What is Parastomal Hernias?

A hernia is an abnormal growth of the bowel at the abdominal wall. It occurs on a weak part of the walls. It mainly affects the stomach or the intestines. A large protrusion often forms around and the intestines. The size of this protrusion depends on the size of the area, which was weak, and the stoma came through. If the size of the weakened area is small, then a small protrusion forms, but if the size of the weakened area is big, then a big protrusion that is noticeable will form. A hernia around the stoma is what we refer to as parastomal hernias.

This condition affects 5% to 10% of people with colostomies and 3% to 10% of people with ileostomies. It is difficult to tell who can get parastomal hernias and who can't. However, some factors make people vulnerable to contracting this complication. They include;

Site of the stoma

When a stoma is made outside the rectus abdominus muscle, then you can get a hernia around the stoma.

Age

The older you become, the weaker your muscles become. When this affects the abdominal muscle, then herniation can happen at any given time.

Obesity

People with excess weight are more vulnerable to getting a hernia because their weight puts too much pressure on abdominal muscles, making them weaker hence the possibility of a hernia.

Malnutrition

Poor eating habits especially lack of a balanced diet during the stoma surgery recovery period, is dangerous. This is because it might delay the normal healing of the abdominal wall, which is a sign of weakness.

Infection after stoma surgery

An infection might eat up muscles and eventually create a weakness on the abdominal walls.

Increased intra-abdominal pressure

This pressure exerted on the abdominal muscles might come from frequent severe sneezing, lifting of heavyweights, and chronic coughing. This pressure, especially from the heavyweights, is dangerous because it can even cause muscles to tear.

Parastomal hernias may develop very soon after surgery or may take years to build these depending on the patient's condition. 80 % of people who have undergone surgery do not struggle with a hernia. People with a hernia learn how to deal with it after medical intervention.

People often describe Parastomal hernia through its abdominal discomfort. It causes a feeling of fullness in the parastomal area that is not painful but is however uncomfortable. This is dealt with by supporting the hernia with a unique elastic hernia belt. A lycra-type undergarment can also help to make you comfortable. Belts need to be measured accurately to fit your abdomen. If you are having severe pain resulting from the stoma or hernia, you should seek help from an Enterostomal Therapy nurse. The nurse helps you to choose between a belt and a lycra undergarment.

According to your movements, a parastomal hernia can also change the size and shape of the stoma. This may cause a leak in your appliances and even lead to skin problems. When you cannot see your stoma to take care of it, you should contact your nurse for assistance. The hernia affects the normal functioning of the stoma.

In conclusion, the parastomal hernia can be avoided, and in case you get it, it can be dealt with well with the help of medical professionals.

How does it actually work for Ulcerative Colitis? J-Pouch the life savior

The type of Inflammatory Bowel Disease (IBD) that leads to the inflammation in the lining of colon and rectum is called Ulcerative Colitis.

Mostly the patient with ulcerative colitis doesn’t need a surgery .But people who have been suffering from UC for 30 years or more need a surgery.

It has been studied and observed by Crohn’s and Colitis foundation that J pouch is the only procedure in which ulcerative colitis does not react with any medication.

This article will basically tell you how J pouch actually works for UC and what to expect after and before the surgery among the risks and benefits.

What actually a J-pouch is, and what is it’s the working mechanism?

Another name for J-pouch is protocolectomy with ileal-anal anastomosis (IPPA).

After the removal of large intestine (Colon and rectum), the surgeon creates a J-pouch in the body. Just after the removal of large intestine, the surgeon folds small intestine into J shape. This pouch helps to collect the waste, which is then connected with anus, the opening of rectum.

A pair of sphincter muscles that surrounds the rectum remains in the same position even after the surgery. These muscles allow controlling the feces.

The anus also remains on its place even after the surgery. There is no need for long term ostomy pouch or stoma, if a person has gone through the J-pouch procedure.

What happens during the surgery?

The surgery mainly consists of two to three processes.

In the beginning, the surgeon removes the rectum and colon leaving the anus and the sphincter on their place. Then they use small intestine and convert one of its end into a J shape pouch, and then attach it to the anus.

The first process is termed as ileostomy. In this surgery, a hole is created in the wall of abdomen and one end of small intestine is connected to the opening of this hole. This aids feces to reach the ostomy bag; meanwhile the sphincter and small intestine are under healing process.

The second procedure is performed after 8 to 12 weeks of the first surgery .In this operation the ileostomy is reversed by using small intestine and connecting it back. This will allow the normal bowel movement.

In some cases surgeons needs to perform surgeries in three different steps:

• Removing of colon and forming ileostomy

• Removing of rectum and formation of J –pouch with the help of small intestine.

• Reconnecting the intestine and reversal of ileostomy

The people with following issues have higher chances to have three surgeries:

• Poor health conditions

• An emergency case that needs to stop the bleeding

• Toxic megacolon

• Taking high dose steroids

What happens after the surgery?

A patient needs to be in hospital for the recovery and in order to learn the basic care for UC.

After the second and third procedure, a patient will need a short stay at the hospital till the doctors allow him to leave.

The signs that are observed by the patients during healing are:

• Diarrhea

• More number of bowel movements, which is due to loose feces

• More urging need to pass feces at night

• Tiredness, which will get better with healing time. 

• Blood seen in feces

• Loss of water (Dehydration)

• Every surgery has some risks. The risks that are associated with J-pouch surgery are:

• Fastulas and pelvic abscesesses

• Failure to make a pouch

• Defect in pouch orientation

• Pouchitis

It is also reported by American College of Gastroenterology that may be hard for a patient to conceive or get pregnant naturally, following this surgery.

Pouchitis is the most known issue. It can be treated by completing a course of antibiotics.

If the surgery is performed by an expert and an experienced surgeon then there are less chances to have any other complexities.

Advantages:

J-pouch procedure frees a person from life time need for an ostomy bag. Psychologically, it’s also beneficial to pass feces normally through the anus instead of the stoma.

It also does not have any significant effect on the current medication of the patient. Many people will feel a reasonable reduction in the pain level, urgency to pass stool, and diarrhea.

Conclusion:

J-pouch surgery basically involves formation of a colon by folding small intestine into a j-shaped pouch, with the removal of large intestine. This surgery allows a person to pass out feces normally and significantly reduces the discomfort levels and pain. It’s a very common and reliable procedure for the patients who are under a stress regarding their ileostomy.

Proctectomy Surgery for IBD

 There are different kinds of surgeries used for treating IBD, or inflammatory bowel disease. Sometimes it does involve removing the anus and the rectum, and that’s called a proctectomy. 

When both are removed, they usually offer a colectomy, and an ostomy is then done to help remove the stool. If you have UC of Crohn’s disease, usually ileostomy may differ between both of these where the small intestine is pulled through the abdomen towards the outer portion of the body, to make a stoma. Then, the ostomy pouch is worn to collect the stool, emptied a couple times a day. 

What Proctectomy Surgery can do 

Proctectomy surgery can help with rectal cancer, since it does remove this. It also may be done during J pouch surgery, which is done in those who have ulcerative colitis. For the people who get this, they leave the anus, and the last of the small intestine, making it a J and holds your stool just as how the rectum did. 

When the anus also gets taken out, this part of the body is then surgically closed up. Some remark that it’s a “barbie butt” because it reminds them of what the doll’s bottom part looks, and there isn’t a structure there to get the stool out. Proctectomy is a huge surgery, and it s done with general aesthetic, and everything that involves it. 

After the proctectomy and the removal of the anus especially in cases of IBD, they give you a permeant ileostomy. This can be hard for some patients to talk about, but it should be discussed. 

If you have IBD, this can be lifesaving and improve the quality of life in some cases. Those who have IBD and the disease near the anus and rectum deal with lots of pain, different interventions and appointments to help with the fistulas and abscesses. 

After you get proctectomy surgery, usually if you have complications you still feel better, and a better quality of life. 

Why They’d Remove the Rectum 

Those who have Crohn’s disease will get their rectum removed in abut 12-20% of instances. That’s because if the Chron’s disease is affecting the perianal area, it will be monitored and bettered through the removal of this. 

Crohn’s disease also may cause fistulas and abscesses, and they can cause major pain and take forever to heal. In some instances, ileostomies for some time to avoid stool in the area and drains may help, but when they don’t fix the problem, you might need a proctectomy. 

Those who have ulcerative colitis that don’t get a J pouch surgery or aren’t able to have surgery due to perianal problems, this is usually an option too. For a small minority with UC, there is a chance that the rectum might be inflamed, and this surgery may also be recommended since it’ll help you. 

There is also the rare risk of rectal cancer that also may call for the removal of this area, also lowering the risk too. 

What the Surgery entails 

Usually, after it’s been decided, you’re put under general anesthesia and are at the hospital for a few days.  They usually have pain management too, and you typically come home with an ileostomy too, and of course your nurse will help you understand how this happens. 

You also will have stitches where the anus closes up and might need to be cleaned too. 

Overall, this can save your life, and while it may seem like a very long, invasive surgery with a lot that’s going on, it can ultimately help improve the quality of life you have. 

Ulcerative Colitis Surgery: Things you must know

Ulcerative colitis is a kind of disease in which there is an inflammation in the colon and rectum along with irritation and sores. In some cases, medicine can be effective but sometimes surgery is required.

According to Crohn’s and Colitis Foundation, 25 to 40 percent of people suffering from ulcerative colitis need surgery.

Nowadays there are two basic methods for this surgery. This method depends on the age and other medical reports of the patient.

Mostly, people lead a very healthy and prosperous life following the surgery. This article is written for you to learn about the basic things related to ulcerative colitis surgery.

What ulcerative colitis surgery?

An ulcerative surgery becomes crucial if the medication has and other treatments are no more effective.

In case of colon cancer and precancerous changes, ulcerative colitis is required.

Having ulcerative colitis for more than 8 years can develop the chances of colon cancer.

In case of any perforation or bleeding in the colon, emergency surgery is required.

Types

Proctocolectomy with ileostomy

There are two main types of ulcerative colitis surgery:

Proctocolectomy with ileostomy involves the following events:

• Removal of the large intestine

• Placing one end of the ileum to a region in the lower abdomen, mostly on the right side.

• Create a surgical hole in the lower abdomen, termed a stoma

• Passing an end of the ileum through the stoma and connecting the intestine with the skin. This will create an orifice from the small intestine to the exterior of the body.

• Placing an ostomy bag, a bag, or pouch over the stoma. This pouch helps to collect the waste from the small intestine. And then this pouch is emptied into the toilet many times a day.

The feces that move out of the small intestine are not in a solid-state which is why it is hard to notice its movement into the pouch.

It’s not under the control of any patient to control the passing of feces, this is because a stoma has no muscles. Currently, the ostomy bags that are available in markets are very advance. They are flat, odorless, and blend completely with the dress.

After proctocolectomy along with ileostomy, a patient needs to take care of the stoma and should have basic training about the pouch and stomal care.

Some of the bags or pouches are disposable while some can be washed and used again. It depends on a patient’s choice.

• Proctocolectomy and ileoanal pouch-anal anastomosis

This is a new process that assists a patient to pass out feces naturally through anal. Most of the time this surgery is termed as J pouch surgery or ileoanal pouch reservoir surgery.

In this procedure, the anus is preserved rather than its removal. Following events occur during this surgery:

• Removal of the large intestine (colon and rectum), keeping anus safe.

• Making a J pouch or ileoanal reservoir using the small intestine. This internal pouch is used to collect the waste.

• Attaching an internally created pouch with the anus.

• Feces start to accumulate in the pouch and leave the body through the anus, making bowel movements normal and easier.

A patient can feel feces moving out of the anus and he or she will be able to use the toilet normally if they have strong and good anal muscles.

Though the anus has been preserved but still bowel movements are very loose or watery because the colon has been removed.

Fecal incontinence may be seen in some patients. There is nothing to worry about. It can be cured with medicines. It is necessary to have good anal muscles to avoid any incontinence.

In most cases, IPAA is performed in different stages. In the first step, a pouch is created and attached to the anus. Then this bag is left alone for healing, for many weeks.

A transitory stoma is created until the second surgery occurs.

Following 2-3 months this temporary stoma will be closed and waste will be redirected to the internal pouch and pass out through the anus.

Preparation

Preparation depends on the type of surgery. You will be given a detailed overview before the surgery.

Usually, a patient is advised to keep their bowel empty by practicing “bowel prep”. 

Patients may be asked to drink a laxative drink, have antibiotics, and are not allowed to take any solid food item 2 days before surgery.

Always ask your doctor before taking any kind of antibiotics or other drugs before the surgery. It may be allowed to have some medicine with a sip of water but usually, a patient needs to stop taking medicines.

Recovery:

If a surgeon performs the surgery using a long incision, termed as open surgery, then a patient needs to stay in hospital for many weeks.

While in some cases a less invasive surgery, termed laparoscopic surgery is used, then a patient can leave hospital earlier.

Still, it will take several weeks for both types of patients to recover fully.

Right after the surgery, a patient is shifted to recovery. In the recovery room catheter for urine and other drainage tubes are attached with abdomens.

As soon as a patient becomes conscious, the surgeon will tell the details about the removal of drainage tubes and catheters as well. A doctor may advise a patient to sit and have a walk if it is safe for him, this prevents blood clotting.

Complications

The most occurring complication is intestinal obstruction.

Symptoms of obstruction or blockages are:

• Worsening abdominal pain

• Thin, transparent, and foul-odor fluid in the bag

• Vomiting

• Liquid reduction in the pouch

• Bloating around stoma

If you notice any of the following symptoms, you should immediately contact your doctor.

Patients suffering from IPAA must notice the signs of pouchitis. This term is used for an infection in the internal pouch. It can be treated by taking antibiotics.

Nearly half of the patients have chances to get pouchitis. The main symptoms of pouchitis are:

• Diarrhea

• Increased bowel movements

• Pain in abdomen

• Temperature

• Pain in joints

Diet:

Without a colon, it is difficult for the body to digest food. That is why a patient needs to be more conscious about the diet.

It is advised to take small meals many times a day instead of having a large quantity at once.

The food items that are prohibited by the doctors are:

• Dry fruits such as dates, figs

• Raw fruits and veggies

• Spicy foods

• High sugar foods

• Coffee and caffeine food

Foods such as bananas, rice, potatoes can be healthy because they are called binding foods. Drinking a lot of water can help you to avoid dehydration. This will keep your intestines healthy.

 

Conclusion:

Even though ulcerative colitis is life-changing but it has positive aspects as well. This can help you to get rid of a permanent ostomy.

A doctor can guide you about every detail.

Moreover, therapists and support groups are available for the help of emotionally unstable patients.

Everything about ileostomy reversal

An ileostomy is a surgical process in which an incision is made in the abdominal wall and it prevents abdominal walls from any damage. Feces pass through this opening, termed as stoma, without passing through the rectum. In some cases ileostomies are permanent but on the other hand, a reversal is required.

A surgeon creates an ostomy in case of any trauma or colorectal cancer. It is performed to prevent bowel leakage in the abdomen, which can be fatal, after the surgery.

If the surgery is successful then a patient undergoes ileostomy reversal.

This article will help you to understand ileostomy reversal in more depth, also the complications and aftercare.

Procedure:

This procedure is completed in 40 minutes. Following events occur during the surgery:

• A hole will be created by the surgeon in the abdomen so he can access the ostomy down to the connective tissue around the intestines, called fascia.
• Then they will decide which the area for joining two parts of any intestine.
• Next, they will join these two intestinal parts together. This is often termed anastomosis.
• At last, they will close the connective tissues around the intestine and the hole that was created in the belly.

The perspective of this surgery depends on the initial surgery performed by the surgeon.

For examples, the perspective can vary in:

•  Orientation of the incision
• Closing method of anastomosis
•  If the surgeon has used a synthetic mesh over fascia in order to avoid a hernia.

It is necessary for a surgeon to discuss the complications with the patient before and after the surgery.

Timing:

There are different factors that contribute to the timing of the reversal post-surgery. These can be the following:

• Recovery record of the original ileostomy.
• Whether a person needs a chemo or radiotherapy following the surgery.
• Stage of cancer
• Surgeon and the patient’s preference

 

According to the most of the researches a post-surgery are done 3 -6 months following an original ostomy, until there are no issues or complications related to initial surgery.

Whereas the study shows that early stoma closure prevents any complications rather than the late stomal closure.

According to study in 2015, patients who have a gap of 6 months between both surgeries has more chances to develop complications.

Complications:

·        Hernia: If there is bowel leakage directly into the abdominal cavity, this will cause a hernia. It can occur at the location near the wound or the scar. Old age people have higher chances to get a hernia, which shows within the time period of 2 years of the ileostomy.

·        Anastomotic leakage: It’s a very rare situation. In this case, there is leakage at the point of bowel junction. Another surgery is needed to overcome this issue.

·     Abdominal leakage: In this case, infected fluids accumulate inside the abdomen. This can cause inflammation, high fever, and bowel discomforts. This can be treated by bowel drainage and taking antibiotics.

When to see your doctor:

If a patient notices any of the listed signs, he or she must contact his doctor immediately.

Leakage or blockage

• These signs include:

• Intense stomach pain
• Inflammation
• Vomiting
• Nausea
• Short breath
• Unusual Fatigue
• Difficulty in water consumption
• Discomfort during passing urine
• Diarrhea

Infection

There are the chances that fluid present in the abdomen can be infectious. See your doctor if you feel following signs:

• Temperature
• Pain
• Bloating
• Worsening diarrhea

Healing:

Usually, it’s necessary for a person to wait for the healing of the ileostomy and the incision, following reversal surgery.

It has been reported that reversal surgery takes less time for healing as compared to the initial ileostomy surgery. Maybe a patient has to stay in the hospital for 3-4 days.

A person should remain calm and should know the fact that it will take some time to regain normal bowel functioning. Initially, a patient will notice small but frequent movements and passing of gas. A patient needs to stay in hospital until their bowel movements get back to normal.

The incision that was made usually takes 4-6 weeks for a full recovery.

Recovery:

A patient needs to discuss the details with the doctor about the ileostomy reversal.

As soon as the feces start to pass normally through the rectum, the doctor will suggest the following tips for a speedy recovery.

·   Diet:

A patient is advised by a doctor to have selected food items, following their reversal ileostomy. A A low fiber diet called BRAT is suggested to prevent frequent bowel movements. BRAT means:

B stands for bananas

R stands for rice

A stands for applesauce

T stands for toast

It is recommended to have small meals several times instead of eating a lot at a single time. This will prevent any kind of discomfort or inflammation.

The foods that should not be taken by the patients are:

• Chocolates
• Coffee
• Juices
• High carbs food
• Spicy food
• Sugarless food items

·        These food items can cause gas and stomach pain.

Bowel movements:

It is often hard to pass feces after the surgery, since the rectum needs to regain elasticity so that it can store feces again.

Bowel discomforts can be prevented by:

• Applying any kind of moisturizer or skincare product, for example, petroleum jelly or baby jelly; around the anus area right after the bowel movement.
• Soak yourself in Luke warm water, for at least three times a day.
• Use hydrated wipes to clean the anus after passing stool.
• Taking any prescribed medicine

Physical Therapy

Usually, pelvic floor therapy is recommended by doctors. It will help a patient’s pelvic floor muscles to pass a stool normally.

But most of the doctors suggest waiting for a minimum of 6 weeks following the ileostomy reversal, starting this therapy.

 Conclusion:

Ileostomy reversal surgery assists a person to have normal bowel movements and stool passing.

This is less protruding less painful and less time taking than the initial ileostomy. Therefore a patient recovers more fatly.

A patient needs to be careful about the diet and bowel movements.

A physician, nutritionist, or a physical therapist can help a patient to avoid any kind of complications and to recover speedily.