What to Know About Colostomy Surgery (2024)

Colostomy surgery is a surgical procedure to remove part of the colon and create an opening to allow stool to pass out of the body. The stool is collected in a colostomy bag, which is worn on the abdomen.

Colostomy surgery may be used to treat many digestive conditions, including colon cancer, Crohn's disease, intestinal obstruction, birth defects, anddiverticulitis.

What is Colostomy Surgery?

A colostomy is a type of ostomy surgery. Ostomy describes any surgery where an opening is made from an internal organ to the body's surface. In a colostomy, the opening is made from the colon (or large intestine) to the outside of the abdomen.

During colostomy surgery, the surgeon may remove a segment of the colon. This results in the colon being in two separate parts.

One end of the colon is passed through a small hole in the abdominal wall. This small section of intestine, called astomawhen it's outside the body, allows for waste to leave the body from the colon.

The other end of the colon, which is attached to the rectum, may either be removed or closed off with sutures and left in the abdomen.

After the surgery, waste is collected on the outside of the body with an ostomy bag. Today’s ostomy bags come in a variety of shapes, sizes, colors, and materials to suit the wearer’s lifestyle. The stoma and the surrounding skin (peristomal skin) will require special care. Instructions are typically given to patients post-surgery by an enterostomal therapy (ET) nurse.

Who Needs a Colostomy?

Colostomy surgeries are often done as part of treatment for colon or rectal cancer. Other conditions that might cause you to need a colostomy include:

• A birth defect that causes a blocked or missing anal opening
• Inflammatory bowel disease such as Crohn's disease
• An infection
• A bowel blockage, either partial or complete
• Diverticulitis
• A fistula, an abnormal connection between your bowel and another part of your body such as the perineum (the area between the anus and vulva or scrotum)
  

Temporary vs. Permanent

A colostomy could eitherbe temporary or permanent.

Temporary Colostomy

A temporary colostomy may be used when the part of the colon (typically the lower section) needs to heal, such as after trauma or surgery. After the colon is healed, the colostomy can be reversed, returning the bowel function to normal.

In a colostomy reversal, the two ends of the colon are reconnected and the area where the stoma was created in the abdomen is closed. The large intestine is made, once again, into a continuous tube between the small intestine and the rectum. Bowel movements are eliminated through the rectum.

Permanent Colostomy

A permanent colostomy (sometimes also called an end colostomy) is necessary for some conditions, including about 15% of colon cancer cases. This type of surgery is commonly used when the rectum needs to be removed due to disease or cancer. Most of the colon may also be removed and the remaining portion used to create a stoma.

Types of Surgery

There are several different types of colostomy surgery:

Ascending

This colostomy has an opening created from the ascending colonand is created on the right side of the abdomen. Because the stoma is created from the first section of the colon, stool passed through the stoma is more liquid and contains digestive enzymes that irritate the skin. This type of colostomy surgery is the least common.

Transverse

This surgery may result in either one or two openings in the upper abdomen, middle, or right side that are created from the transverse colon. If there are two openings in the stoma (called a double-barrel colostomy), one is used to pass stool and the other is used to pass mucus. The stool that is eliminated through the stoma has passed through the ascending colon, so it tends to be liquid orsemi-formed.

Descending or Sigmoid

In this surgery, the descending or sigmoid colon is used to create a stoma, typically on the left lower abdomen. This is the most common type of colostomy surgery and generally produces stool that is semi-formed to well-formed because it has passed through the ascending and transverse colon.

Colostomy Procedure Steps

A colostomy is major surgery and will require a hospital stay of at least several days and up to six weeks or more of recovery at home. Patients will receive instructions from the surgeon on how to prepare in the days leading up to surgery.

Preparing for Surgery

Your surgeon will give you instructions on how to prepare for your surgery, including medication use, the need for routine exams, and bowel prep.

• Medication: Tell your surgeon about all medications you're taking. Certain classes of drugs may inhibit the healing process (such as prednisone) or interact with other drugs. If you are taking medications, your surgeon may contact your prescribing physician for instructions on either continuing, discontinuing, or adjusting your dose during surgery and convalescence.
• Routine exams: You may need to have certain routine examinations before surgery, such as a physical and a chest x-ray.
• Learn about your stoma: You should also meet with an ET nurse who can explain how to take care of a stoma. In the initial meeting, one important point is to discuss where the stoma will be placed on the abdomen, what kind of supplies will be needed immediately after surgery, and how to best fit caring for an ostomy into daily life.
• Bowel prep: Colostomy surgery will often require a bowel prep to clean out the colon. Follow your surgeon's instructions to remove all stool from the bowel in the day or two before surgery, as if preparing for a colonoscopy. This may be accomplished through a combination of fasting, enemas, laxatives, and/or any of the standard bowel preps.
• Preventing infection: You may also need to take antibiotics or other medications to prevent infections before, during, and after the surgery.

Post Surgery

Directly before surgery, an IV will be placed to receive fluids and anesthetic. The surgery itself will last several hours.

Upon awakening in recovery, a colostomy bag will be attached to the abdomen over a new stoma and there may be one or more drainage tubes. Once vital signs (pulse, blood pressure, respiration) are stable, you will be moved to a hospital room.

For the first few days after surgery, you will continue to receive pain medication through the IV. You will not be given food until your healthcare provider hears bowel sounds from your abdomen which indicates that the intestines are "waking up."

Nurses will help you to get out of bed and sit in a chair or stand, usually a few days after surgery, depending on how your recovery is progressing. Standing and walking as soon as possible is very important, even though it will be uncomfortable.

After your provider hears bowel sounds and the stoma begins to function, the next step is to try to eat some clear liquids, such as broth, gelatin, and juice. If the clear fluids are tolerated well, your provider will let the staff know that your diet can progress to full liquids or solid food.

You should have a meeting with an ET nurse before leaving the hospital to learn more about taking care of a stoma and changing the ostomy appliance. It's also important to learn where to obtain colostomy supplies and get any special instructions for recovery at home.

Risks

All surgeries come with a certain amount of risk. After a colostomy, it's possible to experience complications such as:

• Skin irritation around the stoma and bag
• Infection
• Parastomal hernia, when the intestines push outward through the muscles around the stoma, causing a bulge
• Leakage internally or around the stoma
• Intestinal obstruction caused by a buildup of scar tissue

Recovering at Home

Recovery at home can take two to four weeks, although it may be longer for patients who are very ill before surgery or who have complications. Activity will be restricted at first, and lifting, housework, and driving are not recommended, probably for about four weeks.

The hospital staff will give diet advice before you leave the hospital. Your diet may be restricted to low fiber. Regular appointments with your surgeon will help ensure that the abdomen and the area around the stoma are healing well.

You will learn how to take care of your stoma during the first few weeks of your recovery. An ET nurse will answer any questionsand may help with the first few bag changes. Expect a learning curve as you're getting used to using and maintaining your bag.

The surgeon will give instructions about when it is time to resume regular activities at work, school, or home. If the colostomy is going to be reversed, the surgeon will help decide when that is possible based on your recovery and your personal schedule.

As you recover, your stoma is likely to become smaller. After the first six weeks, you should be able to resume normal activities, including most types of exercise, though you should limit exercises that involve the muscles of your abdomen for a few months post-surgery.

Summary

A colostomy is a surgical procedure that involves removing part of the colon and creating a new opening in the body to pass stool. The stool is collected in a colostomy bag.

Colostomies are often done to treat colon or rectal cancer, but they may also be done for other conditions such as a bowel blockage or Crohn's disease.

People with colostomy bags can go on to lead fairly normal lives. The procedure does not usually impact your lifespan.