A colostomy is an operation that creates an opening for the colon, or large intestine, through the abdomen. A colostomy may be temporary or permanent. It is usually done after bowel surgery or injury. Most permanent colostomies are “end colostomies,” while 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, where 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 astoma. 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 corresponding hole in the abdominal wall. This can be more easily reversed later by simply detaching the colon from the abdominal wall and closing the holes to reestablish the flow of stool through the colon.
Reasons for the procedure
Colostomy surgery may be needed to treat several different diseases and conditions. These include:
- Birth defect, such as a blocked or missing anal opening, called an imperforate anus
- Serious infection, such as diverticulitis, inflammation of little sacs on the colon
- 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. A woman’s perineum is the area between her anus and vulva; a man’s lies between his anus and scrotum.
The reason for the colostomy helps the healthcare provider decide whether it will be short-term or permanent. For example, some infections or injuries require giving the bowel a temporary rest, then reattaching it. A permanent colostomy may be required for a more serious or incurable problem, such as cancer that requires removal of the rectum, or a failure of the muscles that control elimination.
Risks of the procedure
Getting a colostomy marks a big change in your life, but the surgery itself is uncomplicated. It will be performed under general anesthesia, so you will be unconscious and feel no pain. A colostomy may be done as open surgery, or laparoscopically, via several tiny cuts.
As with any surgery, the main risks for anesthesia are breathing problems and poor reactions to medications. A colostomy carries other surgical risks:
- Damage to nearby organs
After surgery, risks include:
- Narrowing of the colostomy opening
- Scar tissue that causes intestinal blockage
- Skin irritation
- Wound opening
- Developing a hernia at the incision
Before the procedure
If possible, be sure to discuss your surgical and postsurgical options with a doctor and an ostomy nurse (a nurse who is specially trained to help colostomy patients) before surgery. 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 wish to attend an ostomy support group. You can find out more about such groups from the United Ostomy Associations of America or the American Cancer Society.
During the procedure
Depending on why you need a colostomy, it will be made in one of 4 parts of the colon: ascending, transverse, descending, or sigmoid.
- A transverse colostomyis performed on the middle section of the colon, and the stoma will be somewhere across the upper abdomen. This type of surgery–often temporary–is typically performed 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. If you have only one stoma, this mucus will pass through your rectum and anus.
- An ascending colostomygoes on the right side of your abdomen, leaving only a short part of the colon active. It is generally performed only when blockage or severe disease prevents a colostomy further along the colon.
- A descending colostomygoes on the lower left side of the abdomen, while a sigmoid colostomy–the most common type–is placed a few inches lower.
After the procedure
You may be able to suck on ice chips on the same day as your surgery. You’ll probably be given clear fluids the next day. Some people eat normally within two days after a colostomy.
A normal stoma is moist and pink or red colored. When you first see your colostomy, it may appear dark red and swollen, with bruises. Don’t worry. Within a few weeks, the color will lighten and bruises should disappear.
The bandage or clear pouch covering your colostomy right after surgery probably 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.