Colostomy surgery is often a frightening prospect for most people. But it can dramatically improve a person's quality of life, especially in cases of serious disease.
Colostomy, in simple terms, is surgery to remove all or part of the colon. It is used to treat many conditions including colon cancer, Crohn's disease, intestinal obstruction, birth defects, and diverticulitis. While removal of the colon is also used as a treatment for ulcerative colitis, a colostomy is not usually indicated, as the colitis will can recur in any sections of the colon that are left in the body.
What 'Ostomy' Means
An ostomy is a surgically-created opening from an internal organ to the body's surface. Colostomy, from "colon" and "ostomy," is the surgery where an opening is made from the colon (or large intestine) to the outside of the abdomen. In a colostomy, the surgeon may remove a segment of the colon, which results in the colon being in two separate parts (think of what a garden hose would look like if it were cut in half). One end of the colon is passed through a small hole in the abdominal wall. This section of intestine, or stoma, allows for waste to leave the body from the colon. The other end of the colon, which is attached to the rectum, may either be removed or closed off with sutures and left in the abdomen.
After the colostomy, waste is collected on the outside of the body with an ostomy appliance. Today’s ostomy appliances come in a variety of shapes, sizes, colors, and materials to suit the wearer’s lifestyle. The stoma and the surrounding skin (peristomal skin) will require special care that is taught to patients post-surgery by an enterostomal therapy (ET) nurse.
Colostomies Can Be Temporary Or Permanent
A temporary colostomy may be used when the part of the colon (typically the lower section) needs to heal, such as after trauma or surgery. After the colon is healed, the colostomy can be reversed, returning the bowel function to normal. In a colostomy reversal, the two ends of the colon are reconnected and the area where the stoma was created in the abdomen is closed. The large intestine is made, once again, into a continuous tube between the small intestine and the rectum. Bowel movements are eliminated through the rectum.
A permanent colostomy (sometimes also called an end colostomy) is necessary for some conditions, including about 15% of colon cancer cases. This type of surgery is commonly used when the rectum needs to be removed because of disease or cancer. Most of the colon may also be removed, and the remaining portion used to create a stoma.
Types of Colostomies
There are several different types of colostomies including ascending, transverse, and descending.
- Ascending. This colostomy has an opening created from the ascending colon, and is found on the right abdomen. Because the stoma is created from the first section of the colon, stool is more liquid and contains digestive enzymes that irritate the skin. This type of colostomy surgery is the least common.
- Transverse. This surgery may have one or two openings in the upper abdomen, middle, or right side that are created from the transverse colon. If there are two openings in the stoma, (called a double–barrel colostomy) one is used to pass stool and the other, mucus. The stool has passed through the ascending colon, so it tends to be liquid to semi-formed.
- Descending or sigmoid. In this surgery, the descending or sigmoid colon is used to create a stoma, typically on the left lower abdomen. This is the most common type of colostomy surgery and generally produces stool that is semi-formed to well-formed because it has passed through the ascending and transverse colon.