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Life with Colostomy
 At
least 70,000, probably many more, people in the UK have a colostomy, so it is
quite likely that you have already met someone who has one, but you would never
know.
Colostomy
Sometimes, for medical reasons, part of the large bowel (colon and rectum) has
to be removed or bypassed. This means that bowel motions can no longer be passed
out of the body through the anus in the usual way. Therefore an operation is
performed to create a new opening on the front of the abdomen. The colon is
brought out through the skin to form a colostomy. This new outlet is pink and
moist like the inside of the mouth and is called a stoma. A colostomy is a
surgical procedure in which a stoma is formed by drawing the healthy end of the
large intestine or colon through an incision in the anterior abdominal wall and
suturing it into place. This opening, in conjunction with the attached stoma
appliance, provides an alternative channel for feces to leave the body. It may
be reversible or irreversible depending on the circumstances.
Need for Colostomy
Most colostomies are formed because of cancer, but this is by no means the only
reason. They can be the result of diverticulitis, perforated bowel, bowel
obstruction, Crohn�s disease, birth defects or accidental injury. In some cases,
rather than to save life, the reason may be to improve the quality of life, for
example in those who suffer from incontinence or chronic constipation, or have a
spinal injury or MS.
Permanent or Temporary Colostomy
A colostomy may be formed to divert the motions away from the part of the bowel
�downstream� from the stoma, to allow a join in the bowel or a diseased section
to heal. If this is the case the colostomy may be temporary as it can be
reversed (the two ends joined together) at a later date. If the whole bowel
�downstream� from the stoma has been removed then a stoma will be permanent.
Life with a Colostomy
Bowel motions are passed out through the stoma and collected in a special
disposable colostomy bag which fits over the stoma and sticks to the skin around
it. These bags or pouches are about the size of your hand; there are many
different types to choose from and they are available on prescription.
Before you go into hospital you will probably be introduced to a stoma care
nurse who will explain what is to happen, discuss with you the best position for
your stoma and answer any questions. After the operation she will teach you how
to care for your colostomy and how to change your bag.
It takes a while to get used to a colostomy, but your confidence will increase
with time as you learn when your colostomy is most likely to be active and you
become quicker and more proficient at changing the bag.
There are other methods of managing a colostomy. Irrigation allows you to decide
when you wish to evacuate the bowel. It involves using specialist equipment to
introduce a measured amount of water into the colon. However, irrigation is not
possible with some medical conditions or types of stoma so before the operation
you may wish to ask your surgeon if this would be an option for you. The
irrigation technique needs to be taught and the first attempts supervised by a
stoma care nurse.
Before your surgery and during the early days after your operation it may help
to speak to someone else with a colostomy.
Having a colostomy will not mean that you have to make significant changes to
your lifestyle. Most people are able to eat the same foods as before; like
everyone else you will be advised to eat regular well balanced meals. You should
be able to wear similar clothes to those you wore before the operation. There
are people who have had colostomies for many years. They have led normal lives,
had careers, have partners and children, take part in sport, and travel all over
the world.
Risks of Colostomy
 Risks of anesthesia include:
-
Problems breathing
-
Reactions to medications
Risks of colostomy include:
-
Bleeding inside your belly
-
Damage to nearby organs
-
Development of a hernia at the site of the surgical cut
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Falling in of the stoma (prolapse of the colostomy)
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Infection, especially in the lungs, urinary tract, or belly
-
Narrowing or blockage of the colostomy opening (stoma)
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Scar tissue forming in your belly and causing intestinal blockage
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Skin irritation
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Wound breaking open
Options in Colostomy
Placement of the stoma on the abdomen can occur at any location along the colon,
but the most common placement is on the lower left side near the sigmoid where a
majority of colon cancers occur. Other locations include the ascending,
transverse, and descending sections of the colon.
Types of colostomy:
Loop colostomy: This type of colostomy is usually used in emergencies and is a
temporary and large stoma. A loop of the bowel is pulled out onto the abdomen
and held in place with an external device. The bowel is then sutured to the
abdomen and two openings are created in the one stoma: one for stool and the
other for mucus.
End colostomy: A stoma is created from one end of the bowel. The other portion
of the bowel is either removed or sewn shut (Hartmann's procedure).
Double barrel colostomy: The bowel is severed and both ends are brought out onto
the abdomen. Only the proximal stoma is functioning.
Colostomy surgery that is pre-planned usually has a higher rate of long-term
success than surgery performed in an emergency situation.
People with colostomies must wear an ostomy pouching system to collect
intestinal waste. Ordinarily the pouch must be emptied or changed a couple of
times a day depending on the frequency of activity; in general the further from
the anus (i.e., the further 'up' the intestinal tract) the ostomy is located the
greater the output and more frequent the need to empty or change the pouch.
Colostomy with irrigation
 People with colostomies who have ostomies of the sigmoid colon or descending
colon may have the option of irrigation, which allows for the person to not wear
a pouch, but rather just a gauze cap over the stoma, and to schedule irrigation
for times that are convenient.To irrigate, a catheter is placed inside the
stoma, and flushed with water, which allows the feces to come out of the body
into an irrigation sleeve. Most colostomates irrigate once a day or every other
day, though this depends on the person, their food intake, and their health.
Alternatives in Colostomy
A UK man has been given a remote-controlled bowel. Colostomy or ileostomy is now
rarely performed for rectal cancer, with surgeons usually preferring primary
resection and internal anastomosis, e.g. an ileo-anal pouch. In place of an
external appliance, an internal ileo-anal pouch is constructed using a portion
of the patient's lower intestine, to act as a new rectum to replace the removed
original.
Additional Resources:
Video
Dated 18 October 2014
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