Colostomy: Surgery, Bags and Stoma Care

A colostomy is an opening in the colon that lets stools pass from the body without going through the anus. During colostomy surgery, an opening is made in the belly called a stoma. Part of the colon is brought through that opening and attaches to a pouch outside the body. Stools pass through the opening and go into the pouch. This is called a pouching system. The pouch is emptied about 1 to 2 times a week. Many people refer to the pouch as a colostomy bag.

A colostomy may be located in any part of the colon. The colostomy is named for the part of the colon that’s used to make the stoma. For example, a colostomy in the sigmoid colon is called a sigmoid colostomy.

Colostomy types

There are several types of colostomies, depending on what part of the colon is affected and what technique is used.

Colostomy types based on location in the colon

These colostomy types are named according to the section of the colon where the stoma is located:

• Sigmoid colostomy. This type of colostomy is in the last section of colon before the rectum, called the sigmoid colon. In sigmoid colostomy, stool is firmer and more formed due to the length of the remaining active colon.
• Descending colostomy. This type of colostomy is in the section of the colon running down the left side of the belly, called the descending colon. Stool is still fairly firm with a descending colostomy because it’s not far from the sigmoid colon.
• Transverse colostomy. This type of colostomy is in the section of colon that stretches horizontally in the upper part of the belly, called the transverse colon. Stool is softer and less formed because this section is earlier in the colon, where less water is absorbed.
• Ascending colostomy. This type of colostomy is in the first section of the colon that runs along the right side of the belly, called the ascending colon. Ascending colostomy is rare and typically temporary. Stool is liquid or semiliquid because it’ forms in the first section of the colon, where less water has been absorbed by the colon.

Colostomy types based on surgery techniques

These colostomy types are based on the surgical technique and stoma design:

• Loop colostomy. In a loop colostomy, a loop of the colon is brought through the belly and partially cut to create one, large stoma with two openings. One opening is for stool. The other opening may be for mucus. A rod or bridge may hold the loop in place.

  Loop colostomy can be temporary. It also can be used to divert stools away from a downstream section of the bowel that needs to heal or rest. The most common type of loop colostomy is a diverting loop colostomy.

• End colostomy. In an end colostomy, one end of the colon is brought through the belly to create a single stoma. The other end is either removed or closed off. End colostomy can be done after part of the colon has been removed due to cancer, trauma or a condition called diverticulitis.

  End colostomy is usually permanent, but it may be temporary to allow the lower bowel to heal before being reconnected.

• Double-barrel colostomy. This style of colostomy involves creating two separate stomas, one for stool and one for mucus. Double-barrel colostomy is usually temporary. It may be used in an emergency, such as a perforated bowel, or when part of the colon needs to heal.

Temporary vs. permanent

Colostomies can be temporary or permanent. A temporary colostomy is used to let a section of the bowel rest and heal. This may take several months. After healing, the colostomy is closed surgically, and stools pass through the anus again.

A permanent colostomy may be needed if your colon or anus is removed or too damaged to fix. This may happen in cases of advanced cancer or serious injury. A permanent colostomy is not reversed, and stool continues to exit through the stoma rather than the anus.

Other ostomy procedures

An ostomy is any surgical procedure where an opening, called a stoma, is created in the belly to allow stools to exit the body. Colostomy is one type of ostomy. But there are other types of ostomies. An ileostomy diverts stools from part of the small intestine called the ileum. A urostomy diverts urine through a stoma, bypassing the bladder.

A colostomy may be needed if injury or a medical condition stops the colon from functioning like it should. If the colon is damaged or blocked, it may not be possible or safe for stools to pass through the colon and out the anus.

A colostomy may be needed in these situations:

• Treatment of colon or rectal cancer. When cancer affects the colon or rectum, all or part of the colon or rectum may need to be removed. This is known as colectomy or resection. These surgeries may be needed if cancer has grown through the colon or rectum, or if the cancer is causing a blockage in the intestine.
• Diverticulitis complications. A colostomy may be needed to manage serious infections or tears in the colon caused by diverticulitis, a condition that causes swollen, bulging pouches in the wall of the colon.
• Trauma or injury. Injury to the colon, such as from an accident or gunshot wound, may require a colostomy.
• Bowel blockage, called obstruction. A colostomy can help relieve blockages in the colon due to cancer, scarring or other conditions.
• Inflammatory bowel disease,(also called IBD). Conditions such as Crohn’s disease or ulcerative colitis can damage the colon.
• A condition present at birth. Conditions you are born with are called congenital conditions. Birth conditions such as Hirschsprung disease or anal atresia may require a colostomy.
• Rectal or anal dysfunction. Nerve damage, cancer or surgery can affect the rectum or anus.
• Recovery from surgery. To protect tissues after colon or rectal surgery, a colostomy may be done to give tissues time to heal.

Complications can happen during or after colostomy surgery, including:

Surgical risks

• Reaction to anesthesia. Possible reactions include breathing difficulties or low blood pressure.
• Infection. There’s a risk of infection at the surgical site or inside the belly.
• Bleeding. Excessive bleeding during or after surgery can happen. If this happens, a blood transfusion may be needed.
• Damage to nearby organs. During surgery, nearby organs or tissues may be accidentally injured.

Stoma-related complications

These risks are specific to the creation and maintenance of the stoma, which is the artificial opening in the belly:

• Prolapse. Part of the intestine may push itself through the stoma, a condition called prolapse.
• Retraction. The stoma may sink below the skin level, leading to leakage or difficulty attaching the colostomy pouch.
• Bleeding. This is more common within the first 30 days after surgery.
• Narrowing, called stenosis. The stoma opening may narrow, blocking the passage of stool. If this happens, the stoma may need to be opened or fixed with surgery.
• Hernia. A hernia can form around the stoma, causing a bulge under the skin.
• Tissue death, called necrosis. Blood supply to the stoma can get restricted. When this happens, the tissue dies. This requires urgent medical attention.
• Skin irritation. The skin around the stoma can become irritated or infected due to leakage or the pouching system not fitting properly.
• Leakage. Leaking from the stoma is more common right after surgery, but it can develop later due to weight loss or gain and pregnancy.
• Separation of the stoma from the skin. The stoma is attached to the skin with stitches. Sometimes, the stitches can detach, creating an open wound.

Bowel-related complications

These risks involve the intestines and their function following colostomy surgery:

• Blockage. The stoma or intestines can become blocked. The blockage is called an obstruction. It can lead to pain and digestive issues.
• Post-surgery scar tissue, called adhesions. Scar tissue may form after surgery, binding organs and tissues together. This may possibly cause blockages or limit blood flow.

Other complications

These risks are less common but can be serious:

• Dehydration. Increased fluid loss through the stoma can lead to dehydration, especially in the early stages after surgery.
• Difficulty absorbing nutrients. If large segments of the bowel are bypassed or removed, nutrients may not be absorbed.

In addition to these physical risks, a colostomy can have a psychological impact. Adjusting to life with a colostomy can be challenging and may affect mental health and quality of life. If you’re having a difficult time adjusting to living with a colostomy, reach out to your healthcare team. The care team can offer resources to help or connect you with a support group.

Whether your colostomy is temporary or permanent, proper preparation can ease the transition and help you adapt to your new routine. Preparing for colostomy surgery typically involves these steps.

Preoperative review

This is a time for you to talk with the care team about topics that may affect the procedure and recovery. These topics may include:

• Caffeine, alcohol, tobacco and e-cigarettes. These products and certain medicines may affect how you heal and recover. If needed, your care team can offer advice on how to quit or cut back.
• Medicines or supplements that you take. You may need to stop taking certain medicines or supplements before surgery.
• Build physical strength. If you’re able and your healthcare team approves, engage in light exercise such as walking or stretching. Stronger overall health can speed up healing after surgery.

• Marking the stoma site. A member of the care team marks the stoma site. Another name for a stoma is ostomy. The stoma typically is placed near the surgery location. This may be in the ascending, transverse, descending or sigmoid colon.

  Your natural skin folds, muscles in your belly or any scars you have can affect the stoma site. The location of your belly button, waistline and hip bone also may be factors. Your care team can help choose a spot that you can easily reach and see when you sit and stand. However, the final site selection is determined during surgery, when the surgeon can see the colon.

• Diet and fasting. You may need to follow a special diet or take a bowel-cleansing solution before surgery. Talk with your care team about your instructions.

Plan for your hospital stay

You’ll spend a few days in the hospital after your colostomy, depending on your situation. Plan for someone to take care of your responsibilities at home and at work.

Think ahead to what you might like to have with you while you’re recovering in the hospital. Things you might pack include:

• A robe and slippers.
• Toiletries, such as your toothbrush and toothpaste and, if needed, your shaving supplies.
• Comfortable clothes to wear home. Loose-fitting clothes are ideal after surgery to avoid pressure on the stoma.
• Activities to pass the time, such as a book, magazine or games.

During your colostomy

Colostomy surgery can be performed using either an open or minimally invasive approach. The choice depends on factors such as your overall health, the reason for the colostomy, and the surgeon’s recommendation.

• Open colostomy. Open surgery involves making a longer incision in the belly to access the colon. The surgeon moves or removes the affected part of the colon by hand. Open surgery typically requires a longer hospital stay and recovery time but may be necessary for complex cases. This approach is more common in emergency situations.

• Minimally invasive colostomy. Minimally invasive colostomy includes laparoscopic or robotic colostomy. Both laparoscopic and robotic surgery use a few small incisions in the belly. A laparoscope is a thin tube with a tiny camera at the end. The camera lets the surgeon see inside the body during surgery.

  A robotic surgery system includes a camera arm and other arms that hold the surgical tools. Several members of the care team are in the surgical room during robotic surgery. They use a monitor to guide the camera and tools.

The type of operation you undergo depends on your situation and your surgeon’s expertise. Laparoscopic or robotic colostomy may reduce the pain and recovery time after surgery. But not everyone is a candidate for these procedures.

Colostomy surgery typically involves the following steps:

• Anesthesia and preparation. After you arrive for your surgery, your healthcare team takes you to a preparation room. Your blood pressure and breathing are monitored. You may receive an antibiotic medicine through a vein in your arm.

  You are then taken to an operating room and positioned on a table. You are given a general anesthesia medicine to put you in a sleep-like state so that you won’t be aware during your operation.

• Surgical incisions. If you’re having open surgery, a large incision is made in your belly. For laparoscopic surgery, several small incisions are made, just large enough to place a camera and surgical tools.
• Colon removal or bypass. The surgeon identifies the section of the colon to bypass. If necessary, the diseased or damaged part of the colon is removed. An opening in the abdominal wall is created.
• Creation of the stoma. The colon is brought through the abdominal wall to form the stoma. The colon is sewn to the skin at the opening to secure the stoma. The stoma now serves as the new exit point for stool, which will be collected in an ostomy pouch.
• Closure of incisions and colostomy pouch placement. If you have a temporary colostomy, the surgeon makes sure that it will be possible to reattach the colon in a future reversal surgery. The surgical site is closed with stitches or staples. A colostomy pouch then is attached to the stoma to collect waste.

After your colostomy

Depending on whether you have open or laparoscopic surgery, you may stay in the hospital for a few days to a week. Healing after surgery may take time. Full recovery may take a few weeks. It’s important to rest and recover. People who had laparoscopic or robotic surgery usually recover faster than those who had open surgery.

While you’re recovering in the hospital, your healthcare team can teach you how to care for your colostomy. Your team may include a nurse who specializes in ostomy care, called a wound ostomy continence nurse or a WOC nurse. Your care team also can answer questions you may have about your new pouching system and about adjusting to daily life while wearing one.

Here are a few colostomy basics to know:

The pouching system

A WOC nurse or someone on your healthcare team can help you decide which type of pouching system is best for you. Your pouching system includes both a pouch to hold the stool, often called a colostomy bag, and a sticky barrier called a wafer. The wafer attaches the pouch to your skin and protects the skin.

The opening in the wafer should fit closely around the edge of your stoma to protect your skin as much as possible. Stools should not touch the skin for long periods of time. This causes healthy skin to break down. If the pouching system lifts off your skin, you must change it to protect your skin.

Stoma care instructions

Knowing how to care for your stoma, often called an ostomy, is an important part of preparing for a colostomy. A WOC nurse or another healthcare professional may offer you information on:

• Stoma care. A healthcare professional may meet with you to teach you what to expect with your colostomy. This person can teach you proper cleaning and maintenance techniques for your pouch and caring for your stoma.
• Stoma supplies. A healthcare professional can help you choose the ostomy supplies that suit you best. Some companies offer samples that help you explore different products. As you recover and become more familiar with your ostomy and its supplies, you may feel the need or desire to experiment with different products to better meet your preferences.

Emptying the pouch

A WOC nurse or someone on your healthcare team can teach you to empty your pouching system from the bottom of the pouch. You do this while you sit on the toilet. In the hospital, your colostomy pouch system is changed every 1 to 4 days. At home, you change it about 1 to 2 times a week. To keep the pouch from showing under clothing, empty it once it reaches one-third full. This also avoids excess weight in the pouch system, which may loosen the seal.

Colostomy irrigation may be an option for people who have a descending or sigmoid colostomy. Irrigation is one way to manage your colostomy if your stool is soft to formed. Irrigation is done through the colostomy. Irrigation “trains” your bowel to empty only with the irrigation. If you’re interested in irrigation, ask your healthcare team for more information.

Stool consistency

Stools typically start passing through your stoma a few days after the creation of your colostomy. At first, stools are liquid, but they usually thicken within a few weeks. The type of colostomy you have, your diet, your emotional state and your medicines may affect the consistency of your stools.

If you have a transverse colostomy, you may pass loose or semiformed stools often throughout the day. If you have a descending or sigmoid colostomy, stools may be formed or solid. This is because the colon absorbs some of the water.

The frequency of stools may be unpredictable when bowel function first returns. Shortly after surgery, you may need to empty the pouch more often. Over time, you should have less output.

Odor control

Odor is a common concern for people with colostomies. Although the pouching system is odor-proof, there will be some odor when you empty it. You may find that certain foods cause more odor in your stool.

You may use an odor eliminator or deodorant in the pouching system if the odor bothers you. There are also different deodorants available that you can take by mouth. A member of your care team can talk with you about these products.

Living with a colostomy

It takes time to become comfortable with a colostomy. Many questions may run through your mind as you plan your first ventures outside of your home. Can I still travel after colostomy? Can I swim? How do I shower? Do I need to buy different clothes? How will it affect my intimate life? Once you adjust, you’ll find it’s possible to do many of the same activities you enjoyed before your colostomy.

Bathing and swimming

You can shower with or without your colostomy pouch. Water will not go into the stoma. However, keep shower spray from hitting directly on your stoma or pouching system. This helps prevent injury to the stoma. And it helps prevent the pouching system from becoming loose.

Shower or bathe when the stoma is less active. For example, do so first thing in the morning. Soap does not harm your stoma. But you need to rinse off any soap film from the skin around the stoma. Soap that gets under the pouching system may cause skin irritation.

You may swim with a colostomy. Swimsuits with a pattern or design in the fabric may be more concealing. Dry the tape and pouching system well after you bathe, shower or swim. A hair dryer placed on a cool setting can help dry.

Clothing

The style of clothes you wore before surgery may not need to change now that you have a colostomy. However, the stoma has a different placement in each person. Sometimes clothing adjustments may be necessary. Most people avoid restrictive clothes, such as a belt. Restrictive clothes below the colostomy can prevent stools from flowing into the pouching system.

Intimacy

Intimacy after a colostomy can still be fulfilling, though it might take some adjustment due to changes in body image and the presence of a stoma and pouch. Many people worry about leaks or odor, but using a smaller pouch, emptying it beforehand, or covering it with clothing or a special wrap can help ease those concerns. Open communication with a partner about feelings and preferences, along with time to build confidence, can make physical closeness feel natural again.

Diet and nutrition

A colostomy does not affect the ability of your body to digest food. Over time, you learn your own response to food. The following information may be helpful in managing your colostomy:

• Eat on a schedule. Eat meals at regular times and try to eat three or more small meals a day. This helps digestion and controls stool output.
• Eat slowly and chew food well. Chewing helps digestion.
• Stay hydrated. Drink 64 to 80 fluid ounces (1.9 to 2.4 liters) of water each day. That’s about 8 to 10 glasses. This helps prevent constipation and dehydration.
• Try new foods one at a time. This helps you find out what foods agree with you.
• Keep track of how different foods affect your stool. This helps you choose foods to improve stool consistency.

For the first two weeks after surgery, limit foods that may cause gas or loose stools. These include beans, beer, broccoli, cabbage, cauliflower, onions and carbonated drinks. Also limit foods that you may not digest fully. These include fresh fruits and raw vegetables. This helps to lessen the amount of gas and stool you have.

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Your colostomy usually does not limit your physical activity. Light exercise helps build muscles, and it keeps the digestive tract working properly. The level and type of exercise you choose often depends on the exercises you were comfortable with before surgery.

Walk inside or outside. It is one of the best physical activities you can do after surgery. In the first weeks after surgery, you only may be able to take short walks. As you feel comfortable, slowly increase the distance you walk.

Travel

Traveling with a colostomy is very doable with some planning. Pack extra supplies in your carry-on bag, such as pouches, wafers and cleaning gear. You might need them on the go, and checked luggage can get lost. Stay hydrated, watch what you eat to avoid gas or loose stool, and know where bathrooms are, especially on planes or long drives, so you can empty your pouch comfortably.

After colostomy surgery, expect a few weeks of recovery at home. You may feel weak at first, but eventually your strength will return.

If your colostomy was temporary, your surgery may be reversed in a few months, once tests show that everything is healed. Your healthcare team can monitor your recovery during follow-up visits, then decide on the next steps.