An ostomy is a hole made by surgery to allow stool or urine to leave your body through your belly. It’s a new exit route for waste if you can’t poop or pee the way you usually would. Your ostomy’s exact spot on your abdomen will depend on your reason for the surgery.
At the hole, a small open end of your ureter or small or large bowel sticks out through your skin. This is called a stoma, and it will look red or pink. It has no nerve endings, so it shouldn’t be painful. Your surgeon will connect a pouch, which collects urine or stool, to your stoma.
Reasons for Ostomy
Your doctor might recommend ostomy to treat serious bowel problems or to let a body part heal after a surgery. You also might need an ostomy if certain organs are diseased or have to be removed.
The reasons include:
- Colorectal, rectal, or bladder cancer
- Injury to the bowel or bladder
- A serious bowel disorder, such as Crohn’s disease or ulcerative colitis
- A blocked bowel
- Diverticulitis (when tiny pouches in your colon become inflamed)
- An infection
- Fecal incontinence (loss of control over your bowel movements)
Types
Two main kinds of ostomy help remove feces, and one type diverts urine:
Ileostomy. The bottom of your small intestine, called the ileum, is brought up through your abdominal wall to make a stoma. This is often done if you have rectal cancer or inflammatory bowel disease.
Colostomy. If you have part of your colon removed, a colostomy can attach the remaining colon to the outside of your body.
Urostomy. The tubes that carry urine to your bladder are routed to your stoma. You might get this if you have cancer or other diseases that cause serious bladder problems.
You have options besides traditional ostomy. One is putting a pouch inside your body to collect stool, which exits directly through the anus.
A temporary ostomy can be removed later. Even a permanent ostomy can sometimes be reversed.
Surgery
You’ll be in the hospital and under general anesthesia, which means you won’t be awake or feel any pain.
Before the operation, your surgeon or specially trained nurse will find the best spot for your stoma, usually the flat front part of your abdomen.
The surgery will differ based on the type of procedure you need. Generally, your surgeon takes part of an internal organ, such as the bowel, and connects it to an opening in your abdominal wall.
A nurse or therapist will show you how to care for your stoma and how to empty your waste pouch.
You should be able to get back to your regular activities a couple of months after the surgery. You may need to avoid driving and heavy lifting for 2 or 3 weeks. After you’ve recovered, you’ll probably be able to go back to most activities except for contact sports like karate or football.
Common issues that come up later include gas, diarrhea, and constipation. Talk to your doctors if these problems are severe or don’t go away.
Complications
Sometimes, you might have problems after an ostomy surgery. They can include:
- Itchy, red, or irritated skin around your stoma
- Bleeding inside your body
- Infections
- Blockage in your small or large intestine
- Problems with your stoma, such as a hernia (weakening of the abdominal wall) or prolapse (when the bowel pushes through the stoma)
- A vitamin B12 deficiency
- An electrolyte imbalance
- Discharge from your bottom
- Problems absorbing water, vitamins, and other nutrients
- Feeling the urge to poop
Tell your doctor if you have any of these symptoms or any other problems.
Life With Ostomy
It will take time to get used to going to the bathroom in a different way. After the surgery, your stool will come out through the stoma and empty into a disposable bag.
How often you’ll poop or pee will depend on what you eat, the type of procedure you had, and your bathroom patterns before the surgery.
You may need to change your diet to control your bowel movements for a little while after surgery. But you should be able to eat what you want once you fully recover.
You might worry about negative reactions from your friends, family, or sexual partner. When you’re out, your clothing will cover your ostomy, so most people won’t even know about it.
If you have a hard time with the social, emotional, and practical changes in your life, talk to your doctor, family, and friends. You might join a support group or work with an enterostomal therapist, who’s trained on the day-to-day issues of living with a stoma. It can be easier for you to adjust when you have support from others.
Tips for Intimacy After Ostomy
When you have to get a stoma or ostomy bag as part of your colorectal cancer treatment, it takes some getting used to. The surgery may change the way you feel about yourself, your body, and sex for a while.
If you’re curious about sex and intimacy after an ostomy, it’s a good sign that your body and mind are ready to move forward. These tips will help.
Doctors often recommend waiting 3 weeks after the surgery, but it’s up to you. Some people head back to the bedroom as soon as they can as a way to connect with their partner and their pre-surgery life. Others may not think about it for months or years. It’s most important to be comfortable with your body and confident with your stoma first. Once it feels like part of you, the rest will follow.
Things may be different
After ostomy surgery, common sexual side effects may include erection problems, vaginal dryness, not being able to reach orgasm, and pain. But those problems may be temporary. So if you still have any of these issues after the first few times you have sex after your surgery, tell your doctor. Some medications can also lower sexual desire and cause ejaculation and erection issues.
Prep your pouch
You might feel less spontaneous about sex when you have a pouch. Before you head behind closed doors, empty and clean your pouch, and then make sure the seal is tight. If it makes you feel better, use paper tape for an added layer of security. Once you do that, focus on being present in the moment, not on the pouch.
Ease the odor
If you’re worried that the smell of your pouch might be a distraction, try a deodorizer. Various brands make them in tablets, drops, and sprays. There are also pills you can take to curb the odor of your own waste. See what your doctor recommends.
What to wear
A “passion pouch” is smaller than a regular bag and has a closed end instead of a drain. (You’ll need to switch back to your regular pouch later.) You can also use a pouch cover to camouflage things a bit. You can find clothing that gets you in the mood and hides your pouch at the same time. Special boxer shorts and cummerbunds for men and crotchless lingerie help hide a pouch, for instance.
Take sides
Get creative with positioning that doesn’t hurt and keeps your pouch out of the way. Try the side position on the same side as your stoma.
Talk it out
Just like in any relationship, communication is key. As much as you’re comfortable, share any fears and physical issues with your partner. Talk about what you like, don’t like, and what you’re willing to try. Being open is just as important as being a good listener when it’s your partner’s turn to talk.
When it’s time to stop talking and start trying, it’s not unusual for anxiety to follow you into the bedroom. Take a deep breath and remember, nothing’s sexier than a good attitude and a sense of humor about whatever comes up along the way.