A colostomy is a surgical procedure that creates a new opening, called a stoma, in the abdomen. This opening diverts a section of the colon, or large intestine, allowing stool to exit the body into a specialized external collection system. Understanding a colostomy involves examining the physical characteristics of the stoma and the manufactured collection system worn over it.
The Appearance of the Stoma
The stoma is the visible part of the colostomy, appearing as a small, moist piece of tissue protruding slightly from the abdominal wall, usually located on the left side. Its color is a distinct, healthy pink or red, similar to the mucous membrane found inside the mouth. Immediately after surgery, the stoma may appear swollen and dark red, but this puffiness and initial bruising diminish over the first six to eight weeks of healing.
The tissue is soft and moist because it is composed of the internal lining of the colon. The stoma is generally round or oval, often protruding a few centimeters above the skin, though some may be created to be flush with the abdomen. Importantly, the stoma does not contain pain-sensing nerves, meaning the tissue itself has no feeling of pain or touch. The stoma may bleed slightly when rubbed or cleaned due to the blood vessels being close to the surface, which is normal for this delicate mucous tissue.
The Collection System
The complete look of a colostomy involves the pouching system, which is the manufactured equipment designed to collect the output and protect the surrounding skin. This system is composed of two primary components: the skin barrier (wafer or flange) and the collection pouch. The skin barrier is an adhesive plate that sticks securely to the skin immediately surrounding the stoma, known as the peristomal skin.
This barrier protects the healthy skin from contact with the effluent, which can cause irritation. The collection pouch attaches to the skin barrier, creating a sealed, odor-proof containment system for the stool. Pouches are available in one-piece systems, where the barrier and pouch are permanently combined, or two-piece systems, where the pouch can be detached and reattached. Pouches come in various sizes and may be clear for observation or opaque for discretion.
Function and Daily Interaction
The function of the colostomy is to allow stool to exit the body without passing through the rectum and anus. This process is involuntary because the stoma lacks the muscular control of a sphincter. The nature of the output, or effluent, varies depending on where the colostomy is located along the large intestine.
Output Consistency
A sigmoid colostomy, the most common type, produces a more formed or paste-like stool because more water has been absorbed. In contrast, colostomies closer to the beginning of the colon, such as a transverse colostomy, will have a looser consistency.
Pouch Management
Managing the system requires routinely emptying the pouch when it is about one-third full to prevent the weight from compromising the adhesive seal. The pouch is changed every few days, and modern pouches contain integrated filters that help manage gas and control odors.