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Colostomy and Ileostomy

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A stoma is a surgically formed opening between a body cavity, such as the colon or ileum, and the external body environment, such as the outer abdominal wall. After formation of a colostomy or ileostomy, stool flows through the stoma from the colon or intestines respectively, into a collecting device attached to the abdominal wall, thereby bypassing the rectum and anus. SCI individuals who undergo elective colostomy or ileostomy have usually exhausted all other appropriate bowel management options. The most common reasons for undergoing stoma surgery include prolonged bowel management episodes, unmanageable fecal incontinence, and constipation. Autonomic dysreflexia and pain associated with bowel evacuation, difficulties finding appropriate care, perianal disease and pressure ulcers close to the anus may also be reasons to choose a stoma for bowel management. Stoma for bowel management remains uncommon; one study suggested a prevalence in the UK of around 2.5% (Coggrave et al. 2009). There is no general consensus as to when colostomy should be performed in individuals. Aging and increased duration of SCI may contribute to bowel management difficulties (Faaborg et al. 2008) and with increasing life expectancy amongst people with SCI, stoma may become a more common management choice in the future.

Table 15a: Systematic Review on Colostomy

Table 15b: Colostomy after a Spinal Cord Injury

Discussion

Stoma formation is a relatively safe, effective and well-accepted method of managing significant neurogenic bowel management problems in individuals with SCI. Research findings suggest that stoma reliably reduces the number of hours spent on bowel care (Munck et al. 2008; Branagan et al. 2003; Rosito et al. 2002; Kelly et al. 1999; Stone et al. 1990; Frisbie et al. 1986), reduces the number of hospitalizations caused by GI problems (Rosito et al. 2002) and bowel care-related complaints (Frisbie et al. 1986), simplifies bowel care routine (Frisbie et al. 1986), reduces fecal incontinence and improves quality of life (Coggrave et al. 2012; Munck et al. 2008; Safadi et al. 2003; Rosito et al. 2002; Kelly et al. 1999). Stoma increases independence, facilitates travel, elevates feelings of self-efficacy, and does not negatively affect body image (Branagan et al. 2003; Rosito et al. 2002). Stoma was well-received by patients and either met or exceeded their expectations (Rosito et al. 2002; Coggrave et al. 2012). Many SCI subjects wished to have the stoma done earlier (Coggrave et al. 2012; Branagan et al. 2003). There have been a few complications including increased in bowel times in one subject receiving an ileostomy (Kelly et al. 1999) and increased odor in one subject receiving an enterostomy (Frisbie et al. 1986). Overall current evidence supports the earlier education of individuals with SCI regarding the option of stoma for bowel management.

Conclusions

There is level 4 evidence (from six studies) (Frisbie et al. 1986; Stone et al. 1990; Kelly et al. 1999; Rosito et al. 2002; Branagan et al. 2003; Munck et al. 2008) that colostomy reduces the number of hours spent on bowel care.

There is level 4 evidence (from one retrospective pre-post study) (Frisbie et al. 1986) that colostomy greatly simplifies bowel care routines.

There is level 4 evidence (from one case study) (Rosito et al. 2002) that colostomy reduces the number of hospitalizations caused by gastrointestinal problems and improves physical health, psychosocial adjustment and self-efficacy areas within quality of life.

There is level 4 evidence (from one cross-sectional study) (Coggrave et al. 2012) that colostomy reduces need for laxative use and dietary manipulation to assist bowel care.

  • Elective stoma formation is a safe and effective treatment for significant neurogenic bowel management problems and perianal pressure ulcers in persons with SCI, and greatly improves their quality of life.