Colostomy

A colostomy is surgery to create an opening for the colon (large intestine) through the belly (abdomen). A colostomy may be short-term (temporary) or long-term (permanent). It's often done after bowel surgery or injury. Most permanent colostomies are end colostomies. Many temporary colostomies bring the side of the colon up to an opening in the abdomen.

During an end colostomy, the end of the colon is brought through the abdominal wall. Then it may be turned under, like a cuff. The edges of the colon are then stitched to the skin of the abdominal wall to form an opening called a stoma. Stool drains from the stoma into a bag or pouch attached to the abdomen. In a temporary loop colostomy, a hole is cut in the side of the colon and stitched to a matching hole in the abdominal wall. This can be more easily reversed later. This is done by removing the colon from the abdominal wall. Then the holes are closed so that stool flows through the colon again.

Colostomy surgery may be needed to treat several different diseases and conditions. These include:

• A birth defect, such as a blocked or missing anal opening, called an imperforate anus.
• Complications from diverticula. These are small, bulging pouches of the colon. They are common in people older than age 60. They can become infected (diverticulitis). Or they can cause severe bleeding and need bowel surgery.
• Inflammatory bowel disease.
• Injury to the colon or rectum.
• Partial or complete intestinal or bowel blockage.
• Rectal or colon cancer.
• Wounds or fistulas in the perineum. A fistula is an abnormal connection between internal parts of the body or between an internal organ and the skin. The perineum is the area between the anus and vulva or between the anus and scrotum.

If surgeons have the choice to create a temporary colostomy, they often will. Talk with your doctor before surgery to see if your colostomy will be permanent or temporary. Some infections or injuries require giving the downstream bowel a rest with a colostomy so that it can heal. Then it is reattached later.

In some cases, a surgeon may need to make a permanent colostomy. For instance, this may be advised if cancer is the cause and the rectum must be removed. Or it may be advised if there is a failure of the rectal muscles that control bowel movements.

A colostomy won't change the way your digestive system works. Normally, after you chew and swallow your food, it goes through your esophagus, or swallowing tube, into your stomach.

From there, it travels to your small intestine and then to your large intestine, or colon. Hours or days later, the indigestible residue leaves the storage area of your rectum through your anus, as stool. Stool typically stays loose and liquid during its passage through the upper colon. There, water is absorbed from it. So the stool gets firmer as it nears the rectum.

The ascending colon goes up the right side of your body. The stool here is liquid and somewhat acidic, and it contains digestive enzymes. The transverse colon goes across your upper abdomen. And the descending and sigmoid colon go down the left side of your body to your rectum. In the left colon, the stool becomes progressively less liquid, less acidic, and contains fewer enzymes.

Where your colon is interrupted by the colostomy determines how irritating to the skin your stool output will be. The more liquid the stool, the more acidic. And the more important it will be to protect your abdominal skin after a colostomy.

Getting a colostomy marks a big change in your life, but the surgery itself is not complex. It will be done under general anesthesia, so you will be asleep and feel no pain. A colostomy may be done as open surgery, with one main cut. Or it may be done laparoscopically, with several tiny cuts.

As with any surgery, the main risks for anesthesia are breathing problems and poor reactions to medicines. A colostomy carries other surgical risks, such as:

• Bleeding.
• Damage to nearby organs.
• Infection.

After surgery, risks include:

• Narrowing of the colostomy opening.
• Scar tissue that causes intestinal blockage.
• Skin irritation.
• Wound opening.
• Getting a hernia at the incision.

Before surgery, discuss your surgical and postsurgical choices with a doctor and an ostomy nurse. This is a nurse who is specially trained to help colostomy patients. It may also help to meet with an ostomy visitor. This is a volunteer who has had a colostomy and can help you understand how to live with one. And, before or after your surgery, you may want to join an ostomy support group. You can find out more about such groups from the United Ostomy Associations of America or the American Cancer Society.

If the colostomy surgery is not done as an emergency procedure, your care team will give you specific presurgery instructions about diet and medicines. Follow all presurgery directions and contact your doctor if you have questions.

Depending on why you need a colostomy, it will be made in one of four parts of the colon: ascending, transverse, descending, or sigmoid.

• Transverse colostomy. This is done on the middle section of the colon. The stoma will be somewhere across the upper abdomen. This type of surgery is often temporary. It's typically done for diverticulitis, inflammatory bowel disease, cancer, blockage, injury, or a birth defect. In a transverse colostomy, the stool leaves the colon through the stoma before reaching the descending colon. Your stoma may have one or two openings. One opening is for stool. The second possible stoma is for the mucus that the resting part of your colon normally keeps producing. This mucus will pass through your rectum and anus if you have only one stoma.
• Ascending colostomy. This goes on the right side of your abdomen. It leaves only a short part of the colon active. It's generally done only when blockage or severe disease prevents a colostomy further along the colon.
• Descending colostomy. This goes on the lower left side of the abdomen.
• Sigmoid colostomy. This is the most common type. It's placed a few inches lower than a descending colostomy.

You may be able to suck on ice chips on the same day as your surgery. You'll likely be given clear fluids the next day. Some people eat normally within 2 days after a colostomy.

A normal stoma is moist and pink or red colored. When you first see your colostomy, it may look dark red and swollen, with bruises. Don't worry. In a few weeks, the color will lighten and bruises should disappear.

The bandage or clear pouch covering your colostomy right after surgery likely won't be the same type that you'll use at home. Your colostomy will drain stool from your colon into this colostomy pouch or bag. Your stool will probably be more liquid than before surgery. Your stool consistency will also depend on what type of colostomy you have and how much of your colon is still active.

A colostomy requires a hospital stay of about 3 days to a week. Your stay will probably be longer if the colostomy was done for an emergency. You'll learn to care for your colostomy and the appliance or pouch that collects your stool during your hospital stay.

Your nurse will show you how to clean your stoma. You'll do this gently every day with warm water only after you go home. Then gently pat dry or allow the area to air dry. Don't worry if you see a little bit of blood.

Use your time in the hospital to learn how to care for your colostomy. You will need to wear a slim, lightweight, drainable pouch at all times if you have an ascending or transverse colostomy. There are many different types of pouches. They vary in cost and are made from odor-resistant materials.

Some people with a descending or sigmoid colostomy can learn over time to predict when their bowels will move and wear a pouch only when they expect a movement. They may also be able to master a process called irrigation to stimulate regular, controlled bowel movements.

Before going home, talk with an ostomy nurse or other expert who can help you try out the equipment you'll need. What works best will depend on what type of colostomy you have, the length of your stoma, your abdominal shape and firmness, any scars or folds near the stoma, and your height and weight.

Sometimes the rectum and anus must be surgically removed, leaving what's called a posterior wound. In the hospital, you'll use dressings and pads to cover this wound. You may also take sitz baths. These are shallow, warm-water soaks. Ask your doctor and nurse how to care for your posterior wound until it heals. If problems occur, contact your doctor.

The skin around your (pink) stoma should look like the skin on the rest of your belly. But due to exposure to stool, especially loose stool, the skin can get irritated. Here are some tips to protect your skin.

1. Make sure your pouch and skin barrier opening are the right size. Find the smallest hole on the measuring guide that fits around the stoma without touching it. There should be about 1/8 inch between the stoma and the hole on the guide.
2. Change the pouch when it is about 1/3 full to prevent leakage and skin irritation. Don't let your pouch get more than 1/2 full.
3. Remove the pouching system gently, pushing your skin away instead of pulling.
4. Moisture barrier powder, gel, or paste may be used if the skin becomes irritated despite these measures. Wipe away excess powder, gel, or paste.
5. Don't use skin care products that contain alcohol. Alcohol can make your skin too dry.
6. Don't use creams, oils, and lotions on the skin around your stoma. These can make it hard to attach the pouch to your skin.

Follow any specific instructions your doctor or nurse gives you on cleaning your stoma.

Tell your doctor if you have:

• Severe cramps that last more than 2 hours.
• Blocked stoma or stoma collapse.
• Excessive bleeding from the stoma or a moderate amount of blood in the pouch. (Note: Eating beets will lead to some red discoloration in the stool.)
• Severe injury or cut to the stoma.
• Ongoing skin irritation.
• Continuous nausea or throwing up.
• Bad or unusual odor for more than a week.
• Change in your stoma size or color.
• Blocked or bulging stoma.
• Watery stool for more than 5 hours.
• Inability to wear the pouch for 2 to 3 days without leaking.
• Anything abnormal that concerns you.

Depending on the type of pouch system you have, you may need to change your drainable pouch 1 or 2 times every week and when it leaks. Different pouching systems are made to last different lengths of time. This may be anywhere from every day to every week. Ask your care team about what financial resources may be available if you need help paying for colostomy supplies.

A colostomy presents a big change. It takes some adjustment. Even though you can feel the pouch against your body, no one else can see it. Don’t feel the need to explain your colostomy to everyone who asks. Only share as much as you want to.

For some people and their immediate family members, a colostomy can cause depression, anxiety, or self-esteem issues. Ask for mental health resources if you or your immediate family is having a hard time adjusting to the surgery. A short explanation would simply be that you had abdominal surgery. Think about joining a support group to help adjust to the colostomy. Your ostomy nurse or care team can provide support group resources.

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure.
• The reason you are having the test or procedure.
• What results to expect and what they mean.
• The risks and benefits of the test or procedure.
• What the possible side effects or complications are.
• When and where you are to have the test or procedure.
• Who will do the test or procedure and what that person’s qualifications are.
• What would happen if you did not have the test or procedure.
• Any alternative tests or procedures to think about.
• When and how you will get the results.
• Who to call after the test or procedure if you have questions or problems.
• How much you will have to pay for the test or procedure.