Colostomy

Approved by the Cancer.Net Editorial Board, 09/2021

A colostomy is surgery to create an opening called a stoma. The opening creates a passage from the large intestine to the outside of your body. This is so that solid stool and gas can leave the body through the stoma instead of passing through the rectum. The waste is collected in a pouch worn on the outside of the body. A colostomy can be temporary or permanent.

What is the large intestine?

The large intestine is the lowest section of the digestive system. It has two parts, the colon and the rectum.

The large intestine is below the small intestine, where nutrients are digested and absorbed into your bloodstream. Material you cannot digest moves from the small intestine into the colon. The colon absorbs water from the waste material and then stores it until your next bowel movement.

Why do I need a colostomy?

You may need a colostomy if:

The large intestine is blocked or damaged, including by cancer or problems with the blood flow to the bowels
Part of the large intestine is surgically removed
You have a tear in the large intestine, causing an infection

If you have certain types of cancer or other conditions, you may be more likely to need a colostomy. These include:

Colorectal cancer
Prostate cancer
Ovarian cancer
Uterine cancer
Cervical cancer
Chron's disease
Ulcerative colitis
Pre-cancerous polyps on the colon

How long will I need a colostomy?

If you need a cancer-related colostomy, you may only need it for a few months while the colon or rectum heals. But some people may need a permanent colostomy.

Types of colostomy

There are several different types of colostomy. They are named for the part of the colon that is connected to the outside of your body. Your doctor can give you more details on your specific colostomy.

Sigmoid colostomy. This is the most common colostomy. It is done in the bottom part of the large intestine, where waste is moved to the rectum. The stool from this type of colostomy are more solid and regular than from other types.

Transverse colostomy. This type of colostomy is done where the colon goes across the top of the abdomen. The stool in this area is usually soft. This is because it has not gone through much of the colon yet, and still contains a lot of water. There are 3 types of transverse colostomy:

A loop colostomy creates a stoma through which stool exits. In this type, the colon stays connected to the rectum. As a result, people will sometimes pass stool or gas through the rectum.
A single-barrel colostomy removes the colon below the colostomy, including the rectum and anal opening. This type of colostomy is permanent.
A double-barrel colostomy divides the colon into 2 ends that form separate stomas. Stool exits from one of the stomas. Mucus made by the colon exits from the other. This type of transverse colostomy is the least common.

Descending colostomy. This type of colostomy is done on the left side of the abdomen. Stool from there is usually firm because it has traveled through most of the colon already.

Ascending colostomy. This type of colostomy is done near the beginning of the large intestine. This means the stool is usually liquid, because very little water has been absorbed in the colon. This is a rare type of colostomy. Your doctor may choose to do a procedure called an ileostomy instead.

What should I expect during surgery?

You will receive general anesthesia before the surgery. During the surgery, the surgeon attaches one end of the colon to a stoma in a place where you can see and care for it. Then the surgeon attaches the colostomy bag to the stoma.

The procedure may be done with:

A surgical incision, which is a large cut in the abdomen
Laparoscopic surgery, which uses several small cuts. This method reduces pain and recovery time.

Surgery may include the following risks:

Bleeding inside the colon
Damage to nearby organs
Infection
Bleeding from the stoma

How long will it take to recover from surgery?

Most people stay in the hospital for 4 to 7 days on average after the procedure. But the time you spend in the hospital will depend on why you needed the colostomy. Complete recovery from a colostomy may take up to 2 months. During this time, you will have limits on what you can eat while the colon heals.

If the colostomy is temporary, you may need a reversal, or closure, surgery after the colon has healed. You usually have this surgery about 3 months later.

How to care for your colostomy

Emptying your colostomy bag. Once you have recovered from surgery, you will need to empty the colostomy pouch, also called a colostomy bag. You will probably do this several times a day. You will not be able to control when stool and gas move into the pouch. It is best to empty it when the bag is less than half full.

Colostomy pouches come in many sizes and shapes, but there are 2 main types:

One-piece pouches attach directly to a small adhesive stoma cover called a skin barrier. This cover has a hole in the center with the pouch on it.
Two-piece pouches include a skin barrier and a pouch that can detach from it.

The purpose of the skin barrier is to protect the skin around your stoma from waste and moisture. Pouch options include disposable pouches and pouches you can drain.

Ask your health care team about which type of colostomy pouch you will receive.

Caring for your skin. The skin around your stoma will always look red. It may bleed occasionally, which is normal. But bleeding should not continue for more than a few minutes.

It is important to make sure your pouch is correctly connected to your stoma. Pouches that do not fit well can irritate the skin. You should also keep this area clean and dry. If this skin looks wet, bumpy, itchy, or painful, contact your health care team. These can be signs of infection.

Managing colostomy concerns

It is important to know what problems can happen with your colostomy, what is normal, and when to call the health care team. Some common colostomy concerns include:

High stool output. During the first few days after surgery, you may pass more stool than normal through the stoma. This will become less as your body gets used to the stoma and the colostomy. If it does not decrease after a few days, call your health care team. You may lose too many fluids, and this could cause an electrolyte imbalance. Electrolytes are minerals that help keep your body working correctly.

Managing gas. Just like with stool, you will also need to release gas from your colostomy pouch. The way you do this depends on the type of pouch. Some pouches have a filter that deodorizes and vents gas. This keeps the pouch from stretching too much, coming off, or bursting.

The amount of gas you have depends on your diet and the type of colostomy. Foods and drinks such as beans, onions, milk, and alcohol can cause a lot of gas. Swallowing air can also increase the amount of gas in your colon. This happens when you chew gum or drink through a straw.

You may have a lot of gas right after surgery. But you should have less as your body heals. Your health care team can help you make food and lifestyle choices to reduce gas.

Whole pills or capsules in stool. Coated pills and extended-release capsules may come out intact in your pouch. This can mean that your body did not absorb the medication. Tell your health care team if this happens. They may be able to prescribe liquid or gel medications instead.

Blocked stoma. Scar tissue or undigested food may block the stoma. If this happens, stool and gas cannot pass into the pouch. You may have abdominal pain or swelling, nausea, or vomiting.

You might be able to move the blockage out of the way yourself. Try avoiding solid food and drinking extra fluids, including warm drinks like tea. You can also try massaging your abdomen around the stoma or pulling your knees up to your chest and rocking from side to side. If these tips do not work, call your health care team right away.

Questions to ask the health care team

Can you explain the colostomy surgery?
What are the common side effects of this surgery?
How long will the colostomy surgery take?
What will my recovery from this surgery be like?
When should I let you know if I experience any side effects?
What side effects do you need to know about right away?
Who should I contact about my side effects during regular business hours? After?
How should I care for my colostomy?