What to Know About Colostomy Surgery
Colostomy surgery may be used to treat many digestive conditions, including colon cancer, Crohn’s disease, intestinal obstruction, birth defects, and diverticulitis. Many people may fear the idea of having colostomy surgery, but the truth is that it can often bring about a greater quality of life, extend a person’s life, or even save life. Colostomy surgery, in simple terms, is when part of the colon is removed (called a colectomy) and an opening is created in the abdomen to allow stool to pass out of the body and be collected in an appliance that is worn on the abdomen.
An ostomy is a surgically-created opening from an internal organ to the body’s surface. Colostomy, from “colon” and “ostomy,” is the surgery where an opening is made from the colon (or large intestine) to the outside of the abdomen.
During colostomy surgery, the surgeon may remove a segment of the colon, which results in the colon being in two separate parts (think of what a garden hose would look like if it were cut in half). One end of the colon is passed through a small hole in the abdominal wall. This small section of intestine, called a stoma when it’s outside the body, allows for waste to leave the body from the colon. The other end of the colon, which is attached to the rectum, may either be removed or closed off with sutures and left in the abdomen.
After the surgery, waste is collected on the outside of the body with an ostomy appliance. Today’s ostomy appliances come in a variety of shapes, sizes, colors, and materials to suit the wearer’s lifestyle. The stoma and the surrounding skin (peristomal skin) will require special care that is taught to patients post-surgery by an enterostomal therapy (ET) nurse.
Temporary vs. Permanent
A colostomy could either be temporary or permanent.
Temporary colostomy. A temporary colostomy may be used when the part of the colon (typically the lower section) needs to heal, such as after trauma or surgery. After the colon is healed, the colostomy can be reversed, returning the bowel function to normal.
In a colostomy reversal, the two ends of the colon are reconnected and the area where the stoma was created in the abdomen is closed. The large intestine is made, once again, into a continuous tube between the small intestine and the rectum. Bowel movements are eliminated through the rectum.
Permanent colostomy. A permanent colostomy (sometimes also called an end colostomy) is necessary for some conditions, including about 15 percent of colon cancer cases. This type of surgery is commonly used when the rectum needs to be removed due to disease or cancer. Most of the colon may also be removed and the remaining portion used to create a stoma.
Types of Surgery
There are several different types of colostomies:
Ascending. This colostomy has an opening created from the ascending colon and is created on the right side of the abdomen. Because the stoma is created from the first section of the colon, stool passed through the stoma is more liquid and contains digestive enzymes that irritate the skin. This type of colostomy surgery is the least common.
Transverse. This surgery may result in either one or two openings in the upper abdomen, middle, or right side that are created from the transverse colon. If there are two openings in the stoma (called a double-barrel colostomy), one is used to pass stool and the other is used to pass mucus. The stool that is eliminated through the stoma has passed through the ascending colon, so it tends to be liquid or semi-formed.
Descending or sigmoid. In this surgery, the descending or sigmoid colon is used to create a stoma, typically on the left lower abdomen. This is the most common type of colostomy surgery and generally produces stool that is semi-formed to well-formed because it has passed through the ascending and transverse colon.
Colostomy surgery is a major operation and will require a hospital stay of at least several days and up to six weeks or more of recovery at home. Patients will receive instructions from the surgeon on how to prepare in the days leading up to surgery.
Preparing for Surgery
For those taking other medications, the surgeon may ask to contact the prescribing physician for instructions on either continuing, discontinuing, or adjusting the dose of drugs during surgery and convalescence. It is important to make the surgeon aware of all medications, as certain classes of drugs may inhibit the healing process (such as prednisone) or interact with other drugs (making them more or less effective).
It may also be necessary to have certain routine examinations prior to surgery, such as a physical and a chest x-ray. Patients should also meet with an ET nurse who can explain how to take care of a stoma. In the initial meeting, one important point is to discuss where the stoma will be placed on the abdomen, what kind of supplies will be needed immediately after surgery, and how to best fit caring for an ostomy into daily life.
Colostomy surgery will often require a bowel prep to clean out the colon. In the day or two prior to surgery, it will be necessary to follow the surgeon’s instructions to remove all stool from the bowel, as if preparing for a colonoscopy. This may be accomplished through fasting, enemas, laxatives, any of the standard bowel preps such as GoLytely or Phospho Soda, or a combination of these. It may also be necessary to take antibiotics or other medications to prevent infections prior to, during, and after the surgery.
At the Hospital
Directly before surgery, an IV will be placed to receive fluids and anesthetic. The surgery itself will last several hours.
Upon awakening in recovery, a colostomy bag will be attached to the abdomen over a new stoma and there may be one or more drainage tubes. Once vital signs (pulse, blood pressure, respiration) are stable, it will be time to move to a hospital room.
For the first few days after surgery, patients continue to receive pain medication through the IV. No food will be given until the doctors hear bowel sounds from the abdomen which indicates that the intestines are “waking up.”
Nurses will prompt when it is time to get out of bed and sit in a chair or stand, usually a few days after surgery, depending on how recovery is progressing. Standing and walking as soon as possible is very important to the recovery process, even though it will be uncomfortable at first.
After the doctor hears bowel sounds and the stoma begins to function, the next step is to try to eat some clear liquids, such as broth, gelatin, and juice. If the clear fluids are tolerated well, the doctor will let the staff know that the diet can progress to full liquids or solid food.
There should be a meeting with an ET nurse before leaving the hospital in order to learn more about taking care of a stoma and changing an ostomy appliance. It’s also important to learn where to obtain colostomy supplies and get any special instructions for recovery at home.
Recovering at Home
Recovery at home can be two to four weeks, although it may be longer for patients who are very ill before surgery or who have complications. Activity will be restricted at first, and lifting, housework, and driving are not recommended, probably for about four weeks.
The hospital staff will give advice about diet before leaving the hospital, and it may be restricted to low fiber. Regular appointments with a surgeon will help ensure that the abdomen and the area around the stoma are healing well.
The first few weeks at home will be a time of learning how to take care of a stoma. An ET nurse will answer any questions and may help with the first few bag changes.
The surgeon will give instructions about when it is time to resume regular activities at work, school, or home. If the colostomy is going to be reversed, the surgeon will help decide when that is possible based on recovery as well as personal schedule.
Having colostomy surgery is a big change but for many, it means a new lease on life. Embracing the change can take time and reaching out for help with everything from learning how to manage an ostomy to coming to acceptance is important. The surgeon will be the biggest source of support and should give a time schedule for returning to activities and what is acceptable based on the recovery process. People who have an ostomy are able to swim, date, exercise, and do the other things that they did before surgery.
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- United Ostomy Association of America, Inc. “Frequently Asked Questions Following Ostomy Surgery.” UOAA 2013.