A colostomy is a surgical procedure that creates an opening in the abdomen for the large intestine (colon) to drain stool. Depending on the condition and the surgery, a colostomy can be temporary or permanent, depending on whether it is necessary to treat a disease or problem of the colon or rectum.
Some of the common reasons why a colostomy may be needed are:
Colon or rectal cancer
Inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis)
Diverticulitis (infection of small pouches in the colon)
Intestinal obstruction (blockage of the bowel)
Injury or trauma to the colon or rectum
Congenital anomalies (birth defects) of the colon or rectum
Fistulas or wounds in the perineum (the area between the anus and the genitals)
A colostomy changes the way stool passes out of the body. The stool will be softer or more liquid, and it will drain into a bag attached to the skin around the opening (stoma). It will look pink or red, and it will be moist and secrete mucus. Stomas do not have nerve endings, so they are not painful, but they may feel sensitive to touch.
Some of the symptoms that may occur after a colostomy are:
Bleeding from the stoma
Skin irritation or infection around the stoma
Hernia (bulging of the intestine through the abdominal wall)
Prolapse (protrusion of the intestine through the stoma)
Stenosis (narrowing of the stoma)
Gas, odor, or noise from the stoma
Changes in bowel habits or stool consistency
Dehydration or electrolyte imbalance
Psychological or emotional distress
A colostomy is usually planned in advance, based on the diagnosis and treatment of the underlying condition. The surgeon will explain the procedure, the risks and benefits, and the alternatives. Prior to surgery, the patient will undergo a number of tests, including blood tests, urine tests, chest X-rays, electrocardiograms, and colonoscopies (examination of the colon with a flexible tube and camera).
The surgeon will also mark the best location for the stoma on the abdomen, usually on the left side. It depends on the colon affected part of the body and the individual's shape where the stoma should be placed. In addition to providing education and support to patients and their families before and after surgery, wound, ostomy, and continence nurses (WOC) are trained to care for and teach patients with ostomies.
The treatment of colostomy involves the surgery to create the stoma and the care of the stoma and the colostomy bag. Under general anesthesia (the patient is asleep and pain-free), it is done through a large incision in the abdomen or through several small incisions and a camera. The surgeon will remove or bypass the diseased part of the colon and bring the healthy end of the colon through the abdominal wall to create the stoma. A dressing will cover the stoma and it will be stitched to the skin.
According to the type and extent of the surgery, the patient will remain in the hospital for 3 to 7 days. In addition to pain medication and antibiotics to prevent infection, the patient will also be given fluids and nutrition through an intravenous (IV) line until the bowels begin to work again. As the patient returns to normal, he or she will begin with clear liquids, progress to soft foods, and finally solid foods.
The patient will learn how to care for the stoma and the colostomy bag with the help of the WOC nurse and other health care providers. It is necessary to empty and change the bag several times a day, depending on how much stool is present and how thick it is. The patient will also need to clean the stoma and the skin around it with water and mild soap, and apply a skin barrier cream or powder to protect the skin from irritation. To conceal the bag under clothing, the patient will need a special belt or garment.
After recovering from the surgery, the patient will be able to resume most normal activities and hobbies. For a few weeks, the patient will need to avoid heavy lifting, strenuous exercise, and contact sports. The patient will also need to follow a balanced diet and drink plenty of fluids to prevent dehydration and constipation. Beans, cabbage, broccoli, spicy foods, alcohol, and carbonated drinks, for example, may cause gas, odor, or diarrhea.
During follow-up visits, the surgeon and the WOC nurse will monitor the patient's stoma healing and adjustment to the colostomy. It may also be beneficial for the patient to join a support group or an online community of people with ostomies to share tips and experiences.
It is true that some conditions that may require a colostomy are not preventable, such as congenital anomalies, cancer, or trauma. However, some of the conditions may be prevented or managed by adopting a healthy lifestyle and following medical advice.
Eating a high-fiber diet and drinking plenty of water to prevent constipation and diverticulitis
Avoiding smoking and excessive alcohol consumption to reduce the risk of colon cancer and inflammatory bowel disease
Getting regular screening tests for colon cancer, such as fecal occult blood test (FOBT), sigmoidoscopy, or colonoscopy, especially after the age of 50 or if there is a family history of the disease
Seeking medical attention for any persistent or severe symptoms of the colon or rectum, such as abdominal pain, bleeding, change in bowel habits, weight loss, or anemia
Following the prescribed treatment plan for any chronic condition that affects the colon or rectum, such as inflammatory bowel disease, Crohn’s disease, or ulcerative colitis
Taking precautions to avoid injuries or infections of the colon or rectum, such as wearing protective gear, practicing safe sex, and maintaining good hygiene
Colostomies are major surgeries that change how stool is removed from the body. A colostomy may be necessary for various reasons, such as cancer, infection, obstruction, or injury of the colon or rectum. Depending on the condition and the surgery, they may be temporary or permanent. The patient can live a normal and active life with a colostomy, although it requires careful care and adjustment. A colostomy can be managed with the help of a skilled surgeon, a WOC nurse, and a supportive family and friends.
