What is a colostomy?
A colostomy is a surgical procedure that creates an opening, or stoma, between the colon (large intestine or bowel) and the abdominal wall to provide an alternative route for elimination of stool from the body. A colostomy is performed when a portion of the large bowel, including the colon, rectum, or anus, is diseased and must be bypassed or removed.
Colostomies are most commonly located in the transverse colon or in the descending or sigmoid colon. Since the stool is changed from liquid to solid during its passage through the colon, transverse colostomies drain mushy stool, whereas descending or sigmoid colostomies drain more solid stool.
There are three types of colostomies: end stoma, double-barrel stoma, and loop stoma.
- In an end stoma, the bowel is divided into two sections; the distal (lower) section is removed or sewn shut, and the proximal (upper) section is brought out to the abdominal wall as a stoma.
- in a double-barrel stoma, the bowel is divided, and both ends of the bowel are brought out to the abdominal wall as stomas; stool drains from the upper stoma and mucus drains from the lower stoma.
- In a loop colostomy, the bowel is not divided; instead, an opening is made in the abdominal wall, and the loop of the bowel is brought to the abdominal surface and held in place with a support device until the bowel heals to the skin. An opening is made into the front wall of the bowel to allow stool to pass out of the body. A loop colostomy usually is intended to be temporary.
When is a colostomy needed?
Colostomy surgery is performed on thousands of people in the United States each year, most commonly for diverticulitis, tumors, injuries, or birth defects.
Your stoma is formed by turning the colon back on itself and suturing the edges of the colon to the skin. Your stoma should appear moist and bright red; the red, healthy color shows that its blood supply is adequate. Because the blood vessels in your stoma are superficial, you may sometimes find blood on the cloth when you clean the stoma. This slight bleeding is similar to that which occurs when you brush your teeth, and clears up just as fast. Because there are no sensory nerve endings in your stoma, you will have no feeling in it. Stomas usually are round but can be irregularly shaped. Loop colostomy stomas tend to be oval and larger than end stomas. Because the stoma has no sphincter muscle, you will not be able to control the passage of stool.
How do I care for the stoma?
The drainage from your stoma can irritate your skin;; to prevent this, you must always wear a properly fitting pouch, which collects the stool from your colostomy, and change the pouch as necessary. If irrigation is part of your regimen, you will change the pouch when you irrigate.
Many kinds of pouches are available; your ostomy nurse will help you select the best one for you. As you recover from surgery and progress in dally activities, changes in your abdomen and other factors may necessitate a change in the type of pouch you use.
How do I empty the pouch?
You should empty your pouch when it is about one-third to one-half full of gas and stool. (If the pouch gets too full, the weight may cause it to pull away from your skin.) To empty the pouch:
- Sit on the commode. Remove the clip or rubber band from the bottom of the pouch, and turn the bottom of the pouch back on itself to form a cuff. (This helps keep the end of the pouch clean.)
- Drain the stool into the commode. You may rinse the pouch with cool water (use a small squirt bottle) if you wish.
- Clean the bottom of the pouch with toilet paper, a damp paper towel, or a baby wipe. It is very important to clean the bottom of the pouch to prevent odor.
- Uncuff the pouch; attach the clip or rubber band.
How do I change the pouch?
When changing the pouch, you should first assemble all items: a new pouch and skin barrier, pouch closure (rubber band or clip), paste (if needed), and equipment for disposing of used pouches. The skin is best cleansed with plain water; soap leaves a residue that may irritate the skin.
Follow the steps below in changing your pouch and caring for the skin around the stoma:
- Gently remove the soiled pouch by pressing down on the skin while pulling up on the pouch. Discard the soiled pouch in a plastic bag (save the pouch closure).
- Gently clean the skin and stoma with warm water, using a soft washcloth or a paper towel.
- If the area is hairy, remove hair with an electric razor or safety razor. Always shave from the stoma out to prevent injury. (If you use a safety razor, use shaving cream and rinse the skin thoroughly.)
- Check the size of the pouch opening to be sure it fits around your stoma without leaving skin exposed.
- Apply paste around your stoma if needed. Then center the pouch, press it into place, and attach the clip or rubber band. If your skin becomes red or irritated, notify your ostomy nurse or doctor. You may try a light (e.g., Stomahesive) to any raw areas to provide protection and improve pouch adhesion.
How do I perform irrigation?
If you have a descending or sigmoid colostomy, you may be taught the irrigation procedure. This procedure is like an enema; it stimulates the bowel to move. Irrigation is done every day at the same time, because this regulates the colon to move once a day at a time that is convenient for you. It often takes weeks or months for the bowel to become regulated, and medication or post-surgical treatment often affects the bowel's usual habits. Your ostomy nurse can help you work out an appropriate schedule and solve any problems you may have.
What dietary guidelines should I follow?
There is no special diet for a person who has a colostomy. Your ability to digest and absorb nutrients has not changed, and there are no forbidden foods. However, you may want to modify your diet somewhat to reduce gas, since you will not be able to control the passage of gas. Food will affect you the same way it did before your surgery. However, you may notice that certain foods make your stool looser or thicker. For example, some foods have a laxative effect on stool. This may be a concern if you are trying to regulate your colostomy with irrigations. Other foods may cause constipation. By experimenting you will find out what foods you can eat with confidence and what foods you may need to limit or avoid. Your doctor, ostomy nurse, or hospital dietitian will give you guidelines for setting up your diet.
How long does it take to adjust to a colostomy?
A colostomy is a major adjustment, and it is normal to feel sad, angry, frustrated, or depressed. Be honest about your feelings, and share them with loved ones if you feel comfortable doing so. If you deal honestly with your feelings, the sadness and anger will lessen and you will be able to adjust to life with a colostomy. You may find support groups helpful, and your ostomy nurse will also be available to talk with you. There are also outpatient ostomy/wound clinics that our physicians here can provide referrals to assist in this transition and to assist in issues with skin irritation or trying new products.
Even though you will have to adjust your life-style, you can manage your recovery and minimize the effect this change will have on your life. The first step to successful recovery is to resume your normal activities. It is important to avoid stopping the things you enjoy doing and currently there are many ways of helping you to achieve that.
How is sexuality affected?
Concerns about intimacy are legitimate and should be discussed openly with your partner. Remember that you are the same person you were before the surgery, and you have the same capabilities to feel, love, and respond to others as you did before. The effect of this type of surgery on sexual function varies with each individual. Discuss any problems you may have with your doctor or ostomy nurse.