A colostomy is a surgical procedure that creates an opening in the abdominal wall, known as a stoma, to divert a section of the colon (large intestine) outside the body. This opening allows stool to exit, bypassing the rectum and anus, and is typically covered by a collection pouch. Whether a person must wear this pouch system constantly depends entirely on the underlying medical condition and the specific type of surgery performed.
Temporary and Permanent Colostomies
The duration a person lives with a colostomy depends on whether the procedure is temporary or permanent, based on the surgical technique and the patient’s prognosis. A temporary colostomy is created to allow a diseased or injured section of the bowel to rest and heal without the passage of stool. This is often a loop colostomy, where a loop of the colon is brought through the abdominal wall, creating two openings: one for stool and one for mucus.
Temporary colostomies are reversed once initial healing is complete, typically taking a few weeks to several months. Once the surgeon determines the downstream bowel is adequately healed, a second surgery reconnects the two ends of the colon, allowing stool to pass normally.
A permanent colostomy, most often an end colostomy, is required when the lower colon, rectum, or anus must be completely removed or are non-functional due to disease or trauma. An end colostomy brings one end of the remaining colon through the abdomen to form a single stoma; the other end is removed or closed off. Since the normal exit pathway is permanently disabled, this type of colostomy is irreversible and functions as the sole exit point for stool.
Medical Reasons for Long-Term Use
A permanent colostomy is necessary when restoring the natural pathway is impossible or poses a severe health risk. Conditions like low-lying rectal cancer often require an abdominoperineal resection (APR), which removes the anus, rectum, and part of the sigmoid colon, eliminating the natural exit for waste. In these cases, the permanent end colostomy is the only option for waste elimination.
Severe inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis, can cause irreparable damage requiring complete removal of the colon and rectum, resulting in a permanent stoma. Catastrophic trauma to the pelvic or abdominal area that damages the rectal sphincter muscles or lower colon may also mandate a permanent diversion.
The stoma’s location influences the output characteristics. A colostomy created from the sigmoid colon (descending colostomy) produces more formed output because most water has been reabsorbed. Conversely, a colostomy higher up, such as a transverse colostomy, produces semi-liquid stool, as less water has been absorbed.
Alternative Stoma Management Options
While a permanent colostomy requires a continuous pathway for waste, not all patients must wear a full collection pouch constantly. Individuals with a stoma created from the descending or sigmoid colon can use a technique called colostomy irrigation due to the formed consistency of the stool. This method involves intentionally flushing the colon with water through the stoma to stimulate a bowel movement.
The process uses a specialized irrigation set with a cone inserted into the stoma, allowing 500 to 1,000 milliliters of lukewarm water to enter the colon. This infusion stimulates peristalsis, the muscular contractions that move waste, effectively emptying the colon at a predictable time. Initial drainage takes about 15 minutes, with total evacuation requiring up to an hour.
Routine irrigation, typically performed once a day or every other day, establishes a regulated bowel pattern that significantly reduces or eliminates stool output between sessions. This regulation allows the person to wear a small, discreet cap or closed stoma plug for extended periods, sometimes up to 48 hours, instead of a full collection pouch. Qualification requires a descending or sigmoid colostomy and training from a specialized ostomy nurse and physician approval.