Anus praeter - the artificial anus

definition

Anus praeter is the outdated technical term for the artificial anus. As the name suggests, an artificial anus was surgically created through the abdominal wall in order to continue to enable the excretion of the stool and / or to protect the subsequent intestinal sections that were affected by an illness or operation.

An anus praeter can be used for permanent stool drainage or temporarily (for a certain time) can be created. Depending on where the anus praeter leads the stool out or on which section of the intestine the artificial anus is located, a distinction can be made between ileostomy, coecostoma, transversostoma or colostoma.
The transverse ostomy is an anus praeter attached to the transverse large intestine (Transverse large intestine, transverse colonAn ileostomy removes the stool from the ileum, which is part of the small intestine (Duodenum) is. A colostoma derives it from the sigmoid intestine / sigmoid loop (Sigmoid colonA rare unloading stoma is the coecostoma. There is a stoma in the appendix area (Coecum).

indication

There are several reasons (Indications) for the use of an anus praeter. An ileostomy can e.g. after removal or partial removal (Resection) of the large intestine (Colon) can be created. The main reason for removal is usually colon cancer or cancer of the rectum (rectum). The sphincter muscle at the end of the colon may also have to be removed here. This leads to the fact that the stool can no longer be held back and it comes to unwanted feces (fecal incontinence). To prevent this, an anus praeter is created and the anus (Anus, anus) locked.

If conservative therapy becomes ineffective or complications arise, these indications for removal of the large intestine and anus praeter can come:

• Ulcerative colitis: a chronic inflammation of the colon
• Colon cancer
• Crohn's disease: a chronic inflammation of the gastrointestinal tract, especially of the small intestine (Duodenum) and colon.
• Malformations: e.g. a congenital intestinal obstruction (Intestinal atresia)
• Intestinal obstruction (Ileus)
• Diverticulitis: an inflammation of the large intestine caused by a protrusion of the lining of the large intestine
• Fecal incontinence in neurological diseases

An anus praeter can also be created temporarily. If, for example, the lower part of the large intestine is removed due to the cancer, but it is possible to connect the section of the intestine directly with the sphincter, then an anus praeter is created to initially protect this area or the seam. After the (suture) healing, the anus praeter can be closed again or removed (relocation). Until the relocation is carried out, anus praeter patients should expect that it may take some time up to this point and that it will also take a while after the relocation before normal elimination has returned.

When can an anus be repositioned earlier?

With an anus praeter, you have to distinguish whether a permanent installation takes place or a relocation is planned in the course of the process. After some operations, such as the permanent removal of the anus, the anus praeter must be preserved until the end of life. In most cases, however, the intestinal passage can be restored and the anus praeter can be moved back again after a while. Most of the time an anus praeter is not moved back until the wounds have healed. As a rule, a temporary anus praeter remains for at least 6 weeks and can then be removed. If an anus praeter is created because of problems with wound healing during an operation on the intestine, the period can be considerably longer. A typical complication of bowel surgery is insufficient bowel closure, which leads to infections. If an anus prater is created due to this complication, it must exist until everything has healed. Only then can the relocation take place.

How does a relocation work?

Relocating an anus praeter requires another operation under general anesthesia. When creating the anus praeter, the intestine is sewn to the abdominal skin and grows together with it. When moving back, this connection is separated again. The end of the intestine that served as the exit must then be reconnected to the intestine. This connection is also called an anastomosis. After the anastomosis is created, the patient's food must be rebuilt very slowly in order for the wound to heal well. The most important complication of this procedure is suture insufficiency, which allows germs to escape and lead to infections.

What complications are there with a preter anus?

An anus praeter can cause various problems. A very common complication is a prolapse of the anus praeter, in which a piece of the intestine is everted through the opening. This does not cause any pain, but it can happen that the bag in which the excretions are collected is no longer completely sealed. A number of other problems arise from leaks. Inadequate care of the anus praeter can lead to inflammation of the skin, as the excretions cause skin irritation. Another important complication that can occur with an anus praeter is entrapment of parts of the intestine. This so-called hernia can be harmless and not cause any problems.

However, if the vessels that supply the intestine are clamped, it can lead to a very dangerous undersupply, in which the undersupplied intestinal sections can die. If this complication is not remedied promptly, life-threatening blood poisoning, also known as sepsis, occurs. The intestine is a very sensitive organ, so the unnatural positioning of the intestine can lead to blockages. Diarrhea is to be expected regularly depending on the position of the anus praeter. If an anus praeter is installed relatively far at the beginning of the digestive tract, not enough water can be withdrawn from the stool, since the withdrawal of water takes place to a large extent at the end of the digestive tract in the large intestine. Complications that should not be underestimated that occur with an anus praeter are also psychological stress, since the physical integrity is disturbed to a high degree.

Prolapse

In the case of a prolapse, a piece of the intestine turns inside out through the artificial anus. This situation is not dangerous in itself. However, the changed conditions caused by a prolapse require an adjustment in the care of the anus praeter. When changing the collection bag, the stoma must be pressed inwards before a new bag is attached. This is not painful.However, if the incident exceeds a certain size, the bowel must be pushed back into the abdominal hole in a new operation and fixed there.

Psychological problems with an anus praeter

The creation of an anus praeter represents a very large change in all areas of life for those affected. It is therefore not surprising that an anus praeter brings psychological problems with it. If you tell a patient that an anus praeter is necessary, that is a great burden for most people. In addition, an anus praeter usually has to be created due to another serious illness. The changes that an anus praeter causes on a daily basis can be extremely stressful for some people. Young patients often wonder whether they can do their work with the anus praeter because they fear stigmatization and exclusion. Another problem that younger patients in particular have is the fear of loss of sexuality. The change in the body raises the question of whether they are still attractive for many. A working relationship and good advice is very important with this problem. Older patients who can no longer cope with the increased effort of personal hygiene on their own may have to move to a care facility, which many understand as a loss of self-determination. Serious mental disorders can arise as a result. In general, it is important that patients in whom an artificial anus is created receive psychological support in the run-up to the operation and that they receive constant psychological support afterwards. With an extensive explanation of how to deal with an anus praeter, problems can be eliminated from the start.

Type of excretion

In ileostomy and coecostomy, the stool is initially 1-2 l, later 500-750 ml of liquid to thinly mushy stool. This stool is also sometimes aggressive because it contains a lot of bile acids and digestive enzymes. With the tranversostomy and colostomy one sees a thick mushy to shaped stool and a stool frequency of 1 - 3 times / day (Colostomy) or 3 - 4 times / day (Transverse ostomy).

Supply items

A one-part system is differentiated from the two-part system. A system consists of a skin protection plate and a bag. A one-piece system is mainly used for the tranversostomy and colostomy, since the stool is mushy to firm, changing the bag is limited to 1 - 3 times a day and therefore the skin does not suffer from it Change is charged. This system consists of a skin protection plate and a bag, which cannot be separated from each other, so make a whole.

The two-part system is a system where the skin protection plate and bag can be changed separately. This means that changing the skin protection plate can be limited to every 3 to 4 days and then changing the bag if necessary. To fix the bag there is a locking ring on the skin protection plate, where a bag can be attached to prevent stool from leaking. The skin protection plate can be glued or fastened with a belt.

A distinction is made between open (Eject bag) and closed bag. The pouch can be used to empty the pouch without changing the pouch. The bag is closed by a clamp. This system is mainly used for ileostomy, as the consistency of the stool is very fluid and requires frequent bag changes, which in turn would put a lot of strain on the skin. The closed bag system can also be used with the transverse ostomy and colostomy, since emptying is not so frequent here.

The opening of the skin protection plate can already be adapted to the size of the stoma and can be used immediately. But it can also be that the stoma size has to be cut individually first. To do this, you need a template that is standardized to your own stoma size. With this template you save yourself having to measure the stoma size again and again.

Supply of the anus praeter

For the stoma care you need water, pH-neutral soap, discarding bag, possibly gloves, possibly a razor and toilet paper, compresses or cellulose. If necessary, the template, a pair of scissors and a pen.

If the skin protection plate and the bag are changed, proceed as follows: First carefully remove the skin protection plate and bag and dispose of them in the bag provided. The bag can be knotted after supply and disposed of in a garbage can. Then the skin is cleaned from the outside in with a wet compress / cellulose and soap. Care should also be taken to wipe away soap residues or grease residues (cream) so that it is not difficult to attach the new skin protection plate later. The skin is dried with a dry compress / cellulose. The existing hair around the stoma can be removed with a (disposable) razor. This is intended to cause hair follicle inflammation when changing the skin protection plate, where hair can be torn off again and again (Folliculitis) be avoided. In addition, the skin protection plate to be glued would not adhere if there was strong hair growth. To avoid injuries to the stoma, the stoma is shaved away. Attach the protective skin plate and pouch. Possibly. determine the opening of the skin protection plate beforehand with the template.

nutrition

When it comes to nutrition, there are no more precise guidelines or particularities that must be particularly observed. Basically, you can eat anything you like. Every anus praeter patient has to find out for himself what food he is getting or what is affecting his own stool consistency and thus causing discomfort such as flatulence (flatulence), Constipation (Constipation) or diarrhea (Diarrhea), to lead. When choosing food you should consider which foods are laxative (E.g. spirits, fruit, coffee), plugging (Chocolate, wine), odor-generating (Fish, garlic, cheese), odor-inhibiting (Spinach, yogurt), flatulent (Cabbage, carbonated drinks) and gas-inhibiting (yogurt) are. At first it might be appropriate to keep some kind of nutrition log for a few days. In this way, you can record your eating behavior and the consequences of your choice of food in order to minimize or avoid the disturbances. In general, as with non-anus carriers, it is important to pay attention to a balanced diet and regularity, to drink a lot and Spread meals evenly throughout the day.