What Is A Colostomy?

Introduction

A colostomy is a medical procedure where a part of the colon (large intestine) is brought to the surface of the abdomen, creating a small opening called a stoma. The opening will provide a route from the large intestine to the outside of your body. The stools that form in the colon will now leave the body through this stoma instead of the rectum and anus and then be collected in a bag/pouch attached to the stoma.¹

About the large intestine

The large intestine or colon is an essential part of the digestive system. It is responsible for absorbing water from waste materials and storing the waste until it is eliminated from the body. The large intestine starts from the caecum and continues to the ascending colon, the transverse colon, the descending colon, and then the sigmoid colon. Water and electrolytes are removed from the colon, which makes the food waste firmer as it passes through.^2,3

Which conditions will require a colostomy?

Conditions that need a temporary colostomy:

• A serious infection in the large intestine, such as diverticulitis
• An acute inflammation such as inflammatory bowel disease (IBD) (ulcerative colitis or Crohn’s disease)
• An injury to the large intestine that may require giving the bowel a temporary rest to heal.
• A blockage or damage in your colon or anus which may be caused by cancer or a blood flow problem
• Fistulas or wounds in the perineum. A fistula is an abnormal connection between parts of the body.
• A birth defect such as an imperforate anus (missing or blocked anal opening)^2,4

Conditions that need a permanent colostomy:

• A blocked or damaged colon due to advanced colorectal cancer
• Abdominoperineal resection, which is the permanent removal of the rectum and anus, usually for the treatment of rectal cancer
• Irreparable damage to the muscle that controls the elimination of the stool^2,4

Types of colostomy

Loop colostomy

In a loop colostomy, a segment of the colon is brought out through an abdominal incision, forming a U-shape with two closely positioned openings. One opening connects to the functional part of the bowel for waste expulsion, while the other links to the inactive section leading to the anus. This surgical procedure is commonly temporary.⁵

End colostomy

This is the most common type of colostomy. In an end colostomy, one end of the colon is brought out through the stoma and stitched to the skin. Typically, end colostomies are permanent, but, in emergency situations, temporary end colostomies might be considered.⁵

The procedure of colostomy 

Before the surgery

• Like other surgery, you will have a preoperative assessment before a colostomy. Your doctor will help you fully understand why you need the colostomy, what will happen during the operation, what the risks are, and what kind of adjustments you will have to make after having the colostomy. You can also prepare your list of questions regarding the procedure. A consent form for the procedure will be given to you to sign
• The doctor will ask if you are currently taking any medicines
• A blood test will be taken to check your wellness for surgery, as well as an ECG test
• Your doctor may also ask you to take laxatives to empty your bowels and to fast for six to eight hours before the surgery^2,4

During the surgery 

• You will receive anaesthesia to keep you asleep
• The procedure may be done with a surgical incision/open surgery (large cut in the abdomen) or laparoscopic surgery (minor cuts and less invasive, using a tiny camera called a laparoscope)
• Your surgeon will identify the section of the colon that will be used to create the stoma
• Next, an opening in the colon will be created and brought out through the incision. The bowel will be stitched to the skin to create a stoma. For a loop colostomy, the surgeon will place two openings in the abdominal skin. However, with an end colostomy, there is only one opening from the bowel, while the other part of the bowel is sealed
• The incision will be closed by stitches or staples^2,3

After the surgery

After colostomy surgery, you will need to recover in hospital for a few days. The time you spend there varies depending on your underlying condition. You may be given a fluid drip, a catheter to drain your urine, and, if needed, oxygen to help you breathe. Typically, a healthy stoma is pink or red and moist, but, after surgery, it may appear swollen, dark red, or even bruised. However, there is no need for concern, as it typically returns to its normal appearance within a few weeks. 

Your stool consistency will depend on your colostomy type and which part of your colon is still active. If you have an ascending colostomy, only a small portion of your colon remains active. The consistency of food waste will still be liquid because this part of the colon does not fully digest it. If you have a transverse colostomy, your stools tend to be more solid, although not as solid as your usual stool consistency. If the surgery involves the lower segment of the colon, the descending and sigmoid colon, the stool is more likely to look like the typical solid stool you are familiar with. This is because a more significant portion of the colon remains active, allowing the stool to solidify.^2,4,5

Risks/benefits and complications

Risks during procedure

• Bleeding
• Infection
• Damage to nearby organs
• Breathing problems during anaesthesia^4,6

Benefits

• Live-saving: in many cases, a colostomy is the final stage of more complicated surgery, such as a colectomy, and it is typically a life-saving intervention. It allows the body to continue functioning with the loss of a major organ
• Improved quality of life. You will no longer live in the bathroom and will not have to worry about the frequency or consistency of your bowel movements
• Comfort and freedom
• Allows time for temporary healing of part of the bowel
• Improved social life and self-esteem^4,8

Potential complications

• Failure of stoma closure 
• Intestinal obstruction/blockage
• Functional problem (bowel control or digestion)
• Stoma prolapse: it may protrude or bulge outwards.
• Stoma stenosis: the stoma may narrow or tighten, obstructing the passage of stool.
• Stoma fistula: a small channel develops in the skin alongside the stoma.
• Leakage: the digestive waste leaks onto the surrounding skin
• Skin irritation as a result of constant exposure to stools.
• Hernia^6,7

Living with a colostomy

• Adjusting to life with a stoma: initial challenges are normal, but a full and active life is still possible
• Colostomy equipment: a stoma nurse, who you will meet before and after your colostomy surgery, will help you choose the most appropriate colostomy supplies for you
• Ordering supplies: before leaving hospital, you will receive an initial supply of colostomy products, along with your prescription details. Additional prescriptions can be obtained from your GP
• Colostomy irrigation: washing out your colon with water every day, or every other day, can be an alternative to wearing a colostomy appliance
• Diet after colostomy: a low-fibre diet is initially advised. As you recover, you will gradually transition to a balanced diet. A return to previous dietary preferences is generally possible
• Smell: modern appliances neutralise smells with air filters. People with a colostomy usually notice the odour since it is their own body, but actually, someone beside them will not be able to smell the stoma
• Work, travel, and daily life: return to work is possible; support belts may be needed for strenuous jobs. Travel is feasible with extra planning and access to a RADAR key for public disabled toilets. Sex life adjustments may be needed; a stoma nurse can provide advice
• Emotional support: seek support groups or counselling for emotional challenges related to a colostomy⁹

FAQs

What is the purpose of a colostomy? 

The primary purpose of a colostomy is to change the route of food waste through the bowels, allowing the body to continue functioning with the loss of a major organ and improving the patient's quality of life.⁸

Can you still pass stools after a colostomy?

Yes, after a colostomy, a person can still pass stools. The stool is diverted through the stoma, which is an opening in the abdominal wall, and collected in a colostomy bag.⁸

Do you pass wind after a colostomy?

Gas emissions can still occur through the stoma after a colostomy. It happens because bacteria in the colon can produce gas, which may pass through to the stoma. You might notice more gas/wind after getting a colostomy, but it will decrease as your bowel heals.⁸

Summary

A colostomy is a procedure to create an opening, called a stoma, in the abdomen, to divert stool from the colon. It is typically done when a portion of the colon has been removed or when other conditions affect bowel function. Colostomies can be temporary or permanent, depending on the underlying cause. With proper care and management, individuals with colostomies can maintain a healthy lifestyle and enjoy normal activities.