A colostomy is a surgical procedure that creates a new pathway for waste material to leave the body when the normal route through the colon, rectum, and anus is no longer possible. This procedure is performed to divert the flow of stool, allowing an injured or diseased section of the large intestine to heal or bypassing an area that has been permanently removed or obstructed. The need for a colostomy is always related to a serious underlying medical condition.
Understanding the Colostomy and Stoma
A colostomy is one type of ostomy, a general term for a surgically created opening on the abdomen that allows for the removal of bodily waste. Other common types include an ileostomy, which diverts waste from the small intestine, and a urostomy, which diverts urine. Because a colostomy involves the large intestine, the resulting stool is often more formed or paste-like than the typically liquid output from an ileostomy.
The opening created on the abdominal wall is called a stoma, which is the visible portion of the diverted intestine. The stoma is typically red or pink and moist, resembling the lining of the inside of the mouth. Since the stoma does not have a sphincter muscle, the passage of stool and gas cannot be controlled, necessitating the use of an external collection pouch, often referred to as a colostomy bag.
Primary Medical Conditions Requiring Colostomy
The most common reason for needing a colostomy is the treatment of colorectal cancer, often requiring the surgical removal of a portion of the colon or rectum. When a tumor causes an obstruction or when the lower rectum and anus must be removed, the colostomy provides a safe, alternative pathway for waste elimination. Severe complications from diverticulitis, where small pouches in the colon wall become inflamed or tear, can also require an emergency colostomy. This is often performed when a perforation or abscess leads to a life-threatening infection within the abdomen.
Inflammatory Bowel Disease (IBD), specifically advanced or severe Crohn’s disease and ulcerative colitis, is another frequent indication for the procedure. These conditions can lead to such extensive damage, scarring, or perforation of the bowel that a portion must be bypassed or removed entirely. In emergency situations, such as severe abdominal trauma from an accident or injury, a colostomy may be performed immediately to divert stool and allow the injured section of the colon to rest and heal.
Colostomies are also sometimes necessary for congenital defects present at birth, such as anorectal malformations or Hirschsprung disease, where the anus or rectum is blocked or missing. In adults, a colostomy can be utilized to treat severe, unrelenting bowel obstruction caused by scarring or other conditions that impede the normal passage of waste. Furthermore, a colostomy can be created to protect a newly created surgical connection in the lower bowel, preventing stool from contaminating the area while it heals.
Determining Temporary Versus Permanent Necessity
Whether a colostomy is temporary or permanent depends on the underlying medical issue and the specific goal of the surgical intervention. A temporary colostomy is created to allow a section of the bowel to rest, heal, or recover from surgery or injury without the constant passage of stool. These are often loop colostomies, which are usually reversed within a few months, allowing the bowel to be reconnected and function to return to normal.
A permanent colostomy is required when the lower part of the colon, the rectum, or the anus must be removed or is non-functional due to the extent of the disease. This situation most commonly occurs following surgery for low-lying rectal cancer or severe, irreversible damage from IBD or trauma. In a permanent procedure, the end of the remaining colon is brought through the abdominal wall to form a single stoma, and the patient will use the external pouching system indefinitely.
Daily Life and Adjustment After Surgery
Adjusting to life with a colostomy involves learning the routine for managing the external pouching system, which collects the output from the stoma. The pouching system consists of a skin barrier that adheres to the body and protects the skin around the stoma, and the bag itself, which may be a one-piece or two-piece system. Drainable pouches are typically emptied several times a day once they are about one-third full, while closed pouches are discarded when full.
Dietary adjustments are often needed to manage the consistency and frequency of output, with many people working with dieticians to create an individualized plan. Patients are taught how to perform pouch changes and care for the skin surrounding the stoma to prevent irritation and leakage. The Wound, Ostomy, and Continence Nurse (WOCN) is a registered nurse with advanced training in ostomy care. These nurses provide education, troubleshoot issues with appliance fit, and offer support to help individuals return to normal activities such as work, travel, and exercise.