What is a colostomy?
A colostomy, or bowel diversion, is a surgical procedure used to divert one end or a loop of the large intestine out through the wall of the abdomen. An incision is made in the skin and through the abdominal wall to create an opening called a stoma, sometimes also known as an ostomy. Over this, a small pouch – known as a colostomy bag – is placed in order to collect excreted stool and other human waste.
Colostomies can be permanent or temporary (around 65 percent of procedures are permanent). They are used to treat a variety of conditions that affect the large bowel (colon) and lower digestive tract, such as Crohn’s disease, colorectal cancer and ulcerative colitis. It is generally considered a routine procedure, yet it does carry some risks.
Reasons for needing a colostomy
Temporary colostomy surgery may be necessary following surgeries to remove or repair part of the large intestine. This form of bowel diversion allows stool and other waste to be diverted away from the repaired section of the colon, through the opening in the abdomen, giving the surgery site a chance to recover and heal.
In contrast, a permanent version creates an artificial outlet for stool, and is necessary when the body can no longer rid itself of these substances as the digestive system would normally, through the anus. This may be needed if the surgery involves the removal of the lowest part of the colon (the rectum) or the anal sphincter muscles.
Conditions and diseases that may require a permanent approach include:
- Abdominal/pelvic region cancers including colorectal cancer and more rarely anal, vaginal or cervical cancer
- Inflammatory bowel diseases including Crohn's disease, ulcerative colitis and, more rarely, diverticulitis
- Bowel obstructions or injuries
- Fecal incontinence (in severe cases)
- Hirschsprung’s disease (a rare disease where the bowel lacks nerve cells)
Types of colostomy
There are a variety of different colostomy types, each corresponding to a different section of the colon.
- Sigmoid: This is the most common type of colostomy, affecting the lower portion of the colon. A suitable treatment for conditions affecting the part of the colon near the anus, such as perianal Crohn’s disease.
- Transverse loop: A transverse colostomy affects the top of the abdomen. This procedure externalises a loop of the intestine creating two openings; the proximal end – to which the pouch is fixed – and the distal end – which is inactive (no stool comes from this end).
- Transverse single-barrel: This technique creates a single opening through the abdominal wall. It is permanent, and sometimes called a terminal colostomy.
- Transverse double-barrel: In this method, the two ends of the bowel are sutured together and passed through the abdominal wall.
- Descending: This method is performed on the left-side of the colon. Having already passed through the right-side of the colon, the output is solid and controllable.
- Ascending: This method is performed on the right-side of the colon. Output is typically liquid. This is a rare operation because a stoma of the small intestine is usually preferred.
Good to know: A person will be provided with recommendations to help prepare for their particular surgery. These may be different depending on each case; if a person has colorectal cancer, they may be recommended a different procedure and prep guidelines to someone with Crohn’s disease, for example. One may be given written related literature to consult, such as a colostomy guide. The colostomy guide will typically include instructions on food and liquid intake, clearing the bowel of stool and other waste, as well as recommended supplies and recovery tips.
Always call the doctor with any questions about the preparatory process, as it is important to follow all guidelines as closely as possible for best results.
Reversal of a temporary colostomy
Reversing a temporary colostomy is generally a routine procedure carried out when the colon has healed. After reversal, stool and other waste will be excreted through the anus as normal and the stoma and pouch will no longer be needed. Reversal is normally carried out between 12 weeks and a number of years after the initial procedure, depending on a person’s recovery.
Risks of a colostomy
Although considered a fairly routine surgical procedure, colostomies still carry the chance of complications. As with any major surgical procedure, there are risks due to going under general anaesthesia and blood loss, as well as colostomy specific risks that include:
- Skin complications, ranging from mild irritation to ulceration and infection (present in 18 to 55 percent of cases)
- Retraction – when the stoma in the abdomen recedes into the skin (present in 32 to 40 percent of cases)
- Parastomal hernia (present in 14 to 40 percent of cases)
- Necrosis, caused by insufficient blood supply to the stoma (present in 2 to 22 percent of cases)
- Stomal prolapse – when the stoma becomes displaced (present in 2 to 22 percent of cases). This is more likely to occur when the muscle tone in the abdomen is poor, or in cases of excessive weight gain or obesity.
Life after a colostomy
Immediately following a temporary or permanent colostomy, a hospital stay of roughly two-weeks should be expected. To fully recover, however, two months may be needed. After recovery, modern advancements in colostomy care and improvements in pouch design mean that – following a period of adaptation – most people are able to lead a relatively normal life.
This includes being able to go back to work, enjoy a regular diet and take part in physical activity. Individuals who have undergone colostomy surgery should, however, be aware that their stoma and pouch do need to be looked after to keep them functioning correctly. Advice on how to do this and how to change a colostomy bag will be given by doctors and nurses after the procedure has taken place.
Good to know: In some cases, colostomy irrigation may be recommended. This is a method for people who have had permanent colostomies to achieve regular bowel movements, by flushing their colon with water inserted through the stoma, daily or every two days. This allows waste to exit the body as normal through the rectum and anus, as an alternative to collecting stool in a colostomy bag. Colostomy irrigation can help prevent constipation and is ideal for people who had regular bowel function before surgery, and whose colostomies affected the sigmoid portion of the colon.
Mayo Clinic. “Ostomy: Adapting to life after colostomy, ileostomy or urostomy.” August 21, 2014. Accessed July 5, 2017. ↩