Colostomy

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What is a colostomy?

A colostomy is a surgical procedure that brings the end of the large intestine (also known as the large bowel or the colon) through the front of the abdomen, most commonly on the left side and just below the navel, where a stoma (opening) is created allowing attachment of an ostomy pouch for collecting stool.

Before and after image of colostomy

What exactly is the stoma?

A stoma (Greek meaning "mouth") is what you see when you look at your ostomy. It is the actual opening of the bowel or intestine through the abdomen that allows for the passage of stool. It usually sits just below the navel but may be higher up depending on your surgery. The size of your stoma will diminish for up to two months after your surgery.

Image of an ostomy stoma

The color of your stoma will be pink or red, somewhat like the inside of your mouth. A little bit of normal bleeding may occur during the cleaning of your stoma. Stomas vary in size, shape, and location. They usually are about one inch around, but may be smaller or larger. Some protrude while some lay flatter.

There are two basic kinds of stomas, depending on which kind of surgery was performed:

  1. End Stoma - the bowel is cut and the end is brought to the surface; the rectum and the anus may or may not be left intact
  2. Loop Stoma - a loop of bowel is brought to the front of the abdomen usually when the stoma is intended to be temporary; following surgery this type of stoma may be temporarily supported by a bridge or rod

Stomas do not cause pain and in fact sensation on the stoma is diminished. You will also not need to worry about the stoma getting infected as this is very rare. Stomas, by design, are intended to come in contact with stool; however, it is important to keep the surrounding skin clean to prevent skin complications.

What will the stool be like?

The consistency of your stools may be pasty to solidly formed, depending on the exact location of your ostomy within the colon. The most common is a descending or sigmoid colostomy (involving the descending or sigmoid colon). With this type, you may find that you have the same bowel patterns and stool consistency as before your surgery.

How often will I have to empty the pouch?

It depends on your bowel patterns and habits, and also on where in the colon your ostomy is located. You may only have to empty every few days, once daily, or several times a day. You will need to empty gas just as if it were a stool. If your stool is solid and difficult to empty from the pouch, you may have to coat the inside of the pouch with cooking spray, mineral oil, or a commercial ostomy lubricant. You may want to consider a closed end pouch if you have no more than two stools a day since this is a shorter pouch that you remove and discard with each bowel movement.

Will my colostomy be permanent?

This depends on the reason for the surgery and the actual surgery that was performed. If your anus and rectum are left intact, the colostomy is usually reversible and therefore does not need to be permanent.

Will odor be a problem?

If properly fitted and attached, ostomy pouches by design are odor-free so you should not detect any odor. If strong odor is a problem when emptying or changing your pouch, this is usually associated with gas, loose bowels, diarrhea, or the types of food being eaten.

Things that may increase stool odor:
  • Foods: eggs, cabbage, cheese, cucumber, onion, garlic, fish, dairy foods, and coffee
  • Medicines such as vitamins and antibiotics
Things that may decrease stool odor:
  • Foods: parsley, spinach, yogurt, buttermilk, orange juice and cranberry juice
Tips to control odor:
  • Make sure the flange of the pouch and wafer are securely snapped
  • Use a spray room deodorizer when emptying the pouch, especially when emptying gas
  • Place ostomy deodorizing drops into the pouch for additional odor control

What about gas?

Everyone expels some gas (also called "flatus"). This is especially true during the early weeks and months after surgery. The following are ways to help control and deal with gas:

Things that may increase gas:
  • Foods: cucumbers, cabbage, broccoli, mushrooms, onions, fish, dried beans, milk, cheese, carbonated drinks, and beer
  • Chewing gum
  • Swallowed air (this can be reduced by eating leisurely in a relaxed atmosphere with your mouth closed, by chewing well and by not using a straw)

There are pouches available that come with filters built-in that vent the gas without releasing odor. There are also commercially available air release vents that you can insert into your pouch. Contact us for further information regarding either of these options.

Will regular irrigation be needed?

In the past, the process of irrigation (infusing water into the colon via the stoma) was used to regulate stool output by stimulating the colon to empty. With today's modern, disposable supplies irrigation for the most part is not needed. It may be necessary to irrigate if you experience frequent or severe constipation. You should first try to stimulate the colon naturally by drinking more water and increasing fiber. Check with your doctor or ostomy nurse if constipation persists despite these measures.