Colostomy: What is it and How is the Procedure Done?

A colostomy is a surgery that involves making a temporary or permanent opening, referred to as a stoma. The stoma is a path that leads from the large intestine to the outer part of your abdomen. This enables feces and gas to leave the body without having to pass through the rectum. The solid waste gets collected in a pouch that you wear from the outside. Colostomy creates an opening from the colon or large intestine, or via the abdomen.

Below are some of the common types of this surgery:

Sigmoid colostomy

Located in the bottom part of the large intestine, sigmoid colon specializes in moving solid waste to the rectum. In this type of colostomy, the feces is usually more solid than in other colostomies. This is one of the most common types of colostomy.

Transverse colostomy

In this, the colon stretches over the top of the abdomen. The feces, in this case, is generally soft because water from the feces has been absorbed only by a small part of the colon. Transverse colostomy can be further classified into three categories:

• Single-barrel – This permanent colon surgery specializes in removing the colon below the colostomy, which includes the anal opening and the rectum.
• Loop – This colostomy involves making a stoma for the feces to exit. The individual who undergoes this surgery passes gas or feces through the rectum at times. This is because the colon remains connected to the rectum.
• Double-barrel – In this colon surgery, the colon is segregated into two separate ends to create separate stomas. While one stoma allows passage for feces, the other enables the passage for mucus made by the colon. It is one of the least common colostomy.

Ascending colostomy

In this type of surgery, the colon extends from one tip of the large intestine to the right side of the abdomen. As the colon only works partially, it is unable to absorb water from the feces entirely. This implies that the feces is largely liquid. An ileostomy is often more recommended for this part of the colon and, hence, this type of colostomy is rare.

Descending colostomy

This enables the colon to channelize feces down the left side of the abdomen. The feces, in this case, is usually solid.

What is Colostomy for?

Colostomy may be required for a range of medical conditions as below:

• Colon or rectal cancer
• Severe infection like inflammation of the little sacs on the colon, referred to as diverticulitis
• Colon or rectal injury
• Birth defect like blocked anal opening, known as imperforate anus in medical terms
• Inflammatory bowel disease
• Partially or completely blocked intestines
• Injuries or fistulas in the perineum. A fistula refers to abnormalities in certain internal body parts, or between an internal organ and the skin. A man’s perineum is between the scrotum and anus, while a woman’s perineum refers to the body part between the vulva and anus.

The need for this surgery determines whether you will need a permanent or temporary colostomy. Some injuries and bowel infections require temporary rest to the bowel before reattaching it. In such cases, a temporary colostomy is usually recommended.

On the other hand, there are certain injuries and incurable conditions that need permanent colostomy. For instance, the inability of the rectal muscles to control excretion and in cases of cancer that require removal of the rectum.

What are the Risks of Colostomy?

Colostomy is a major surgery and below are some probable risks of the surgery:

• Damage to adjacent organs
• Infection
• Bleeding
• Allergic reactions to anesthesia
• Scarred tissue leading to blockage of the intestine
• Narrowing of the opening of colostomy
• Development of hernia at the surgical incision

How to Prepare for Colostomy?

Below are the tips you need to keep in mind to prepare for the surgery:

• Your doctor will most likely ask you to fast for 12 hours before the surgery.
• You will be physically examined by your doctor, following which they will evaluate your personal and family medical history. Based on these analyses, you will be prescribed certain blood tests, as per their advice.
• You may be prescribed an enema or laxative that you need to take the night before the surgery to clear your bowel.
• Consult your doctor and discuss the medications that you may be taking currently – prescription medications, OTC (over-the-counter) medications, supplements, vitamins, herbals, and also illicit drugs. They will advise you on whether you need to temporarily discontinue or adjust any medications around the time of the colostomy surgery. Certain medications like aspirin and inflammatory drugs may have to be discontinued as they may increase the risk of bleeding.

What Happens During Colostomy?

The surgery is generally performed under general anesthesia. The procedure may be undertaken by making one big incision or several small incisions. It may be an open surgery or laparoscopic surgery. As discussed before, the type of surgery that will be required depends on the part of the colon that needs to be operated on – sigmoid, transverse, descending, and ascending.

While permanent colostomies are referred to as ‘end colostomies’, temporary colostomies surgically join the side or end of the colon to the abdominal wall to form an abdominal opening known as stoma. This end of the colon is surgically attached to the stoma. Feces pass from the stoma into the pouch that is attached to the abdomen.

What is the Recovery Period for Colostomy?

The average duration for hospital stay after a colostomy varies between three days and one week post-surgery. Complete recovery from the surgery may take up to two months. In case of temporary colostomy, you might require a closure surgery after the colon has healed. This surgery is generally performed after three months from the surgery.

Post-surgical Care for Colostomy

The following are the after-care procedures for the surgery:

• A pouching system is usually advised, which you need to wear externally. These are odor-free and available in different types of reusable and disposal varieties. You can purchase these from drug stores as well as from online portals as per your preference. The expense towards these pouching systems is usually covered by health insurance plans.
• Certain irrigation techniques offer increased control over the timing and frequency of bowel movements. You can use this as per the guidance of your doctor.

Learn more about Other Digestive Health Issues here.