What is it?
A colostomy is a surgical procedure by which a surgeon brings part of your large intestine through a hole in your abdomen to create a stoma. Generally, the stoma will be placed on the left-hand side of your navel. The procedure can be temporary or permanent and is usually done when parts of the colon, rectum or anus aren’t working properly because they are injured or diseased. Sometimes, a temporary colostomy is performed when a part of the bowel needs to rest after surgery or a period of infection.
The colostomy provides the body with a new exit way for stool and gas, the output is generally firm and formed. Because the stoma doesn’t have a muscle to control when stool is leaving the body, you will need to wear a stoma pouch.
Types of colostomies
With a loop colostomy, a loop of the colon is pulled out through a cut in your abdomen, the loop is then opened up and stitched to the skin to form a stoma. This type of colostomy actually consists of 2 stomas that sit right next to each other. One is connected to the working part of the colon, the other one is connected to the inactive piece of the colon. In some cases, a support device like a rod or bridge may be used to hold the colon loop in place while it heals. This is usually removed after a few days.
A loop colostomy is typically a temporary measure performed in an acute situation. This is because it can be more easily reversed by removing the colon from the abdominal wall and closing the holes to re-establish the flow of the stool.
With an end colostomy, an end of the colon is pulled out through a cut in the abdomen, turned under like a cuff, and is then stitched to the skin to create a stoma. Often, end colostomies are permanent but sometimes they are used in emergencies. Your doctor will likely choose for you to have a permanent colostomy if it’s too risky or impossible to re-join the two parts of your bowel.
Possible Causes for a Colostomy
There are various reasons why you might need a colostomy, all of which affect your colon These reasons can include:
- Hirschsprung’s disease
- Irritable Bowel Syndrome (IBS): Condition affecting the colon that causes diarrhoea, bloating, constipation, and abdominal pain
- Colonic polyps: Extra tissue growing inside the colon that my become cancerous
- Crohn’s disease
- Blockage of the bowel
- Injury to the bowel
- Colorectal cancer
- Diverticulitis: Small pouches in the large intestine become infected or inflamed
- Ulcerative colitis: Irritable bowel disease that causes long-term inflammation of digestive tract
- Wounds or fistulas in the perineum: Abnormal abdominal connection between internal parts of the body or between an internal organ and the skin
Prior to your surgery, your doctor will probably want to take a blood sample, perform a physical exam, and look at your medical history. This is to make sure that you’re fit and ready for your colostomy surgery. If you are on any medication, whether that’s prescription or over-the-counter stuff, it is important that you let your doctor know. Certain medicines, like blood thinners, have to be stopped 1 to 2 weeks before surgery. Please do not stop taking any medicines without consulting with your doctor first, however! From about 12 hours before the actual procedure, you will likely have to fast, and you might also be given a laxative or enema to cleanse the bowels.
If you like, you can ask your doctor or nurse if the hospital has access to an ostomy visitor. This is a volunteer who has had a colostomy and can help you to understand how life with one might be. If this isn’t possible, there might be an ostomy support group near you which you can visit before and after your surgery. Feeling a little shy? Don’t worry, there are many amazing support groups on Facebook.
Once you’re under general anaesthetic, your surgeon will start by making an incision in your abdomen. This can either be one larger cut or a few smaller cuts – called a laparoscopy. The surgeon will then locate the best part of your colon for the stoma and place a ring onto the abdominal wall that will hold the part of the intestine in place. This ring may be permanent or temporary and is generally used to help the skin around the intestine to heal. Depending on why you are having a colostomy, it will be made of either the ascending, transverse, descending, or sigmoid colon.
Transverse Colostomy: A transverse colostomy is usually performed in the middle section of the colon and your stoma will sit somewhere across your upper abdomen. This type of colostomy is often temporary and typically done for things like diverticulitis, IBD, cancer, bowel obstruction, injuries, or birth defects. Stool will leave the colon through your stoma before it reaches the descending colon.
Ascending Colostomy: With an ascending colostomy your stoma will likely be on the right side of the abdomen. This type of colostomy is generally done when a blockage or a disease prevent a colostomy further along in the colon.
Descending Colostomy: With a descending colostomy your stoma will likely be located in the lower left side of your abdomen. As the output has moved through bigger parts of the colon it will generally be pasty to formed.
Sigmoid Colostomy: A sigmoid colostomy is the most common type of colostomy and the stoma will generally be placed a few inches lower than with a descending colostomy. Because the stool has moved through most of the colon the output is generally more solid and regular than with other colostomies.
After the surgery
Your initial recovery after surgery will be spent in hospital. You might have an IV for fluids, a catheter to drain urine from the bladder and an oxygen mask if you’re struggling with your breathing. During the first days of your recovery you will slowly be introduced to food and drink to ensure there are no digestive problems. On the first day, you will most likely only be given ice chips to ease the thirst, then clear liquids, and eventually soft foods. A specialist ostomy nurse will teach you how to use your colostomy bags correctly and you’ll get all the necessary instructions for your diet and activity level.
Potential Risks of a Colostomy
A colostomy is considered major surgery and, as with any other surgery, there is always a risk of possible short-term or long-term complications. These risks are:
- Problems due to scar tissue
- Wound breaking open
- Internal bleeding or bleeding from the stoma
- Damage to nearby organs
- Blockage of your colostomy
- Prolapse of the colostomy
- Skin irritation
- Narrowing of the stoma
The Colostomy Pouch
With a colostomy, you will generally need to wear a closed, non-drainable colostomy bag. If the output of your stoma is particularly fluid, you can speak to your nurse or doctor about getting a drainable bag. The pouch system is available a s a one-piece and two-piece system. With the first one, bag and skin barrier are one unit. This means that you will have to change the adhesive baseplate every time you change your bag. With a two-piece system, on the other hand, bag and adhesive baseplate are two pieces and you are able to change your bag without removing the skin barrier.
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