A colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall.

During this procedure, one end of the colon is diverted through an incision in the abdominal wall to create a stoma. A stoma is an opening in the skin where a pouch is attached for collecting feces. People with temporary or long-term colostomies have pouches attached to their sides where feces collect and can be easily disposed of.

Colostomies aren’t always permanent, especially in children with birth defects.

A colostomy can be the result of one of several procedures to correct problems with the lower digestive tract. Other “ostomies” include ileostomy and urostomy. An ileostomy is a diversion of the bottom of the small intestine. A urostomy is a diversion of the tubes that carry urine out of the bladder.

A colostomy may also be referred to as bowel diversion therapy.

Colostomies are performed due to problems with the lower bowel and create new pathways for stools to pass. Once a colostomy has been created, your intestines work very much the same way as before, except for two changes:

  • the colon and rectum beyond where the colostomy has been done are disconnected or removed
  • the anus is no longer where stools leave the body

The conditions that can require a colostomy include certain illnesses, injuries, or other problems with your digestive tract, including:

  • Crohn’s disease
  • diverticulitis
  • an injury to the colon or rectum
  • intestinal obstruction, which is a blockage in the large bowel
  • colon cancer
  • Hirschsprung’s disease, a rare condition that mostly affects children, and can cause stools to become stuck in the bowels
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Illustration by Cristie Wilson

A colostomy can be short-term (a few months), or a life-long situation. The different types of this procedure have to do with where they are located on the colon.

Temporary colostomy

A temporary colostomy gives part of the bowel time to heal by redirecting where stools go.

This healing can take a few months or a few years, but once healing has occurred, the colostomy can be reversed.

Permanent colostomy

When part of the rectum becomes diseased — such as with cancer — a permanent colostomy is done. In this case, the diseased part of the colon is removed, or permanently cut off with the colostomy positioning.

Transverse colostomy

Transverse colostomies are some of the more common colostomies, and are divided into two types:

  • loop transverse colostomies
  • double-barrel transverse colostomies

In general, transverse colostomies are done in the upper abdomen. This type of colostomy allows the stool to leave the body before it reaches the descending colon, and is typically temporary, allowing parts of the colon to heal.

A loop transverse colostomy creates two openings in the abdomen: One opening is for stools, the other is only for mucus, which is a normal byproduct of defecation.

A double-barrel transverse colostomy involves dividing the bowel into two complete parts. Each part has its own opening, or stoma, in the abdomen. Just like with a loop transverse, one opening is for stools, and the other is for only mucus.

WIth transverse colostomies, a lightweight, drainable pouch holds the stool and mucus and protects the skin from coming into contact with the stool. Usually, this pouch can easily be hidden under clothes.

Ascending colostomy

In an ascending colostomy, only a small portion of the colon stays active, and the colostomy itself is placed on the right side of the abdomen. Because only a small portion of the colon stays active, the output is liquid, and contains a large number of digestive enzymes. A drainable pouch has to be worn at all times.

Ascending colostomies are rare these days, and ileostomies are usually recommended instead.

Descending and sigmoid colostomies

As the name would suggest, a descending colostomy is placed in the descending colon, on the lower left side of the abdomen. Typically, the output can be controlled, and is firmer.

A sigmoid colostomy is done on the sigmoid colon, and is a few inches lower than a descending colostomy. A sigmoid colostomy allows for a larger part of the colon to still do its job, so the stool output is usually more solid and happens on a regular basis.

A colostomy is a major surgery. As with any surgery, there are risks of allergic reactions to anesthesia and excessive bleeding.

A colostomy also carries other risks, such as:

  • damage to nearby organs
  • scar tissue forming in the abdomen, which can cause blockages
  • parastomal hernia, which is when your intestines bulge out through the muscles around the stoma. This can cause a bump in the skin.
  • stoma blockage, which is when a buildup of food can block the opening and cause issues, including nausea, swelling, and output issues
  • irritated skin around the stoma
  • stoma fistula — a small hole that can develop next to the stoma
  • stoma retraction, when the stoma may sink into the skin and cause leakage around the colostomy pouch
  • stomal ischaemia, when blood supply to the stoma is restricted. This may require additional surgery.

Your doctor can best explain your personal risks, risks and advantages of the surgery, and the potential for complications.

Before surgery, your doctor will take blood samples, perform a physical exam, and review your complete medical history. During these visits, tell your doctor about any prior surgeries you’ve had and any medications you’re taking, including over-the-counter medicines and supplements.

Your doctor will likely ask you to fast for at least 12 hours before surgery. You may also be given a laxative or an enema to take the night before surgery to help cleanse your bowels.

You should prepare to stay in the hospital for 3 to 10 days. This includes packing the right necessities, arranging care for your children, pets, or home, and taking the appropriate amount of time off of work.

While individual hospital practices may vary, you can expect something very similar to the following during your colostomy:

After changing into a hospital gown, a nurse will place intravenous access, or an IV, in your arm. This allows the hospital staff to give you fluids and medications easily, and it’s also how you’ll be given your general anesthesia. This will put you into a deep, painless sleep during the operation.

While you’re asleep, the hospital staff will wheel you into the operating room for your colostomy. When you’ve been cleaned and prepared, your surgeon will make an incision in your abdomen. This incision may be large, or it may be a series of smaller incisions.

Smaller incisions are used for laparoscopy. This type of surgery involves using small tools and a camera that’s inserted into an incision. The camera will be used to guide your doctor during the surgery.

The actual colostomy surgery is typically performed this way: First, your doctor will locate the ideal part of the large intestine for the opening, or stoma. They will then cut the intestine in the appropriate area and bring it through your abdominal wall.

Next, your doctor will surgically implant a ring onto your abdominal wall. This ring will hold the end of the intestine in place. This ring may be permanent, or it may be placed temporarily to help your skin heal around your exposed intestine.

After everything is in place, your doctor will close your wound with stitches and you’ll be brought into a recovery room. During that time, the staff will wait for you to wake up and they’ll watch your vital signs to ensure everything goes smoothly.

Recovery in the hospital involves being slowly reintroduced to liquids and foods to ensure there are no digestive problems. On the first day, you’ll most likely be given only ice chips to ease your thirst. Afterward, you’ll be given clear liquids and eventually soft foods.

Once doctors are sure your bowels are working normally, you can start eating a regular diet, usually about 2 days after surgery.

What is a colostomy bag?

You’ll also be taught how to use colostomy bags correctly and how to keep your stoma clean, most likely by a stoma nurse who has been specially trained.

A colostomy bag is where your feces will collect while you have your colostomy. Hospital staff will also instruct you on your diet, activity level, and more. It’s important to follow these instructions.

You’ll have follow-up appointments with your doctor to check on your condition and the colostomy.

While it can take some time to adjust to life with a colostomy, most people eventually learn how to continue with their regular life. Most colostomy equipment is discreet and can be hidden under clothes. After you have healed from your surgery, you should be able to do most of what you loved doing before.

As long as you pay attention to any new symptoms or pains in the area around your colostomy, and keep it properly cleaned and cared for, living a full life is completely possible.