ileostomy

An ostomy is surgery to create an opening (stoma) from an area inside the body to the outside. It treats certain diseases of the digestive or urinary systems. It can be permanent, when an organ must be removed. It can be temporary, when the organ needs time to heal. The organ could be the small intestine, colon, rectum, or bladder. With an ostomy, there must be a new way for wastes to leave the body.

There are many different types of ostomy. Some examples are:

• Ileostomy - the bottom of the small intestine (ileum) is attached to the stoma. This bypasses the colon, rectum and anus.
• Colostomy - the colon is attached to the stoma. This bypasses the rectum and the anus.
• Urostomy - the tubes that carry urine to the bladder are attached to the stoma. This bypasses the bladder.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Your colon, also known as the large intestine, is part of your digestive system. It's a long, hollow tube at the end of your digestive tract where your body makes and stores stool. Many disorders affect the colon's ability to work properly. Some of these include:

• Colorectal cancer
• Colonic polyps - extra tissue growing in the colon that can become cancerous
• Ulcerative colitis - ulcers of the colon and rectum
• Diverticulitis - inflammation or infection of pouches in the colon
• Irritable bowel syndrome - an uncomfortable condition causing abdominal cramping and other symptoms

Treatment for colonic diseases varies greatly depending on the disease and its severity. Treatment may involve diet, medicines and in some cases, surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

A polyp is an extra piece of tissue that grows inside your body. Colonic polyps grow in the large intestine, or colon. Most polyps are not dangerous. However, some polyps may turn into cancer or already be cancer. To be safe, doctors remove polyps and test them. Polyps can be removed when a doctor examines the inside of the large intestine during a colonoscopy.

Anyone can get polyps, but certain people are more likely than others. You may have a greater chance of getting polyps if you :

• Are over age 50
• Have had polyps before
• Have a family member with polyps
• Have a family history of colon cancer

Most colon polyps do not cause symptoms. If you have symptoms, they may include blood on your underwear or on toilet paper after a bowel movement, blood in your stool, or constipation or diarrhea lasting more than a week.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Colorectal cancer is cancer that develops in the tissues of the colon or rectum. Your colon and rectum are part of your digestive system:

• Your colon is the first and longest part of your large intestine. It absorbs water and some nutrients from foods. It also changes the leftover waste products into stool (poop).
• Your rectum is the lower part of your large intestine. It's where your body stores stool.

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancer that affects either of these parts may also be called colorectal cancer.

Colorectal cancer happens when there are changes in your genetic material (DNA). These changes are also called mutations or variants. Often, the genetic changes that lead to colorectal cancer happen during your lifetime and the exact cause is unknown. But certain genetic changes that raise your risk for colorectal cancer are inherited, meaning that you are born with them.

Besides genetics, other factors, including your lifestyle and the environment, can affect your risk of colorectal cancer.

Anyone can get colorectal cancer, but certain factors make you more likely to develop it:

• Being older; your risk of getting colorectal cancer increases as you age.
• Having a personal or family history of colorectal cancer.
• Having a history of adenomas. Adenomas are colorectal polyps (growths) that look abnormal under a microscope or are 1 centimeter or larger. Adenomas are not cancer, but they can sometimes turn into cancer over time.
• Having a genetic syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colorectal cancer).
• Having chronic ulcerative colitis or Crohn disease for 8 years or more.
• Having three or more alcoholic drinks per day.
• Smoking cigarettes.
• Being Black; Black people have an increased risk of colorectal cancer and death from colorectal cancer compared to other races.
• Having obesity.

Colorectal cancer may not always cause symptoms, especially at first. If you do have symptoms, they could include:

• A change in bowel habits that lasts more than a few days, such as:
  • Diarrhea
  • Constipation
  • Feeling that the bowel does not empty completely
  • Your stool is narrower or has a different shape than usual
• Blood (either bright red or very dark) in the stool
• Frequent gas pains, bloating, fullness, or cramps
• Weight loss for no known reason
• Fatigue

Because colorectal cancer may not cause symptoms at first, it's important to have screening tests for colorectal cancer. Screening tests look for signs of a disease before you have any symptoms. They can help find cancer early, when it may be easier to treat.

Most experts recommend that start screenings at 45 and continue until at least age 75. People over 75 and those who are at high risk should talk to their providers about how often you need screening and what type of test they should get.

The types of tests include different stool tests and procedures such as colonoscopies and flexible sigmoidoscopy. Talk with your provider about how often you need screening and what type of test you should get.

If you have symptoms that could be caused by colorectal cancer or if your screening test results are abnormal, you may need to have more tests to find out if you have cancer. Possible tests include:

• A physical exam.
• A digital rectal exam. For this exam, your provider inserts a lubricated, gloved finger into your rectum to feel for lumps or anything unusual.
• The tests that are also used for screening (colonoscopy, stool tests, etc.) and biopsy, if you have not already had them.
• Other blood and tissue tests.

Your treatment options usually depend on your age, your general health, how serious the cancer is, and which type of cancer you have.

For colon cancer, your treatment may include one or more of these options:

• Surgery.
• Radiofrequency ablation, a procedure that uses radio waves to heat and destroy abnormal cells. The radio waves travel through electrodes (small devices that carry electricity).
• Cryosurgery, a procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy abnormal tissue.
• Chemotherapy.
• Radiation therapy.
• Targeted therapy, which uses drugs or other substances that mainly attack specific cancer cells and cause less harm to normal cells.
• Immunotherapy.

For rectal cancer, your treatment may include one or more of these options:

• Surgery.
• Radiation therapy.
• Chemotherapy.
• Active surveillance, which means having regular tests to see if your rectal cancer has changed. If the tests show the cancer is starting to grow, then you will have treatment to try to cure the cancer.
• Targeted therapy, which uses drugs or other substances that mainly attack specific cancer cells and cause less harm to normal cells.
• Immunotherapy.

Avoiding the risk factors that you have control over may help prevent some cancers. That includes:

• Not smoking
• Limiting alcohol to under three drinks per day
• Managing your weight

There are also other steps you can take to try to prevent colorectal cancer. They include:

• Getting regular colorectal cancer screenings
• Having polyps removed before they can become cancerous
• Getting regular exercise

Crohn's disease is a chronic (long-lasting) disease that causes inflammation in your digestive tract. It can affect any part of your digestive tract, which runs from your mouth to your anus. But it usually affects your small intestine and the beginning of your large intestine.

Crohn's disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are other common types of IBD.

The cause of Crohn's disease is unknown. Researchers think that an autoimmune reaction may be one cause. An autoimmune reaction happens when your immune system attacks healthy cells in your body. Genetics may also play a role, since Crohn's disease can run in families.

Stress and eating certain foods don't cause the disease, but they can make your symptoms worse.

There are certain factors that may raise your risk of Crohn's disease:

• Family history of the disease. Having a parent, child, or sibling with the disease puts you at higher risk.
• Smoking. This may double your risk of developing Crohn's disease.
• Certain medicines, such as antibiotics, birth-control pills, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. These may slightly increase your chance of developing Crohn's.
• A high-fat diet. This may also slightly increase your risk of Crohn's.

The symptoms of Crohn's disease can vary, depending where and how severe your inflammation is. The most common symptoms include:

• Diarrhea
• Cramping and pain in your abdomen
• Weight loss

Some other possible symptoms are:

• Anemia, a condition in which you have fewer red blood cells than normal
• Eye redness or pain
• Fatigue
• Fever
• Joint pain or soreness
• Nausea or loss of appetite
• Skin changes that involve red, tender bumps under the skin

Stress and eating certain foods such as carbonated (fizzy) drinks and high-fiber foods may make some people's symptoms worse.

Crohn's disease can cause other problems, including:

• Intestinal obstruction, a blockage in the intestine
• Fistulas, abnormal connections between two parts inside of the body
• Abscesses, pus-filled pockets of infection
• Anal fissures, small tears in your anus that may cause itching, pain, or bleeding
• Ulcers, open sores in your mouth, intestines, anus, or perineum
• Malnutrition, when your body does not get the right amount of vitamins, minerals, and nutrients it needs
• Inflammation in other areas of your body, such as your joints, eyes, and skin

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A family history
• A physical exam, including:
  • Checking for bloating in your abdomen.
  • Listening to sounds within your abdomen using a stethoscope.
  • Tapping on your abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged.
• Various tests, including:
  • Blood and stool tests.
  • A colonoscopy.
  • An upper GI endoscopy, a procedure in which your provider uses a scope to look inside your mouth, esophagus, stomach, and small intestine.
  • Diagnostic imaging tests, such as a CT scan or an upper GI series. An upper GI series uses a special liquid called barium and x-rays. Drinking the barium will make your upper GI tract more visible on an x-ray.

There is no cure for Crohn's disease, but treatments can decrease inflammation in your intestines, relieve symptoms, and prevent complications. Treatments include medicines, bowel rest, and surgery. No single treatment works for everyone. You and your provider can work together to figure out which treatment is best for you:

• Medicines for Crohn's include various medicines that decrease the inflammation. Many of these medicines do this by reducing the activity of your immune system. Certain medicines can also help with symptoms or complications, such as nonsteroidal anti-inflammatory drugs and anti-diarrheal medicines. If your Crohn's causes an infection, you may need antibiotics.
• Bowel rest involves drinking only certain liquids or not eating or drinking anything. This allows your intestines to rest. You may need to do this if your Crohn's disease symptoms are severe. You get your nutrients through drinking a liquid, a feeding tube, or an intravenous (IV) tube. You may need to do bowel rest in the hospital, or you may be able to do it at home. It will last for a few days or up to several weeks.
• Surgery can treat complications and reduce symptoms when other treatments are not helping enough. The surgery will involve removing a damaged part of your digestive tract to treat:
  • Fistulas
  • Bleeding that is life threatening
  • Intestinal obstructions
  • Side effects from medicines when they threaten your health
  • Symptoms when medicines do not improve your condition

Changing your diet can help reduce symptoms. Your provider may recommend that you make changes to your diet, such as:

• Avoiding carbonated drinks
• Avoiding popcorn, vegetable skins, nuts, and other high-fiber foods
• Drinking more liquids
• Eating smaller meals more often
• Keeping a food diary to help identify foods that cause problems

In some cases, your provider may ask you to go on a special diet, such as a diet that is:

• High calorie
• Lactose free
• Low fat
• Low fiber
• Low salt

If you are not absorbing enough nutrients, you may need to take nutritional supplements and vitamins.

National Institute of Diabetes and Digestive and Kidney Diseases

Your small intestine is the longest part of your digestive system - about twenty feet long! It connects your stomach to your large intestine (or colon) and folds many times to fit inside your abdomen. Your small intestine does most of the digesting of the foods you eat. It has three areas called the duodenum, the ileum, and the jejunum.

Problems with the small intestine can include:

• Bleeding
• Celiac disease
• Crohn's disease
• Infections
• Intestinal cancer
• Intestinal obstruction
• Irritable bowel syndrome
• Ulcers, such as peptic ulcer

Treatment of disorders of the small intestine depends on the cause.

Ulcerative colitis (UC) is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. It is one of a group of diseases called inflammatory bowel disease.

UC can happen at any age, but it usually starts between the ages of 15 and 30. It tends to run in families. The most common symptoms are pain in the abdomen and blood or pus in diarrhea. Other symptoms may include:

• Anemia
• Severe tiredness
• Weight loss
• Loss of appetite
• Bleeding from the rectum
• Sores on the skin
• Joint pain
• Growth failure in children

About half of people with UC have mild symptoms.

Doctors use blood tests, stool tests, colonoscopy or sigmoidoscopy, and imaging tests to diagnose UC. Several types of drugs can help control it. Some people have long periods of remission, when they are free of symptoms. In severe cases, doctors must remove the colon.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases