Surgical Procedures: Colostomy
What is a colostomy and how is it performed?
A colostomy is a surgical procedure that is done to connect the colon, or large intestine, to the surface of the abdomen to allow stool to pass into a collection bag. This is done because the rectum, anus, or the sphincter that controls the passage of stool has been removed, or is temporarily not being used.
For stool to pass from the colon to the collection bag, a stoma (hole) is made in the abdominal wall. The stoma is made from the intestine and should be pink to red in color, warm, moist and is able to secrete mucus. There is no sphincter muscle to allow the person to control the passing of stool. The location of the stoma will depend on the area of the colon used to create the stoma. The size of the stoma varies.
Having a colostomy will not change your body’s ability to digest food. There may be changes in stool consistency based on the location of the stoma along the colon.
A colostomy may be permanent or temporary. Your provider will talk to you about your specific surgery and plan for colostomy.
A colostomy may be done to treat certain cases of:
- Colon cancer.
- Rectal cancer.
- Certain birth defects.
- Inflammatory bowel disease.
- Colon/rectum injury.
- Bowel obstruction.
- Perineal fistula/wound.
There are several different types of colostomy that are separated into three groups. Each group refers to a particular part of the colon: transverse, ascending and descending. They include:
- Transverse colostomies are located in the upper middle or right abdomen and include:
- Loop transverse colostomy: Placement of two stomal openings. One expels stool, the other mucus.
- Double-barrel transverse colostomy: Two stomas are created, one for stool and the other for mucus. The bowel is cut and each end is brought to the surface of the abdomen. The stoma which expels only mucus is smaller than the one for passing stool. At times, the stoma used to expel mucus is closed and mucus passes through the anus.
- Ascending colostomy: Not often used. The stool passed from this type of colostomy is liquid and contains digestive enzymes. This is because the location of the colostomy is in a part of the colon that is earlier in the digestive process.
- Descending and sigmoid colostomies: This colostomy is in the lower left portion of the abdomen. The stool passed from this colostomy is often firm and controllable. With a sigmoid colostomy, the stool is even more solid and controllable.
What are the risks associated with a colostomy?
There are risks and side effects related to having a small bowel resection. Risks and side effects may be:
- Reaction to anesthesia. (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure.)
- Damage to near-by organs.
- Stomal stenosis. (Narrowing of the stoma opening.)
- Adhesion/scar tissue formation (An adhesion is scar tissue that joins 2 pieces of tissue that should not be joined. They are often painless and do not need treatment. Serious cases can cause a blockage in the bowel or limit blood flow.)
- Bowel obstruction (This is a blockage in the bowel that can limit digestion or the removal of stool.)
- Skin irritation at the stoma.
Your surgeon and healthcare team will discuss with you the specific risks of your procedure.
What is recovery like?
Recovery from a colostomy will depend on the procedure you have had. You may spend several days in the hospital recovering.
You will be told how to care for your surgical incisions/stoma and will be given any other instructions prior to leaving the hospital, such as the need for stomal irrigation (flushing). Full instructions on caring for your stoma will be given to you by a specially trained stoma nurse/therapist.
Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.
Your provider will talk to you about any activity restrictions you will have. In general:
- Do not lift, bend or twist until you are told that you can. Ask about when you can start to exercise.
- Do not drive while taking narcotic pain medication.
- Return to work in 2-4 weeks, depending on your occupation and work demands.
- Speak with your healthcare team about showering, submerging your surgical incisions in water, diet, sexual activity and stoma care.
What will I need at home?
- Thermometer to check for fever, which can be a sign of infection.
- Incision and stoma care supplies, often supplied by the hospital, your healthcare team or the stoma nurse/therapist.
When to call your doctor?
- Signs of infection including fever, redness, odor and drainage at your incision.
- Nausea, vomiting, abdominal bloating, or cramps lasting more than 2 hours.
- Leg swelling and/or sudden shortness of breath.
- Any new or worsening pain.
- Decrease in urination.
- Changes in your stoma including retraction (pulling inward), changes in size or color, stoma blockage or bulging, bleeding, wounds, skin irritation/sores and/or watery stool for 5 or more hours.
How can I care for myself?
You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.
Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.
There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.
Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.
- Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.
American Cancer Society. Colostomy: A Guide. 2017. Found at: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/ostomies/colostomyguide/colostomy-guide-toc
Johns Hopkins Medicine. Colostomy. Found at: http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/colostomy_92,p07727/
Augusta University. Colostomy and Ileostomy Surgery. Found at: http://www.augusta.edu/mcg/surgery/midds/patient_education/colostomy_surgery.php