One Ostomy Doesn’t Fit All

Most people don’t realise there are different types and functions of ostomies and stomas. Consider this your crash course in the basics.

In everyday conversation, the words ‘stoma’ and ‘ostomy’ are used interchangeably. But they are not the same thing. Technically, the stoma is the physical opening on a body, and an ostomy is the surgical procedure that creates the opening. 

At any given time, around 50,000 Australians have an active stoma. Among these, ostomies – which reroute the bowel or bladder – are the most common. And the name of the ostomy changes depending on where on the body it is.

An ostomy has one of two functions. Most common are diversion ostomies, aimed to change where poo or wee goes, to then come out of the stoma into an ostomy bag. Less common are continent ostomies. As the name suggests, they’re ‘continent’, so they shouldn’t leak and don’t need a bag to collect waste. 

From there, ostomies are grouped by what they manage – wee or poo – and whether they divert waste or allow controlled emptying. In terms of specific types, there are:

Urine Diversion Ostomies

Urostomy (urinary diversion using bowel) 

A urostomy is usually formed using an ileal conduit (a segment of small intestine) to divert urine out of the body. It often drains urine from the kidneys to ureters (the tube from the kidney to the bladder) and out through the bowel segment and stoma into an ostomy bag. It’s typically permanent and has continuous urine drainage into an external pouch. It’s used for bladder cancer, removal and severe bladder dysfunction. 

Vesicostomy (direct bladder opening) 

A vesicostomy describes when a small opening is made directly from the bladder into the lower abdomen, without any bowel segment used. The urine drains from the bladder through the stoma, usually into a nappy or dressing. It’s most commonly used in children with neurogenic bladder or obstruction, to protect kidneys by reducing the bladder pressure. A vesicostomy is often temporary or reversible.    

Nephrostomy (kidney drainage) 

A nephrostomy is when a tube is inserted directly into the kidney through the back so urine bypasses the ureters and bladder entirely, flowing from the kidney through the inserted tube into an external catheter drainage bag. It’s most commonly used for blocked ureters (due to kidney stones or tumours), infection or kidney pressure (hydronephrosis) and in emergency or temporary decompression. It’s often temporary, but can be long-term in complex cases.

Urine Continent Ostomies

Mitrofanoff (bladder catheterisable channel)

A mitrofanoff is where a channel using the appendix or small intestine is created to connect the bladder to the skin. It enables people to catheterise directly through the channel to empty the bladder manually. There is no external urine bag and it enables independence for people who can’t empty their bladder without assistance. 

Bowel Diversion Ostomies

A colostomy or ileostomy describes the part of the bowel used, and end, loop and double barrel are terms to describe how the surgeon brings it to the surface. These are independent of one another, so you may see people with different combinations.

Colostomy (large bowel)

A colostomy is formed using the large intestine/colon. The output is usually more formed stools – closer to typical bowel motions – which makes it easier to manage than an ileostomy. They are most commonly used for some congenital conditions (anorectal malformation, Hirschsprung disease), injury or obstruction to the large colon, or bowel cancer.

Ileostomy (small bowel)

An ileostomy is formed from the ileum (small intestine). Ileostomies can require higher daily management due to continuous output that is liquid to semi-liquid. Because the stool bypasses the large intestine – where water is reabsorbed and stool thickens – it’s much more liquid by the time it reaches the stoma, making hydration and electrolyte management more important.

They are most commonly used for Crohn’s disease and ulcerative colitis, to divert poo from the diseased large colon, resulting in symptom reduction. It can also be used in bowel cancer or other cases where the large colon has been removed.

Also note:

An end ostomy can be an end colostomy or end ileostomy, and is where one end of the bowel is brought out as a single stoma. It’s more common in permanent colostomies (for example, after rectal cancer surgery), and is also used for ileostomy either permanently or temporarily. 

A loop ostomy is also used in both, however loop ileostomies are very common and loop colostomies are less common. This is where a loop of bowel is opened to create a stoma with two openings. A loop ileostomy is most often used as a temporary diversion to protect the healing bowel after surgery or due to disease.

A double barrel ostomy can be either a colostomy or ileostomy. This is where the bowel is divided completely and bowel ends are brought out as two separate stomas. It’s less common, and used in specific surgical situations like trauma or complex disease. 

Bowel Continent Ostomies

Appendicostomy/MACE (large bowel)

Known by multiple names – the acronym MACE (Malone Antegrade Continence Enema), Malone or appendicostomy – this intervention sees surgeons use the appendix as a channel to connect the colon to the abdomen and form a stoma. This enables bowel emptying via flushes (antegrade enemas) that flush the bowel from the beginning of the large colon. Most commonly, the stoma opening comes out through the belly button, but it can be placed in the lower right of the abdomen if your appendix isn’t long enough.

There is no continuous stool output, but there may be a little leakage of fluid/mucus. It’s designed for bowel continence, chronic constipation management and predictability, and is commonly used for neurogenic bowel or bowels that lack motility. 

Chait/Cecostomy/Mini-ACE (large bowel)

Very similar to the appendicostomy, but instead of using the appendix to form a channel, a tube is used to form the channel/join. A chait/cecostomy and mini-ACE are the different types of tubes that may be used through the stoma to perform an antegrade continence enema. These devices can be used in a MACE temporarily to keep the channel open while it heals.

Ostomies aren’t one-size-fits-all. They exist across a spectrum – from temporary to permanent, from diversion to continent, from bowel to bladder. Behind each ostomy is a different reality, routine, level of independence and way of navigating the world.

When we treat ostomies as one uniform concept, we miss the complexity and the people behind them. Understanding that diversity is the first step in moving beyond assumptions and towards real awareness.