RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling

1. RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling Ostomy Surgeries

2. Ostomy Surgeries • Numerous medical conditions, including congenital defects, trauma, inflammatory bowel disease (IBD),and bowel and bladder cancer, can be treated by ostomy surgeries • These surgeries close the normal route of elimination of bodily wastes and create a new opening (stoma)

3. Ostomy Surgeries • GI Stomas • Jejunostomy • Ileostomy • Cecostomy • Colostomy

4. Colostomy • Colostomy: A surgically created opening in the abdominal wall through which digested food passes. • Temporary colostomy • Permanent colostomy • Reasons for surgery: Cancer, diverticultis trauma, imperforate anus • Vocational impact – restrict heavy lifting

5. Ileostomy • A surgically created opening in the abdominal wall through which digested food passes. The Ileum (the lowest part of the small intestine) is brought through the abdominal wall to form a stoma. A Ileostomy is performed when a disease or injured colon cannot be treated successfully. • Vocational implication – restrict heavy lifting.

6. Jejunostomy • Can be used for either feeding or removal of stool, depending on if the stoma is at the beginning or end of the Jejunum. • Feeding: A tube is placed into the jejunum versus the stomach (gastrostomy). People with a jejunostomy can eat and drink by mouth. The device is an “insurance” mechanism for nutrition. It can be temporary or permanent. • Stool removal: in certain instances a jejunostomy is conducted similarly to the Ileostomy. Again, this usually temporary.

7. Cecostomy • A tube that goes through the skin into the beginning of the large intestine to help remove gas or feces by injecting a solution (antegrade enema) that flushes the gas and stool out of the rectum. • Can be temporary or permanent.

8. Urinary Stomas • When a urinary stoma is created, the urine does not go to the bladder. The urine is rerouted through an opening on the abdomen (stoma) created by a surgeon. • Vesicostomy:An opening in the bladder created to connect the bladder to an opening on the lower abdomen. • Ureterostomy: The ureter (or ureters) is attached to the skin’s surface through a small opening in the abdomen. • Ileal conduit: A small section of the ileum (small intestine) is used to create a passage for the urine to exit the body. This section of the small intestine, called a conduit, is attached to the abdominal wall to create a stoma. The urine flows from the kidneys, through the ureters, and out the stoma

9. Psychosocial/Vocational implications • Vocational Implications • Ostomy surgery itself does not present obstacles to most vocational functioning – underlying disease process may influence RTW • Changes in body image • Economic costs of living with an ostomy can be considerable when complications from the stoma or disease process develop • Provide information and education to the person in a manner that relays a message of acceptance

10. Additional Resources and Information from the Web • United Ostomy Association (www.uoa.org) • International Ostomy Association (www.ostomyinternational.org) • World Ostomy Resource (www.powerup.com.au/~takkenb/OstomySites.htm) • Crohn’s Colitis Foundation of America (www.ccfa.org) • Oley Foundation (www.oley.org)