What is a colostomy?
A colostomy is a surgery in which the colon (large intestine) is re-routed and attached to an opening in the abdomen and skin called a stoma. The colon, or large intestine, forms and eliminates stool through the rectum. After a colostomy, stool drains into a colostomy bag attached around the stoma instead of through the rectum. You may need a colostomy if your colon is diseased or injured and cannot form and eliminate stool normally.
Many colostomies are temporary and allow a diseased or injured colon to rest. A temporary colostomy is reversed when the colon has healed enough to function normally. Some colostomies are permanent. Your surgeon will decide which type of colostomy is best for you based on your condition.
A colostomy is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion before having a colostomy.
Types of colostomy
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The most common types of colostomy surgeries are:
Descending colostomy places the stoma in the lower-left abdomen.
Sigmoid colostomy places the stoma in the lower-left abdomen, a little lower than where it is for a descending colostomy.
Transverse colostomy places the stoma in the upper-middle or upper-right abdomen.
Other surgical procedures that may be performed
Your doctor may perform other procedures to treat certain conditions. These include:
Bowel obstruction repair is the surgical removal of a blockage in the colon. A bowel obstruction is a blockage that prevents passage of intestinal contents.
Colectomy (also called a bowel resection) is the removal of part or the entire colon.
Why is a colostomy performed?
Your doctor may recommend a colostomy when the colon is diseased or injured and cannot eliminate stool normally through the rectum.
Your surgeon may only consider a colostomy for you if other treatment options that involve less risk and fewer complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a colostomy.
Your doctor may recommend a colostomy to treat:
Abdominal abscess, a collection of pus created by a serious infection in the abdomen
Bowel obstruction, a blockage of the colon
Certain birth defects of the colon, such as Hirschsprung’s disease in which the intestine does not function normally
Colon cancer. Cancer of the colon and/or rectum may require extensive colon resection and colostomy.
Diverticulitis, which is inflammation of small pouches of the bowel
Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis
Injury to the bowel, rectum or area just in front of the anus
Who performs a colostomy?
General surgeons and colon and rectal surgeons perform colostomies. General surgeons specialize in the surgical treatment of a variety of diseases, disorders, and conditions including diseases of the colon. Colon and rectal surgeons are general surgeons with advanced training in the treatment of colon and rectal problems.
How is a colostomy performed?
Your colonoscopy will be performed in a hospital. Your surgeon will make either a large incision (open surgery) or several smaller incisions (minimally invasive surgery) in your abdomen. Your surgeon then cuts out the diseased or damaged colon and pulls the new end out through one of the incisions.
The colon opening is stitched to the outside of the abdomen on the skin. This new opening from your colon is a called a stoma. Feces will now exit your body through the stoma instead of through your rectum.
The location of your stoma varies depending on what part of your colon is diseased or injured. Your surgeon may locate it on either side of your abdomen or in the upper center area.
Surgical approaches to a colostomy
Your surgeon will perform a colostomy using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and a laparoscope through a few small incisions in the abdomen. The laparoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your abdomen to a video screen. Your surgeon watches the screen while performing the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around structures and organs instead of cutting through or displacing them as in open surgery.
Open surgery is a procedure performed by making a large incision in the abdomen. Open surgery allows your surgeon to see and access the surgical area directly. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues and organs than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Surgeons sometimes combine a minimally invasive technique with an open procedure. Your surgeon may also decide after beginning a minimally invasive technique that you need an open surgery to safely and most effectively complete your surgery.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different colostomy procedures and ask why your doctor will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform your colostomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and will not feel any pain.
You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your colostomy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout your surgery and recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a colostomy?
As with all surgeries, colostomy surgery involves risks and possible complications. Most colostomy surgeries are successful, but complications may become serious and life threatening in some cases. Complications can develop during the procedure or throughout your recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain. This can cause a pulmonary embolism, heart attack, or stroke.
Wound infection and septicemia, which is the spread of a local infection to the blood
Potential complications of a colostomy
Complications of a colostomy include:
Blockage or collapse of the colostomy opening (stoma)
Constipation, diarrhea, or obstruction of stools through the colon (bowel obstruction)
Damage to other abdominal organs
Development of scar tissue around the intestines, which could cause bowel obstruction
Hernia, a bulging of an organ or tissue through the abdomen muscles around the stoma
Irritation, sores, infection and other problems of the stoma and nearby skin
Opening of the external abdominal incision
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my colostomy?
You are an important member of your own healthcare team. The steps you take before surgery can help improve your comfort and outcome.
You can prepare for a colostomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during the doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before a colostomy and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a colostomy? Are there any other options for treating my condition?
What type of colostomy procedure will I need?
How long will the surgery take? When can I go home?
What kind of diet can I eat after surgery?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my usual medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my colostomy?
Knowing what to expect can help make your road to recovery after a colostomy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. When you wake up, you may have a tube in your nose that runs down your throat into your stomach. This tube releases air and drains fluid from your stomach until your body is able to process these substances by itself again.
You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Most patients go directly from the recovery room to a regular hospital room. A stay in the intensive care unit (ICU) may be needed for complex cases. ICUs provide 24-hour specialized monitoring and care.
A colostomy usually requires a hospital stay of five to seven days. This gives you time to heal, transition back to eating, and to learn to care for your new colostomy. In about a day, you will be drinking clear liquids. If you tolerate the liquids, you will start to drink thicker liquids and then solid foods.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, your general health, and age. Full recovery takes four to six weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be some discomfort after your surgery, including soreness at the incision(s) and the stoma. Your doctor will treat your pain so you are comfortable and can get the rest you need.
Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a colostomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. Follow your doctor's instructions about when to call for a fever.
Inability to urinate, have a bowel movement, or pass gas
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Numbness or tingling in the affected extremity
Pain that is not controlled by your pain medication, new pain, or severe abdominal pain
Severe nausea and vomiting
Sudden and new abdominal swelling
Unexpected drainage, pus, redness or swelling of your incision, stoma, or skin around the stoma
How might a colostomy affect my everyday life?
A colostomy allows many patients to return to an active, normal life. For example, a colostomy may allow you to enjoy certain foods you used to avoid. Most people who have a colostomy can also enjoy many of their favorite activities, such as sports, sexual activity, outdoor activities, swimming, and most types of work.
A colostomy will also make significant changes to your body and your bowel habits. It will take time to adjust to and learn to manage these changes.
You will wear a colostomy bag on the outside of your body. The colostomy bag requires regular emptying and cleaning. Your healthcare team will teach you how to use your colostomy supplies. The team will also provide support to help you adjust to your new bowel and dietary habits and other changes.
Changes after colostomy include:
Change in some styles of clothing such as bathing suits
Dietary changes including exclusion of certain types of foods and beverages
Restrictions on certain types of work involving physical activity
Significant change in body image
Significant change in elimination habits
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