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Thread: Do you have a colostomy?

  1. #1

    Do you have a colostomy?

    Does anyone have a colostomy? Do you find it easier than the bowel program?

  2. #2
    I had to get a colostomy 2 1/2 years ago. I got
    it because my anal fissure was not healing. I
    stayed off of it for about 5 weeks. This would
    have healed my fissure if on the 3rd day in the
    hospital, when they put zinc on my sore, it burned
    me real bad. Then I suspected a yeast infection
    so I did not help it by putting lotrimin on it for 5
    weeks also. When you get a colostomy, doctors
    make you wait 3 months before you can reverse it. I was not encouraged to irrigate although many SCI's do, did, or does. It put out very very little stool. By the end of the second month I started drinking very large amounts of water to try not to get impacted. I also ate little. If the stress was not enough then the anus fissure began to hurt. When you drink too
    much water, gas gets trapped and it fires up the paralyzed nerves. After 3 years of laying in
    bed, today with an ileostomy there are days of
    pain. I am still in bed wishing for the day that
    I can insert a suppository and sit up in my wheel chair again. If you have to get one then maybe the ileostomy is better if you have to stay in bed to heal. I am praying that I can get
    back up to doing bowels without pain and blood. I am C4/5 for 15 years now. 38 years old and it is
    a bad thing to try to fix something that is not broken. The other differences are the foods that you should try to avoid. Ileostomies don't get a wide variety of foods. Colostomies are not much better. I would rather die than have this gas trap machine.

    David

    david tippitt

    [This message was edited by david65 on 07-08-03 at 05:20 PM.]

  3. #3
    Moderator Obieone's Avatar
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    I have been wondering about that question myself Lightning as my husband has an ileostomy now since his stomach surgery! It seemed to me it might be easier(more convenient?) to live with than spending all that time on the can doing a bowel routine but I think I understand the issue of control David refers to. Looking forward to seeing some other replies!

  4. #4
    I have quite a few clients who have had elective colostomies due to either skin issues or prolonged bowel programs (taking 2-4 hours) that would not respond to any other interventions. Most of them are enthusiastic supporters of this due to the time savings and many are now more independent.

    Published studies indicate that most people with SCI who have had a "temporary" colostomy placed have opted not to have it reversed when this was offered.

    This is certainly not the first option that should be pursued (for a new injury, for example) but may be an option down the road for many.

    (KLD)

  5. #5
    As you will know, I am following up
    on my own reply. It may seem contrary
    to my first post. But since I already
    can say first hand from experience, it
    is a very important and can be complex
    problem that I take seriously. Actually,
    because of the possibility of irrigating
    a colostomy, which I didn't do the 1st time
    around, I can't say for sure. To ileostomy or
    colostomy???

    Plus, in my circumstances, my anus (fissure)
    may break open again if or when I do get to
    reverse and try bowels again. It is a very
    depressing thought for me. But if I got a
    colostomy and irrigated that might solve the
    problem I seem to be having with pain. I can
    say that not using parts of the colon is most
    likley going to lead to diversion colitis or
    worse. I have had my ileostomy for 10 months
    now and I have the colitis.
    I would rather play it safe and try a colostomy, possibly irrigate this time, also
    including flushing out the unused colon thru
    my rectum (anus) with fatty chain acid medication.

    I would like to ask, curious and puzzled, when irrigating
    how is it done, anyone doing this? I
    have read on the UOA forum that a pouch is not
    worn when irrigating!!! This is not what I
    thought. I thought you kept the flange on at
    the least. I could have misunderstood or read
    it wrong. I also hope to successfully do some
    thing soon ... so please pray in early September.


    David

    david tippitt

    [This message was edited by david65 on 07-11-03 at 06:08 PM.]

  6. #6
    Irrigating for colostomies is generally done with the colostomy is in the distal colon (at least the descending colon) as this is when the stool is more solid. You can then irrigate and cover the stoma with a stoma cap or dressing between days. The irrigation is just like an enema, and is done every 2-3 days. A special irrigation sleeve is attached to the faceplate to do this, and you can do it in bed or sitting in the bathroom facing the toilet (or sitting on the toilet with the sleeve between your legs).

    If the colostomy must be done in the proximal (first part) of the colon, then the stool is more liquid, and a bag must be worn all the time as stool can come out any time. Irrigation has no advantage in this case.

    If you have colitis, generally an ileostomy is continued, although a proximal colostomy may be possible for some if the disease process only involves the distal colon.

    (KLD)

  7. #7
    SCI Nurse Question,

    Colitis may be reversable in some types
    of colitis in your experience? I am not
    a doctor, but my impression I got from
    my doctor and some research on internet
    seems to suggest unless the infection gets
    no attention, then it can turn into mega-
    colon and possibly some other problem.

    Here is some info: see attachment

    Not sure yet what the last sentence means.



    david tippitt

    [This message was edited by david65 on 07-11-03 at 09:36 PM.]

  8. #8
    This depends upon the type and cause of the colitis. For example, people with ulceritive colitis rarely recover from this condition.

    If you have colitis, generally an ileostomy is continued, although a proximal colostomy may be possible for some if the disease process only involves the distal colon.
    This means that if the disease (colitis) involves the entire colon, not just the last section, usually the ileostomy remains permanent.

    (KLD)

  9. #9
    I have diversion colitis at the least. Do
    you know if this is reversable like some
    say. Timing is important - the longer the
    inflammation the higher the risk.

    I feel weak at times and I guess a fissure
    may be painful indeed, and my future may be
    tough, just hoping the colitis can get ok.

    Do you know of any SCI's that have healed?

    God Bless,

    David

    david tippitt

  10. #10
    I really don't know much about diversion colitis. You may want to try posting on a forum for those with colitis for more information. This is what I was able to find from one resource (sorry it is in medicalese!!). This is from Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/ Diagnosis/Management, WB Saunders, 2001.


    Diversion Colitis
    Background and Epidemiology
    Diversion colitis is an inflammatory process that occurs in segments of the colon and rectum that are bypassed after surgical diversion of the fecal stream. The entity was first reported in 1981 by Glotzer and associates in ten patients who had undergone ileostomy or colostomy for various indications other than inflammatory bowel disease (IBD). Since then, diversion colitis has been found in patients who have undergone surgical diversion for any indication, including IBD; indeed, diversion colitis has been reported to occur more commonly in patients with IBD (89%) than in those with carcinoma (23%) and other non-neoplastic conditions (50%). The prevalence of diversion colitis has been underestimated because many patients are asymptomatic; however, histologic changes may occur in all patients within months of surgical diversion.

    Pathology
    A spectrum of histologic changes has been described, ranging from lymphoid follicular hyperplasia and mixed mononuclear and neutrophilic infiltration to severe inflammation with crypt abscesses, mucin granulomas, and Paneth cell metaplasia. However, large ulcers and transmural changes are absent, and crypt architecture is generally preserved. Endoscopic findings include erythema, friability, nodularity, edema, aphthous ulcerations, exudates, and frank bleeding, as in idiopathic IBD. After extended periods following diversion, inflammatory pseudopolyps, strictures, and aphthous ulcers may develop.

    Pathogenesis
    Diversion colitis appears to be caused largely by luminal nutrient deficiency of the colonic epithelium. The principal nutrient substrates of colonic epithelium are luminal short-chain fatty acids (SCFAs), which are metabolic products of carbohydrate and peptide fermentation by anaerobic bacteria. Roediger demonstrated that SCFAs are the major and preferred energy source for colonic epithelium and that the distal colon is more dependent on SCFAs for its metabolic needs than is the proximal colon. 134a Butyrate supplies the bulk of oxidative energy to the distal colon, whereas acetate, glutamine, and ketones provide alternative sources of energy. Harig and associates demonstrated that the excluded segments of colon contain negligible amounts of SCFAs and that infusion of glucose results in no appreciable anaerobic fermentation.[135] Obligate anaerobes are reduced in number in the excluded colon, consistent with reduced SCFA production. Moreover, instillation of enemas containing SCFAs resulted in disappearance of endoscopic changes within 4 to 6 weeks in four patients, whereas resolution of histologic abnormalities was slower but incomplete.

    Although SCFA deficiency has been widely accepted as the cause of diversion colitis, other observations suggest that SCFA deficiency may not be the entire explanation for diversion colitis. First, studies in children indicate that SCFA enemas are not universally successful in treating diversion colitis. Second, in germ-free rodents with surgical diversion and in patients receiving long-term parenteral nutrition or elimination diets (all circumstances in which luminal SCFA concentrations are low), mucosal atrophy rather than inflammation occurs. Third, inflammation does not occur in urinary colon conduits, where the fecal stream is diverted, and urine does not contain measurable SCFAs. Finally, in a prospective randomized double-blind study of 13 patients with diversion colitis, butyrate enemas given for 14 days provided no improvement in either endoscopic or histologic parameters. In a subsequent study by the same group, administration of SCFAs did not affect the bacterial population in the excluded colon. Other luminal elements besides SCFA deficiency must play a role, but the nature of such factors is unknown.

    Diagnosis
    The diagnosis of diversion colitis is based on the clinical picture, endoscopic findings, and histology. Diagnosis is relatively straightforward in a patient without preexisting IBD, but radiation colitis and ischemia should be considered in the appropriate clinical setting. Stool specimens for Clostridium difficile toxin, ova and parasites, and cultures are usually adequate to exclude other etiologies.

    In patients with a preoperative diagnosis of Crohn's disease, diversion colitis must be distinguished from recurrent IBD. Colonoscopic findings such as linear ulcers and possibly strictures are said to favor Crohn's disease, as do transmural inflammation, marked crypt architectural abnormalities, and epithelioid granulomas. Lymphoid hyperplasia occurs in both disorders but tends to be more prominent in diversion colitis. If rectal involvement with Crohn's disease is absent prior to diversion, rectal inflammation is more likely to be caused by diversion than Crohn's disease.

    Treatment
    The preferred treatment is surgical restoration of colonic continuity, which rapidly reverses symptoms and histologic changes. If symptoms are moderate to severe and reanastomosis is not feasible, SCFA enemas containing a mixture of 60 mmol of acetate, 30 mmol of propionate, and 40 mmol of butyrate with 22 mmol of sodium chloride per liter are administered into the anus or mucous fistula twice daily for 4 weeks and then decreased to once or twice weekly. There are anecdotal reports that 5-aminosalicylate enemas are effective as well.
    It would appear that the best way to treat this is to undo your colostomy and hopes that it heals. Unfortunately this may also make your anal fissure worse. I would suggest getting a second opinion from another GI surgeon before you do this.

    (KLD)

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