Colostomy

What is a colostomy?

A colostomy is a surgery that changes the way stool (poop) exits your body. During the procedure, a surgeon creates a hole (stoma) in your abdominal (belly) wall. They then connect a portion of your colon to it.

Instead of pooping like you used to, waste collects in a pouch (or colostomy bag) on the outside of your belly. Some people only have a colostomy for a few months, while others need one for life.

A colostomy is a type of ostomy. It may be part of a colectomy operation, a procedure to remove part or all of your colon. Other conditions may require you to stop using your colon, either temporarily or permanently. After surgery, “colostomy” also refers to your newly redirected colon. Your healthcare provider will talk to you about living with and caring for your colostomy.

Types of colostomy

There are several types of colostomies. The names of these procedures correspond with the portion of your colon that a healthcare provider must redirect.

• Sigmoid colostomy. Connects the lower, S-shaped part of your colon (on the left side of your body) to your abdominal wall. Sigmoid colostomies are the most common type. Stool from a sigmoid colostomy is typically more solid than other types of colostomies. This is because it moves through most of your colon before coming out through your stoma.
• Descending colostomy. Connects the left side of your colon (the portion just above your sigmoid colon) to your abdominal wall. A descending colostomy is similar to a sigmoid colostomy, but it occurs just above the S-shaped curve in your colon. Stool from a descending colostomy is firmer, like stool from a sigmoid colostomy.
• Transverse colostomy. Connects the upper portion of your colon (which goes across your abdomen) to your abdominal wall. Transverse colostomies are usually temporary. There are two subtypes — loop colostomy and double barrel colostomy. They share a common goal — to let the affected portion of your colon rest while you heal. People with these types of colostomies may have two stomas — one to pass stool and one to pass mucus. (Even after a colostomy, your colon will still make a protective layer of mucus. This is completely normal.) Stool from a transverse colostomy is usually softer because it’s only traveled about halfway through your colon.

Your healthcare provider will consider many factors. This helps them choose the best option for your situation. Most importantly, it depends on whether you need a temporary or permanent solution.

What conditions are treated with colostomy?

You may need a colostomy if a health condition keeps you from using your colon or anus like you used to. It might be a temporary intervention that allows your body to heal or it may be a permanent solution for an irreversible condition.

Some conditions that may require a temporary colostomy include:

• Diverticulitis
• Inflammatory bowel disease (IBD)
• An injury to your colon
• An obstruction (or blockage) in your colon or anus
• Anal fistula (a tunnel leading from your anal cavity through to your skin or another organ)
• Partial colectomies (when a surgeon decides it’s safer to reconnect the ends of the bowels in a separate operation after they remove part of the colon)

Some conditions that may require a permanent colostomy include:

• Incurable fecal (bowel) incontinence
• Advanced colorectal cancer
• Permanent removal of your rectum and/or anus

How should I prepare for a colostomy?

A colostomy is a major surgery, and it involves some preparation.

Before your surgery

You’ll have a pre-op assessment with your surgeon. Before you sign your consent forms, they’ll make sure you understand the procedure, the risks involved and the lifestyle changes you’ll have to make afterward. You may also discuss your pain management options at this time.

They’ll also take a blood sample to check that you are well enough for surgery. They may also run an EKG test to check that your heart is in good health.

Another healthcare provider (usually a nurse) will teach you about your future ostomy. They’ll also help you choose the best location for the colostomy on your abdomen.

On the day of your surgery

You’ll need to avoid eating for six hours before surgery and drinking clear liquids two hours before surgery. Your surgeon might also recommend an enema or bowel prep (like before a colonoscopy) to take at home.

What happens during colostomy surgery?

You’ll be under general anesthesia for your colostomy. Depending on your situation, your surgeon may do open surgery or laparoscopic surgery.

Open surgery requires a longer incision across your abdomen. Laparoscopic surgery is less invasive. Instead of making one long incision, your surgeon will make several small incisions. Then, they’ll put a tiny camera and special instruments through the incisions. They’ll use these to perform the surgery inside your belly.

During your colostomy operation, your surgeon creates an opening (stoma) in your abdominal wall. Then, they attach part of your colon to your new stoma. For a sigmoid or descending colostomy, your stoma will be on the lower left side of your belly. If you have a transverse colostomy, your stoma will be somewhere across your upper belly, or on the right or left side.

Once your surgeon completes your colostomy, they’ll attach a colostomy bag to your skin. There are several types of colostomy bags. They include closed bags, drainable bags and mini pouches. Your healthcare provider will help you choose the best option for your needs.

What happens after colostomy surgery?

You’ll need to recover in the hospital for the next three to seven days. During this time, you’ll:

• Resume normal eating gradually. You’ll likely be on a clear liquid diet on the day of and/or after surgery. Then, you’ll have a soft or low-fiber diet before eating a regular solid food again.
• Learn all about colostomy care. A wound ostomy continence nurse (WOCN) will teach you about living with a colostomy bag. They’ll also teach you how to care for your stoma.
• Gradually wean from your pain medications. Your healthcare provider may give you a short-term prescription to take home with you.
• Heal from your wounds, and your bowel movements will begin to regulate. It may take several days before your first one.

What are the benefits of a colostomy?

A colostomy is often a life-saving intervention. If you need a colectomy or similar operation, a colostomy lets your body keep working after losing a major organ.

Colostomy can also give your colon a “time out” after a procedure. Or you might need to rest your colon following illness or injury. Colostomy allows healing to take place safely without risking further complications.

What are the risks of a colostomy?

Colostomy is a common and straightforward surgery. It’s generally safe, but there are always some risks, including:

• Bleeding
• Infection
• Reactions to the anesthesia
• Injury to nearby organs
• Skin reactions to the ostomy and its appliances

Even after a successful colostomy, you might develop complications down the road. These may include:

• Skin irritation. This can occur from contact with stool (poop) — especially the acidic, liquid stool of the upper colon. This is the most common stoma complication. A better-fitting colostomy bag usually solves the issue.
• Bowel obstructions. Scar tissue or paralytic ileus (slow-moving bowels) can block poop from moving through your colon after surgery. Most of the time, constipation medications can help.
• Stoma retraction or prolapse. A retracted stoma sinks back below your skin’s surface level. A prolapsed stoma sticks out too far. Both situations can make it difficult to fit your colostomy bag to your stoma securely. If you can’t find a bag that fits, you might need surgical revision on your stoma.
• Parastomal hernia. This type of hernia occurs when loops of bowel bulge through weak muscles around your stoma. A hernia forms a visible bulge next to your stoma. It can grow over time and block the stoma’s output. Your healthcare provider will discuss ways to prevent a hernia after surgery.

What is the recovery time after colostomy surgery?

Each person heals at a different pace. But on average, most people recover from colostomy surgery within six to eight weeks.

Be sure to follow your surgeon’s post-op guidelines. It’s important to get lots of rest. But you should also take short walks around your house. Short walks help your bowels move more quickly.

When should I call my doctor?

Contact your healthcare provider if you experience:

• Constipation or diarrhea that doesn’t go away
• Nausea or vomiting
• Blood in your stool
• A change in your stoma’s regular size or color
• Any strange or foul odors coming from your stoma
• A blockage in your stoma

Can you still poop with a colostomy bag?

Pooping will be different with a colostomy bag. After your surgery, your anus may continue to expel small amounts of poop and other fluids that remain inside (even weeks to months after surgery). But new poop will now exit through your stoma. Most people will be able to feel their bowels move and know when poop is about to come out. But you won’t be able to control it anymore. Unlike your anus, your stoma doesn’t have a muscle system that allows you to close it at will. So, pooping won’t be the intentional action that it used to be.

After colon removal, some people may continue feeling phantom bowel movement urges. These urges are similar to phantom limb syndrome. They find that the urges subside if they sit on the toilet like they used to. If you still have your anus intact and you don’t have a separate stoma for anal discharge, you’ll continue to pass occasional mucus through your anus. This will feel similar to a bowel movement. The inactive colon continues to produce mucus as it always did, to lubricate and protect the skin.

How long after colostomy do you poop?

Waste should begin passing through your stoma about three to seven days after your colostomy.

Will I always have to wear a colostomy bag over my stoma?

Many people always wear their colostomy bag to catch poop when it comes out. Modern colostomy bags are discreet, and you can wear them under almost any kind of clothing. People who have had descending or sigmoid colostomies may be able to predict when they need to poop. They only wear a pouch during those times. They also may be able to induce pooping through colostomy irrigation. By spending time daily clearing out their bowels with water, people can go without a bag between irrigations.

I have a temporary colostomy. When can I have a colostomy reversal?

This will depend on a few factors, including:

• The reason you had a colostomy created
• Your health since the operation
• Whether you can handle more surgery

You can discuss plans for a reversal with your provider during your follow-up visits. They’ll assess your condition and schedule your reversal surgery when they feel you’re ready. It might be a few months to a year after your first surgery. Sometimes, it’s several years. There’s no time limit to a reversal, only health limits.