partner of an ostomate has admitted to feeling anger and resentment towards a sick mate. Such feelings are natural. Until they have been expressed and worked out, both of you may feel guilty and unlovable. There is nothing more frustrating and painful than dealing with a partner who refuses to talk about important issues in a relationship such as sex, anger, fear, rejection, or the ostomy. Going together to a professional counselor may be the answer.
Any sexual difficulty should be addressed by medical professionals, first the ostomy surgeon and/or the WOC(ET) or ostomy nurse. Referrals may be made to gynecologist, therapist or counselors.
Sex and the Single Ostomate
Individuals with ostomies have proven that they can achieve anything they desire. An ostomy alone is not a deterrent to any activities you are otherwise capable of and that includes your social life.
Whether a person desires companionship, active participation in sex, or a serious romance leading to marriage, how one's surgery will be accepted by a potential partner or friend is a normal concern.
Body image is the way we see ourselves in the mirror and like to imagine our appearance. Although the change seems so great to oneself, most others do not see the ostomy as changing in any major way the person they love. Harmony within oneself precedes harmony in a relationship.
|Whom. You can choose whom you want
to tell. Sexual partners will naturally have to be told because, covered or
uncovered, the stoma or pouch will be apparent during intimate moments. You
should tell a prospective marriage partner, because being open and honest is
important to the success of any marriage. In addition, the reaction to your
disclosure gives a good indication of the person's feelings about the whole
You can pick your time to tell but it seems better to tell early in a
relationship. This not only relieves your anxiety, but also if there is an
adverse reaction the letdown is not as harsh as it might be later. Most
people prefer to tell at a time when there is a calm and understanding mood
with their partner. Do not wait until "discovery is imminent."
When you explain the surgery, do it clearly and confidently, with
self-assurance. Start with a simple explanation. You need not be too
detailed and technical at this point. Emphasize that this type of surgery
was necessary and that managing your ostomy does not interfere with your
activities and enjoyment of life.
|Rejection. People do not fall in love with, or like, everyone they date. Nearly every would-be lover gets his or her share of romantic rejection. Individuals with ostomies are no exception. When you experience rejection your ostomy may seem to be the only reason for rejection; however, chances are it is really only a convenient excuse. Be sure it is rejection and not misunderstanding. Allow enough time for him, or her, to think it through.|
Just as you attend to personal hygiene when anticipating intimacy, ostomy hygiene is also important. Of course, good ostomy hygiene should always be practiced:
|The covering for regulated or continent ostomies should always be clean and neat.|
|The pouch for other ostomies should be clean, neat and fastened securely. The pouch should be odor free and preferably opaque. If transparent, use a pouch cover.|
|Unless sex is absolutely spontaneous, the pouch should be emptied beforehand.|
During intimacies, especially the first encounters after surgery or with a new partner, your partner may have a fear of hurting your stoma or dislodging your pouch or covering. Intercourse will not harm the ostomy nor will most positions disturb the pouch or covering.
Women can accomplish covering the pouch or stoma area by wearing a sexy shorty nightgown or crotch-less panties. Some men wear cummerbund type coverings, which encircles the midsection and the pouch can be tucked up out of the way. A pouch cover can be worn. There are many products available that can be purchased or you can make your own covering.
|A physical impairment that affects genital
sexual relations can occur with ostomy surgery, but people to whom this
happens must realize there are also ways for them to enjoy sex, intimacy and
|Extensive surgery in women may cause a
physical impairment resulting in painful intercourse the first few times
after surgery to remove the rectum. A decrease in clitoral feeling and
possible inorgasm may occur.
|Male potency can be affected by ostomy
surgery because necessary surgical procedures may interfere with the nerve
pathways that control the male's ability to have an erection or to
ejaculate. Every male with an ostomy should consider psychological factors
before jumping to conclusions that an erectile problem is physically caused.
Removal of the bladder and therefor damage to the nervesystem can cause problems having an erection of an
|When you have doubts or questions about sexual function after an operation you should discuss the matter with a professional.|
Ostomy surgery knows no demographic bounds. It also happens to people who are homosexual. The same concerns and anxieties are present in gay or lesbian relationships. Apply the same principles for coping with telling, rejection, and preparing for sex.
Since the closing of the anus may present a sexual impairment for some individuals with an ileostomy or colostomy, modifications for sexual fulfillment are necessary. The fact that a person is homosexual should be confided to the physician or surgeon if it is at all possible.
Any sexual difficulty should be addressed by medical professionals, first the ostomy surgeon and/or the WOC(ET) or ostomy nurse. Referrals may be made to gynecologist, urologist, therapist or counselor.
Source: Several sites on Internet.
© Donald Willemsen