A colostomy is a surgical procedure that redirects the normal path of stool elimination by creating an opening, called a stoma, from the large intestine to the abdominal wall. This allows waste to exit the body into an external collection pouch, bypassing the rectum and anus entirely. Whether the anus is sewn closed after this procedure is a common concern, and the answer is not a simple yes or no. The outcome for the anus depends entirely on the specific reason for the colostomy and the surgical technique required to address the underlying disease.
Why the Outcome Varies
The fate of the anus is determined by whether the colostomy is temporary or permanent and the health status of the lower bowel segment. Surgeons aim to preserve as much healthy anatomy as possible, especially if a future reversal of the colostomy is planned. If the segment of the bowel leading to the anus is free of disease and could be reconnected later, the anus and rectum are almost always left intact.
When the lower segment of the colon and the rectum are diseased, damaged, or must be removed due to advanced pathology, the colostomy is typically permanent. Conditions like low-lying rectal cancer, severe inflammatory bowel disease (IBD) affecting the rectum, or extensive trauma often necessitate the complete removal of the lower structures. In these cases, the anus is permanently closed, as the entire route of elimination is no longer functional. The decision hinges on the balance between preserving the possibility of reversal and ensuring all diseased tissue is fully eradicated.
Permanent Closure of the Anus and Rectum
When the anus is permanently closed, it is typically part of a larger operation known as an abdominoperineal resection (APR) or total proctectomy. This procedure involves removing the rectum, the anal canal, and the anus itself, usually for low rectal tumors or other conditions that have severely damaged the distal bowel. The colostomy created in the abdomen then becomes the only exit route for stool.
The closure involves suturing the skin and deeper tissues of the perineum where the anus once was, resulting in a single scar. This procedure is sometimes informally referred to as creating a “Barbie butt”. The resulting wound, known as the perineal wound, can be complex and requires careful management.
Healing of this perineal wound can take significantly longer than the abdominal stoma site, often requiring several months. For patients with inflammatory bowel disease, healing rates can be slower, sometimes taking six months or more. The surgeon’s technique for closing the deeper muscle layers is important for promoting a successful recovery. Sometimes, a surgeon may leave the wound open to heal from the inside out (healing by secondary intention), which leads to a more prolonged healing period.
When the Anus is Retained
If the colostomy is temporary, or if the disease is confined to the upper colon, the anus is not sewn shut and remains physically open. In a common procedure called a Hartmann’s procedure, the colon is divided, and the end leading to the anus (the rectal stump) is sealed internally. The anus and rectum are preserved, maintaining the option for future surgical reconnection.
Although the anus is retained, it no longer passes stool, as the digestive stream is diverted through the stoma. However, the lining of the retained rectum and anus continues to produce mucus, which acts as a natural lubricant. This mucus, along with shed intestinal cells, must be passed periodically through the anus.
Patients may feel a sensation of needing to pass a bowel movement and will pass this mucus discharge, which can be clear, sticky, or discolored. This retained segment is still functional in terms of sensation, and the anal sphincter muscles remain intact, allowing the person to pass the mucus.
Recovery and Long-Term Care Differences
The long-term recovery and care required differ substantially depending on whether the anus was closed or retained. For those who undergo permanent closure of the anus and rectum, the primary focus is on managing the perineal wound healing. Even after the external incision closes, the internal tissues can take time to fully strengthen, and patients may experience discomfort when sitting for several weeks or months.
Patients who have had their rectum removed may experience a phenomenon known as “phantom rectum” syndrome, which is similar to phantom limb pain. This involves sensations of needing to defecate, pressure, or cramping, even though the organ is no longer present. This sensation is experienced by up to 96% of patients and can sometimes be managed by sitting on the toilet as if to pass a stool, which may provide temporary relief.
For individuals with a retained anus and rectum, the main long-term care revolves around managing the rectal discharge of mucus. While some people can easily manage this discharge, others may find it difficult to control, especially if the anal sphincter tone is reduced. Passing the mucus by sitting on the toilet is the recommended method, and sometimes suppositories or enemas are used to help clear the retained segment. Regular medical surveillance may also be recommended, particularly if the original disease was inflammatory bowel disease.