A colostomy is a surgery that connects a part of the colon or large intestine to the surface of the abdomen by creating an opening called a stoma. Afterward, an ostomy pouch or colostomy bag is attached to the stoma where the feces will now pass through.

Who needs a colostomy?

If you suffer from an illness or injury that severely affects your digestive system — such as rectal disease or a medical issues that affect the large intestine — your doctor might recommend that you undergo a colostomy.

These include the following:

1. Colon cancer

2. Rectal cancer

3. Colorectal cancer

4. Anal cancer

5. Diverticulitis

6. Bowel incontinence

7. Hirschsprung’s disease

8. Intestinal or bowel blockage

9. Colon or rectal injury

10. Crohn’s disease

11. Ulcerative colitis

A colostomy may be temporary or permanent. Depending on your health condition and other factors that will be discussed with your healthcare provider, a colostomy may be reversed at least three months after the initial operation. A reversal can also be performed at any later time, with some people living with a colostomy bag several years before undergoing a reversal.

What are the types of colostomies?

The two main types of colostomies are loop and end colostomy. Loop colostomies are usually  temporary, while end colostomies are more often permanent.

Loop colostomy versus end colostomy: what’s the difference?

In an end colostomy, one end of the colon is brought to a surgically created opening on the abdominal wall and stitched to the skin to form a stoma. In a loop colostomy, a loop of the colon is brought out through the stoma, then held in place using a rod or tube. Incisions are made on this loop, creating two openings: one where the stool will exit (active section) and one which will only secrete mucus (inactive section).

When a colostomy reversal is later performed, the colon will simply be detached from the abdominal wall, and the holes will be closed so the stool can flow through the colon once again.

A colostomy can be made in any of the four parts of the colon, depending on the condition to be treated. 

  • Transverse colostomy – This is made in the upper middle section of the abdomen, in the transverse part of the colon
  • Ascending colostomy – This is done on the right side of the abdomen in the ascending colon
  • Descending colostomy – This  is performed on the lower left side of the abdomen in the descending colon 
  • Sigmoid colostomy (the most common type) – This is made a few inches lower than a descending colostomy in the sigmoid colon.

How to prepare for a colostomy

Before your surgery, your doctor and ostomy nurse will discuss the type of colostomy you need based on your medical condition. Some tests might be performed so that the doctor will know your health state, including the medications you’re currently taking. Your healthcare team will thoroughly review your medical history as well.

The night before the surgical procedure, you might need to cleanse your bowels using a laxative or an enema. Colostomy patients typically spend three to seven days in the hospital after the surgery, so it’s best to bring the essentials you will need  during this time. You should also make the necessary arrangements for your home and work to make sure everything is properly taken care of while you are away.

What happens during surgery?

The surgery is performed while you are under general anesthesia, so you won’t feel any pain. There are two ways in which a surgeon can perform a colostomy: through open (laparotomy) or keyhole surgery (laparoscopic). A laparotomy involves making a long incision on the abdominal wall to access the colon. A laparoscopic approach involves making small incisions and uses a tiny camera. 

What happens post-op?

The stoma

The stoma usually looks pink or red and is warm and moist. However, right after the procedure, the stoma might appear darker and slightly bleed. It might also be initially bigger, but it may eventually decrease in size. Since the stoma does not have a nerve supply, it shouldn’t be painful.

What to watch out for

Your stoma will change appearance as it heals in the first postoperative weeks. However, if you notice anything unusual with your stoma’s odor, the skin around it, or your stool, you must let your healthcare provider know..

Here are some signs of possible issues or infections that you should observe and be aware of:

1. Blocked or bulging stoma

2. Bad or unusual odor for more than one week

3. Serious irritation of the skin around the stoma

4. A cut or wound in the stoma

5. Continuous vomiting or nausea

6. Watery stool for more than five hours

7. Fever

8. Pain

Pouching system

An ostomy appliance attached to your stoma will collect your stool and protect the skin around the stoma. A pouching system is made up of a skin barrier and the pouch itself—the pouch collects the drainage, and the skin barrier holds the pouch to the skin.

Ostomy pouches and colostomy bags come in various sizes and styles. They are available in one-piece and two-piece systems. In a one-piece system, the skin barrier and pouch are attached together, while in a two-piece system, there is a skin barrier and a separate pouch.

Exploring the different types of appliances and accessories will help you identify which products suit you the most. Your ostomy nurse and Better Health can work with you and guide you as you search for the right colostomy supplies that fit your lifestyle.

What life is like as an ostomate

An ostomate, or someone who has undergone an ostomy (colostomy, ileostomy, or urostomy), can adjust and adapt to living with an ostomy bag over time. As you heal from your surgery, your ostomy nurse will teach you proper stoma care. This includes keeping your stoma and the skin around it clean and free from infection, when and how to empty and change your colostomy bag, and which pouching system is right for you.

You may also access a range of resources about ostomy and living with a colostomy bag at https://joinbetter.com/. Apart from additional information, you might find joining a support group or an ostomy community helpful. You will be surrounded by people who can give you practical advice and tips on how to cope with the challenges and even thrive.

Remember: having a colostomy doesn’t have to stop you from enjoying life and doing almost everything you used to do before your surgery (the only truly prohibited activity is heavy lifting and intense contact sports.) Most colostomy patients are able to go back to their jobs and continue their usual activities and routines, from working out and socializing to swimming and having sex. For answers to more questions and personalized help, call us at 415-475-8444.

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