Enterostomal therapy
Enterostomal therapy, also known as stomal therapy or ostomy care, focuses on the acute and rehabilitative treatment of patients who have undergone ostomy procedures. This therapy is essential for individuals who have had surgical openings created in the abdomen, such as colostomies or ileostomies, to manage conditions like colorectal cancer, diverticulitis, or bladder cancer. Enterostomal therapy aims to educate patients on caring for their stomas and managing associated challenges, including urinary or fecal incontinence and chronic wounds.
The process involves daily examination of the stoma, skin care, and the use of an external pouching system to collect waste. Patients are guided by enterostomal therapy nurses, who help them select appropriate pouches and teach essential skills for post-operative care. While the stoma itself may initially be swollen, it typically heals and reduces in size within six to eight weeks. The therapy not only addresses the physical aspects of recovery but also supports patients in resuming normal activities and managing emotional concerns related to their condition. Though the risks of complications exist, enterostomal therapy can significantly enhance the quality of life for those needing such surgical interventions.
On this Page
Subject Terms
Enterostomal therapy
ALSO KNOWN AS: Stomal therapy, stoma care, ostomy care
DEFINITION: Enterostomal therapy is the acute care and rehabilitative treatment of patients who have had an ostomy procedure.
Cancers treated:Colorectal cancer, familial adenomatous polyposis, bladder cancer
Why performed: Enterostomal therapy teaches patients how to care for abdominal stomas (surgically constructed connections between the intestines and the skin). It also includes care for urinary or fecal incontinence and treatment of chronic wounds or pressure ulcers.
A colostomy is a surgically created opening of the colon (large intestine) to divert stool, and an ileostomy is a surgically created opening of the ileum (end of the small intestine) to divert stool. Bypassing or removing part of the intestine or rectum may be necessary in the treatment of colorectal cancer, diverticulitis, or inflammatory bowel disease, especially when there is a blockage. The remaining end of the intestine is brought through the abdominal wall, where wastes are excreted through a stoma and collected outside the body in an external pouching system adhered to the skin. The location of the stoma on the abdomen is dependent on where the ostomy was created. In some ileostomy procedures, an internal pouch (called an ileoanal reservoir, ileoanal anastomosis, or “J” pouch), is constructed from the remaining end of the small intestine and connected to the anus to allow normal stool passage via the anal sphincter muscles. Sometimes, a colostomy or ileostomy is temporary, allowing the newly constructed gastrointestinal system to heal when part of these organs have been removed or resected.
A urostomy is a surgical procedure that diverts urine away from the bladder. The ileum or cecum (beginning of the large intestine) is surgically removed and reconstructed into a conduit created for the passage of urine from the kidneys through a stoma in the abdominal wall. The urine is collected outside the body in an external pouching system. A urostomy may be necessary in the treatment of bladder cancer. In some cases when the urinary sphincter muscle does not need to be removed, a “replacement bladder,” called an orthotopic neobladder, can be constructed from a section of the intestines and connected to the urethra to allow normal urination.
Patient preparation: Tests performed before ostomy surgery may include x-rays, ultrasound, colonoscopy or sigmoidoscopy, blood tests, urine tests, and an electrocardiogram (ECG). Complete bowel cleansing is required beforehand, and the patient will receive specific bowel preparation guidelines. The patient will also receive medication and dietary guidelines from an enterostomal nurse, which include following a clear fluid diet. Depending on the type of procedure to be performed, additional tests or patient preparations may be required.
Steps of the procedure: The steps required for enterostomal therapy vary greatly depending on the type of ostomy that the patient has had. In general, steps include gathering supplies; examining the stoma and condition of the surrounding skin daily and reporting abnormalities to the health care team; cleansing the skin; irrigating the stoma with water either daily or every other day; applying barriers, borders, or pastes to the skin around the stoma and applying the pouch; emptying the pouch when it is one-third full; and changing the pouch as prescribed (every one to three days).
After the procedure: Patients who have had an ostomy wear an external pouching system to collect stool or urine because they cannot control the passage of stool, gas, or urine through the stoma. The pouching system also protects the skin around the stoma. There are a wide variety of pouching systems, and an enterostomal therapy nurse will work with the patient to select a system that meets the patient’s preferences and lifestyle.
The stoma is usually swollen and large, but it will reduce in size once it has fully healed, within six to eight weeks after surgery. A nurse will teach the patient how to care for the stoma and skin around the stoma, change the ostomy bag, perform the irrigation procedure, and manage problems or emergencies. The patient will be required to demonstrate these activities independently before being discharged from the hospital. The patient will also receive resources for purchasing ostomy supplies.
The patient does not have feeling in the stoma, but abdominal pain, cramping, bloating, and discomfort are common for a few weeks after the procedure. Pain medication is prescribed as needed.
The patient is usually discharged in three to five days after the procedure, depending on the rate of recovery. Home care enterostomal therapy nursing services will be offered to aid recovery. Regular activities can usually be resumed within six to eight weeks.
After surgery, patients often have concerns about resuming regular activities, returning to work, and engaging in sexual activity. The nurse will discuss these concerns with the patient and can provide referrals to community support resources and other medical specialists as needed.
Risks: As with all surgeries, there are risks associated with ostomy procedures. Complications are rare but may include bleeding, need for further surgery, infection, or scarring. The health care team will discuss the potential risks of the procedure with the patient and his or her family or caregiver.
Results: An ostomy can be a lifesaving surgery, improving symptoms and allowing a patient to enjoy a full range of activities. Enterostomal therapies provide patients with the skills and assistance needed to properly recover.
Bibliography
Amer. Cancer Soc. "Stomas (or Ostomies)." Cancer.org. ACS, 5 Nov. 2013. Web. 14 Oct. 2014.
Amer. Soc. of Clinical Oncology. "Colorectal Cancer: Treatment Options." Cancer.Net. ASCO, Sept. 2014. Web. 14 Oct. 2014.
Aronovitch, Sharon. “Changing a Bowel Diversion Ostomy Appliance: Pouching a Stoma.” Delmar’s Fundamental and Advanced Nursing Skills. Ed. Gaylene Bouska Altman. 2d ed. Clifton Park: Thomson, 2004. Print.
“Enterostomal Therapy.” University Hospitals, www.uhhospitals.org/services/surgery-services/conditions-and-treatments/colorectal-surgery/conditions-and-treatments/enterostomal-therapy. Accessed 10 July 2024.
Fazio, Victor W., and Linda K. Aukett. "Ostomy Surgery of the Bowel." Natl. Digestive Diseases Information Clearing House. Natl Inst. of Diabetes and Digestive and Kidney Diseases, NIH, 13 Aug. 2014. Web. 14 Oct. 2014.
Kohnle, Diana. "Enterostomy." Health Library. EBSCO, 7 May 2014. Web. 14 Oct. 2014.
Miller, Scott. "External Incontinence Devices." MedlinePlus. US NLM/NIH, 2 June 2014. Web. 14 Oct. 2014.