Colostomy Procedure
Overview
A colostomy is a type of surgery that changes how waste exits the body. In this procedure, a surgeon creates an opening in the abdomen, called a stoma, by bringing a part of the colon (large intestine) through the abdominal wall. This stoma becomes the new path for stool to leave the body, bypassing the rectum and anus. Waste is collected in a colostomy bag worn on the outside of the abdomen.
Surgeons often perform a colostomy when part of the colon or rectum is diseased, damaged, or needs to heal. There are temporary and permanent colostomies. A temporary colostomy allows the bowel to rest and heal, while a permanent one may be needed if the lower colon or rectum is removed or permanently damaged.
The main surgical steps include cutting the colon, attaching it to the abdominal wall, and securing the area with stitches. Surgeons may use either traditional open surgery or minimally invasive laparoscopic techniques. After surgery, patients learn how to care for the stoma and manage their colostomy bag.
Purpose and Indications
Surgeons perform a colostomy when the normal path for stool through the rectum and anus is blocked or needs to be avoided. Common reasons include:
- Colon or rectal cancer
- Bowel disease or injury
- Inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease
- Bowel obstruction or intestinal blockage
- Birth defects affecting the intestines or anus
- Infection in the bowel or complications during pregnancy
In these cases, creating a colostomy helps protect the bowel, allow healing, or ensure that waste can exit the body safely.
Types of Colostomies
Colostomies are classified by how the opening is created and where it is located on the colon. Each type is chosen based on the patient’s condition, disease location, and whether the change is needed temporarily or long term.
End Colostomy
In an end colostomy, the surgeon brings one end of the colon through the abdominal wall to form a stoma. The rest of the colon and rectum may be removed or left in place, but not used. This type is usually performed if the rectum needs to heal or has been removed due to disease.
End colostomies are often permanent, especially in cases of colorectal cancer, severe injury, or chronic disease. The most common locations for an end colostomy are the descending colon or sigmoid colon, which are on the left side of the abdomen. However, surgeons can also create end colostomies at the ascending or transverse colon if those areas are affected.
Stool from an end colostomy in the descending or sigmoid colon is usually more formed because digestion is nearly complete. This may help people manage output more easily. Compared to other types, an end colostomy often has one stoma.
Loop Colostomy
In a loop colostomy, the surgeon brings a loop of colon out through the abdomen, usually in the transverse colon. The surgeon makes a small opening on the surface of this loop to create a stoma. This forms two openings: one for stool and one for mucus. Both are seen in a single stoma.
Loop colostomies are usually temporary. They give the lower colon or rectum time to heal after surgery or injury. The loop transverse colostomy is one of the most common forms, often located in the upper abdomen, either in the middle or slightly to the right. Stool from a loop colostomy is often soft or semi-formed, depending on where it is placed. The loop colostomy can be easier to reverse than an end colostomy.
Double-Barrel Colostomy
In a double-barrel colostomy, the surgeon separates the colon into two ends and brings both through the abdominal wall to form two stomas. One stoma passes stool, and the other drains mucus from the non-functioning part of the colon. This type is less common than other colostomies.
The double-barrel transverse colostomy is sometimes used when part of the colon or rectum needs time to heal. This approach can help prevent waste from reaching certain areas while still allowing part of the colon to function. After healing, the surgeon may rejoin the two ends of the colon in a later surgery.
Double-barrel colostomies may be temporary or permanent, depending on the medical reason behind the procedure. Management can be more complex because there are two stomas to care for.
Temporary vs. Permanent Colostomy
Colostomies may be either temporary or permanent. Temporary colostomies are made to allow the colon or rectum to heal after surgery, trauma, or infection. Surgeons often reverse them in a later operation, restoring normal stool passage.
Permanent colostomies are needed when healing is not possible. This can be due to cancer removal, birth defects, or long-term bowel disease. Permanent colostomies are commonly created in the descending or sigmoid colon. Some other types of ostomies include ileostomy and urostomy.
These are different from a colostomy since they connect to either the small intestine or the urinary system, not the colon. Both temporary and permanent colostomies need a stoma, but the care and lifestyle changes vary depending on how long the stoma is needed.
Colostomy Pouching Systems
A colostomy pouching system collects feces and mucus from the stoma after surgery. The pouch must be secure, easy to change, and comfortable.
Types of Pouches
There are different types of colostomy pouches. Most are made from medical-grade plastic and attach to the skin around the stoma with an adhesive or a special wafer. People can choose between one-piece and two-piece systems. A one-piece pouch is attached directly to the wafer, while a two-piece has a separate wafer and pouch that snap together.
Pouches come in both closed-end and drainable styles. Closed-end pouches are thrown away after use and work best for people with firm stool and less frequent bowel movements. Drainable pouches can be emptied and reused, making them useful for looser stool or more frequent output. Some people with a descending or sigmoid colostomy use colostomy irrigation to regulate bowel movements and use smaller pouches called “stoma caps” after irrigation.
A good pouching system should have a leak-proof seal, keep odors contained, and protect skin around the stoma. It should also be nearly invisible under clothing and not restrict movement. The choice depends on stool consistency, lifestyle, and personal needs.
Preoperative Considerations
Before a colostomy, patients need careful planning and support. Pre-op assessment includes checking medical history, current medications, and general health. Blood samples are often taken to check for any problems such as low iron or infection. A wound ostomy continence nurse or ostomy nurse usually meets with the patient.
These nurses help pick the best stoma site and teach about what to expect after surgery. Preoperative education is important. Patients and families get information in different ways, like talking with the nurse, printed handouts, or videos. This helps reduce stress and improves recovery after surgery.
Bowel preparation is sometimes needed. The doctor may ask the patient to follow a clear liquid diet a day or two before the procedure. The table below shows common steps:
| Step | Details |
|---|---|
| Pre-op Assessment | Medical history, labs, health check |
| Meet Ostomy Nurse | Stoma site choice, education |
| Bowel Prep | Clear liquids, laxatives sometimes |
| Education | Info about surgery and care |
How Colostomy Surgery Is Performed
In colostomy surgery, the surgeon makes an opening in the abdominal wall and reroutes the colon to allow stool to exit the body. The surgery may be done in different ways and requires careful planning and preparation from the medical team.
Surgical Approaches
There are two main ways to do colostomy surgery: open surgery and laparoscopic (minimally invasive) surgery. In open surgery, the surgeon makes a larger incision in the abdomen to reach the colon and rectum. This method can give the surgeon a clear view and is often used in emergencies or when there is a lot of scar tissue.
In laparoscopic surgery, the surgeon uses several small incisions, a camera, and special tools to see and operate inside the abdomen. This approach may lead to less pain and a quicker recovery. Both approaches aim to safely connect a part of the colon to the abdominal wall. The choice depends on the patient’s overall health, the reason for surgery, and the location of the problem in the colon or rectum.
Anesthesia and Preparation
The anesthesiologist gives general anesthesia so the patient is unconscious and does not feel pain during the procedure. Before surgery, patients may need to avoid eating or drinking for several hours. The surgical team cleans and sterilizes the abdominal area to help prevent infection. Staff place intravenous (IV) lines to deliver fluids and medications.
Sometimes, the team gives antibiotics before surgery. Doctors often mark the best spot on the abdomen for the stoma with a special pen. This spot is chosen based on body shape, clothing patterns, and ease of care. Proper site selection is important for long-term comfort and function.
Creation of the Stoma
To create the stoma, the surgeon cuts and divides the colon at the chosen spot. The surgeon brings a piece of colon through a small opening in the abdominal wall. The surgeon rolls the end of the colon outward and sews it to the skin. This opening becomes the stoma and allows stool to leave the body into a colostomy bag.
The surgeon checks that the stoma has good blood supply, which helps it heal and stay healthy. The rest of the colon and rectum may be removed or left in place, depending on the medical problem being treated. After the procedure, the team cleans the area and attaches a colostomy bag. Nurses provide instructions on how to care for the stoma and manage the new change.
Immediate Postoperative Care
Right after a colostomy, patients stay in the recovery room so nurses can watch for any problems. Nurses check vital signs often to spot issues like bleeding or infection quickly. Nurses look at the stoma and the area around it for color, swelling, and any unusual fluid. Common monitoring tasks include:
- Checking for signs of bleeding or infection.
- Assessing the function of the stoma.
- Watching for breathing problems or pain.
Patients may have tubes or drains near the surgery site. These help remove extra fluids and lower the risk of infection. Nurses ensure these devices work correctly and stay clean. Basic postoperative care often involves:
| Task | Purpose |
|---|---|
| Checking vital signs | Spotting early surgery risks |
| Monitoring stoma appearance | Detecting infection or problems |
| Managing drains | Preventing swelling or infection |
| Assisting with breathing | Avoiding breathing problems |
Staff manage pain with medicine and teach patients how to move and cough gently to keep their lungs clear. This helps prevent breathing issues. Most patients stay in the hospital for a few days. Hospital staff teach them basic colostomy care skills before discharge.
They also provide tips to avoid common complications and help set up home care if needed. Nutrition and fluids are introduced slowly as the bowel starts to work again. Nurses monitor how patients eat and drink to ensure safe recovery.
Daily Life with a Colostomy
People living with a colostomy need to adjust their routines for stoma care, manage risks for skin problems, and watch for complications. Attention to daily habits and proper care can help with comfort and prevent issues.
Stoma Care and Maintenance
Daily stoma care keeps the skin healthy. After colostomy surgery, patients clean the area regularly with warm, soapy water. The skin around the stoma should stay dry to reduce irritation. A colostomy bag or pouch collects bowel movements.
Patients should empty it when it is one-third to half full and change the bag every few days, or whenever it becomes loose or starts to leak. Patients may follow a clear liquid diet for a few days after surgery.
Choosing foods that avoid constipation and prevent large, hard stools helps protect the stoma. Short and frequent deep breathing exercises help with healing and abdominal strength. Good hand washing before and after stoma care prevents infections.
Potential Complications and Risks
Living with a colostomy comes with some risks. Skin around the stoma can become red, sore, or infected if leaks occur. Patients should check for skin changes each day. Some people may face constipation, especially if they are not drinking enough fluids or eating enough fiber.
Loose stools can also happen, especially right after surgery or during illness. Rare complications include adhesions (bands of scar tissue that may cause pain or block the bowel). Other risks are hernias near the stoma, bleeding from the stoma, or signs of infection such as swelling or pus. It is recommended to contact a doctor if pain, fever, or severe stoma changes appear.
Long-Term Recovery and Outlook
After the initial healing period, people manage a colostomy as part of their daily routine. Most return to regular activities, including work, exercise, and travel. Managing diet helps control bowel movements. Eating slowly and avoiding foods that cause gas or blockages (such as corn, nuts, or raw vegetables) can prevent trouble. Staying hydrated lowers the risk of constipation.
The stoma may change in size or shape over time. Healthcare providers monitor pouch fit and teach how to watch for complications. Ostomy nurses and patient groups support mental and emotional adjustment during long-term recovery.
