A colostomy is a life-saving surgical procedure that involves removing a section of the large intestine and bringing the remaining ends together through an opening in the abdominal wall.
This opening, called a stoma, is where the waste will exit the body. The stoma is connected to an external bag, which collects the waste. While a colostomy may be temporary or permanent, many people live full and active lives with this condition.
There are a few different reasons why someone might need to have the colostomy procedure, including:
- Missing or blocked anal opening. This is usually present in children in the form of congenital disabilities and is known as an imperforate anus.
- Inflammation of sacs present in the colon (diverticulitis)
- Inflammatory bowel disease (IBD)
- Injury to the rectum or colon
- Complete or partial blockage of the bowel or intestine
- Colon or rectal cancer
- Fistulas or wounds in the perineum. The perineum is a sensitive area located between the anus and the vulva or scrotum.
- Faecal incontinence that cannot be cured. It is a medical condition that causes a person to lose control of their bowel movements. This can result in leakage of stool or gas and can be a very embarrassing and frustrating condition to deal with.
- Permanent removal of the anus and/or rectum
- Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract. It can be very debilitating and has no known cure.
- Hirschsprung’s disease is a condition that affects the nervous system and can cause serious problems with bowel movements. This condition is extremely rare, and it mostly affects children.
- Pre-cancerous polyps in the colon
- Colorectal cancer
There are many different types of colostomies, and the type that is right for a patient will depend on their situation.
- Ascending colostomy: The first portion of the colon where the small intestine ends and the large intestine begins is called ascending colon. The word “ascending” is used because this is where the large intestine travels upwards to the right-hand side of the abdomen. In this colostomy procedure, very little of the colon is left active. The food waste here is in liquid form and contains digestive enzymes. After an ascending colostomy, a patient needs to protect their skin from digestive enzymes and take utmost care to prevent leakage.
- Descending colostomy: This is a type of colostomy surgery in which the end of the large intestine (colon) is brought down through an incision in the lower abdomen, and a stoma is created. This colostomy is typically performed when the rectum and anus need to be removed due to cancer or other diseases. Since most of the colon is still active, the food waste is solid in appearance. It doesn’t contain digestive enzymes, which is why it doesn’t irritate the skin. Most patients feel the natural reflex to empty their bowels as they did before the procedure.
- Transverse colostomy: In this type of colostomy, an opening is made in the transverse (or horizontal) direction, as opposed to the more common vertical direction. It is typically performed when the colon needs to be bypassed or removed entirely. The stool is partly solid since it didn’t have enough time to travel through the rest of the colon. It also contains fewer digestive enzymes. As the stoma is created higher on the abdomen compared to other types of colostomies, it can be difficult to conceal.
Colostomy can be performed through any of the following procedures:
- Open surgery: During this colostomy procedure, a surgeon opens up the abdominal cavity using a long incision. Open surgery allows better access to internal organs, which is necessary in certain cases. However, it requires a longer recovery time as it is a major procedure.
- Laparoscopic surgery: Laparoscopic surgery is a minimally invasive option that can offer many benefits. Some of them include faster recovery time, smaller incisions, less pain, and fewer complications. The surgery is performed through a small incision in the abdomen and involves the use of a camera and small instruments to access the colon. This type of colostomy surgery can be performed as an outpatient procedure and has a shorter hospital stay.
- Loop colostomy: Also known as a temporary colostomy, this surgery is easier to reverse. In this procedure, a surgeon pulls a section of the colon as a loop in the abdomen. The two ends of the loop are used for creating two stomas. One stoma is connected to the active part of the colon where the stool will exit the body. The other stoma is connected to the bowel’s inactive part – one that leads to the anus. This opening is where the mucus is discharged.
- End colostomy: In this permanent colostomy, surgeons seal one end of the inactive bowel and create a stoma at the active end. Food waste exits through the stoma while the mucus is discharged through the anus (if it is still intact).
As with any major surgery, a colostomy can also present certain complications:
- Stoma ischemia: A condition where the stoma doesn’t receive enough blood supply post-surgery. Doctors may need to perform additional surgery to fix the complication.
- Stoma fistula: Another major complication is a fistula (small hole) that may develop right next to the stoma.
- Stoma retraction: After the surgery, the stoma may collapse back into the skin. It can lead to leakage around the patient’s colostomy.
- Stoma blockage: Sometimes, the stoma can get blocked due to the accumulation of food wastage. It can cause swelling, nausea, and output problems.
- Parastomal hernia: In this colostomy complication, intestines bulge out and cause a hernia around the stoma (bump in the skin).
- Medicines in the stool: Patients may notice capsules or whole pills in their colostomy. This happens when the patient’s body doesn’t absorb the medications. Notify the medical staff when this happens. The doctors may prescribe gel or liquid medications instead.
- High stool output: While it’s normal to expel high stool output for the first few days after colostomy, it should decrease later on. If it doesn’t, patients need to contact their colostomy care team. Otherwise, they risk losing too many fluids. This can lead to electrolyte imbalance.
- Blockages caused by scar tissue in the abdomen
- Damage to nearby organs
- Skin irritation around the stoma
Besides these colostomy complications, there are always general risks involved in any surgery.
These are:
- Infection
- Reactions to the anaesthesia
- Bleeding
We can divide colostomy care into three phases:
In the hospital
After the colostomy surgery, patients need to stay in the hospital for 3-7 days. The duration of stay will vary depending upon the nature of the emergency. Doctors use this time in the hospital to help patients get accustomed to their new way of life.
They teach how to care for skin (around the stoma) and how to safely discharge the colostomy bag that collects faeces. The pouch itself is made of odour-resistant material.
Patients will need to gently clean the stoma with lukewarm water and pat it dry. It’s not completely unusual to spot a little bit of blood. However, bleeding shouldn’t continue for several minutes.
Since patients who have had a descending colostomy can learn to predict bowel movement, they don’t have to wear the colostomy pouch at all times (eventually). In some patients, their anus or rectum has to be surgically removed.
Therefore, they would need to use pads or dressings in the hospital until the wound completely heals.
If any colostomy complications do occur, doctors address them immediately.
At home
Regular exposure to the stool can lead to irritation of the skin around the stoma.
Patients need to protect their skin by following certain colostomy care tips, including:
- Using barrier creams to treat skin irritation as recommended
- Pushing the skin away to remove the colostomy pouch instead of pulling
- Ensuring that the stoma and pouch are the right sizes
- Changing the colostomy bag regularly to prevent irritation and leakage
Doctors need to be alerted immediately if patients or their family members notice:
- Bulging or blocked stoma
- Bleeding from the stoma
- Sores or serious skin irritation
- Watery stool that lasts for hours
- Change in the colour or size of the stoma
- Unusual or unpleasant odour for over a week
- Continuous nausea
- Cramps that last for over two hours
- Cut or wound in the stoma
- Anything else that the patient feels is unusual
Doctors recommend emptying the colostomy pouch at least once every day to avoid bad odour, leakage, or irritation.
There is also the matter of managing gas after the colostomy surgery. After the procedure, patients will release gas from their stoma. Many colostomy pouches have in-built filters in them.
These filters are designed for deodorising and venting gas. They prevent the bag from bursting, coming off, or stretching too much. The amount of gas released depends on the type of colostomy and diet.
Avoid consuming food and beverages such as alcohol, milk, onions, and beans. It’s also not advisable to drink through a straw or chew gum to avoid swallowing air. The amount of gas produced should reduce as the patient recovers.
If it doesn’t, it’s important to consult the medical team. They can help the patient make suitable lifestyle and food choices.
How long can one expect to live after having a colostomy? This is a question that many people ask, and unfortunately, there is no one-size-fits-all answer.
Life expectancy after colostomy surgery depends on a number of factors, including age, overall health, and the reason for surgery.
That said, some general trends can give patients an idea of what to expect. In general, people who have a colostomy at a younger age tend to have a better prognosis than those who have the surgery later in life.
This is because younger people are generally healthier and have a lower risk of developing complications from the surgery. Additionally, the reason for the colostomy also plays a role in life expectancy.
People who have surgery to treat a non-cancerous condition, such as Crohn’s disease, tend to have a better prognosis than those who have surgery to treat cancer.
This is because non-cancerous conditions are generally less likely to cause complications or return after surgery.
Overall, the vast majority of people who have a colostomy are able to live long and healthy lives. Complications from the surgery are relatively rare, and most people are able to return to their normal activities within a few weeks or months.
If you’re like most people, the word “colostomy” probably conjures up some pretty negative images. But believe it or not, this surgical procedure can actually be life-saving.
It can save a person from a life-threatening bowel obstruction, serious bowel injury, cancer, and other debilitating conditions such as Crohn’s disease, faecal incontinence, and Hirschsprung’s disease.
Depending on your condition, doctors at the CK Birla Hospital will recommend ascending, descending, or transverse colostomy. Visit the CK Birla Hospital or book an appointment with Dr Prof. Amit Javed for proper guidance.
Our team is committed to serve our patients with world class healthcare services. Which is why we have the latest equipments for performing open surgery, laparoscopic surgery, end colostomy, and loop colostomy using the latest innovation in surgical techniques. You will be under the supervision and care of some of the best colorectal surgeons and nurses in the country.
