A colostomy is a surgical procedure that creates an opening in the abdomen, allowing the colon (large intestine) to divert waste. This opening, known as a stoma, provides an alternative pathway for stool to exit the body, bypassing the usual route through the rectum and anus. An end colostomy specifically involves bringing the end of the colon through the abdominal wall to form this new exit point. This procedure manages various conditions that affect the normal function of the lower digestive tract.
Understanding End Colostomies
An end colostomy redirects the flow of feces away from a diseased, injured, or removed section of the colon or rectum. The stoma, created by bringing one end of the large intestine through the abdominal wall and stitching it to the skin, allows stool to drain directly into an external collection pouch.
Many medical conditions can necessitate an end colostomy. These include colorectal cancer, where a tumor may require removal of a portion of the colon or rectum. Inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis, or complications like diverticulitis, can also lead to the need for this procedure to allow the bowel to heal or to manage blockages. Additionally, severe injuries to the colon or rectum, congenital defects, or bowel obstructions may also make an end colostomy necessary.
The Surgical Process
Creating an end colostomy is a surgical procedure performed under general anesthesia, ensuring the patient is asleep and experiences no pain. The surgeon begins by making an incision in the abdomen to access the colon. Depending on the situation, this can be an open surgery with a single large cut or a laparoscopic procedure using several smaller incisions.
The affected part of the colon is then identified and, if necessary, removed. The healthy remaining end of the colon is then brought through a newly created opening in the abdominal wall, forming the stoma. The edges of the colon are carefully sutured to the skin of the abdomen, securing the stoma in place.
Life with an End Colostomy
Living with an end colostomy involves adapting to a new way of waste elimination. The stoma itself is a moist, pink or red opening that protrudes slightly from the abdomen. It resembles the inside of the mouth and does not have nerve endings, so touching it is not painful. Initially, the stoma may appear swollen and dark red, with some bruising, but its color and size will normalize within a few weeks.
Since the stoma lacks muscles to control waste release, stool is continuously collected in an external pouching system. This system consists of an odor-proof pouch and an adhesive skin barrier that attaches to the skin around the stoma. The pouch needs to be emptied when it is about one-third to one-half full, and the entire system requires changing every few days. Routine care involves gently cleaning the skin around the stoma with water and ensuring the skin barrier opening fits snugly to prevent irritation.
Individuals with an end colostomy can resume most daily activities, including exercise and bathing, as the pouching system is designed to be secure and discreet under clothing. Adapting to dietary changes may be necessary to manage stool consistency and gas.
Is End Colostomy Reversible?
The permanence of an end colostomy depends on the underlying medical condition and the extent of the surgical intervention. An end colostomy can be temporary, allowing a diseased or injured section of the bowel to rest and heal. In such cases, the colostomy may be in place for a few months, between three to twelve months, before a reversal surgery is considered. During reversal, the two ends of the colon are reconnected, and the stoma opening is closed, allowing stool to pass through the anus again.
However, an end colostomy is often permanent, particularly if a significant portion of the colon or the entire rectum and anus has been removed, as may occur in cases of advanced colorectal cancer or severe injury. While some end colostomies can be reversed, the procedure is generally more invasive and carries higher risks than reversing a loop colostomy. The decision for reversal depends on factors like the original reason for the colostomy, the patient’s overall health, and their ability to undergo further surgery.