Colostomy

Colostomy is a surgical procedure in which a temporary or permanent opening is created in the large intestine via the abdominal wall.

The small intestine digests the food we eat and absorbs nutrients from the food. The digested food then passes into the large intestine, which consists of two parts: the colon and rectum. The large intestine soaks up water from the undigested food and stores the waste until the next stool discharge. 

Colostomy is needed when certain conditions affect the digestive system and prevent the elimination of stool through the anus. The procedure helps in redirecting the contents of the intestine through a newly created opening (stoma) into a pouch attached to the outside of the abdomen.

This surgery may either be permanent or temporary. Some injuries or infections require a temporary colostomy to allow the large intestine to rest till it recovers. On the contrary, serious and incurable conditions such as cancer require the removal of a part of the large intestine, thus necessitating a permanent colostomy.

Your surgeon may recommend a colostomy if you are unable to empty your bowels or have had surgery to remove your intestines (a part or whole of it) due to any of the following conditions:

• Bowel cancer: Symptoms of bowel cancer are:

  • Recurrent pain or discomfort in the lower abdomen
  • A constant presence of blood in stool
  • Persistent bloating (accumulation of gas in the abdomen and intestines leading to swollen tummy)
  • Repeated changes in bowel movements
• Diverticulitis: Symptoms of diverticulitis are:
  • Diarrhoea
  • Constipation
  • Pain occurring in the bottom left region of the abdomen
  • Occasional presence of blood in your stool
• Vaginal/cervical cancer: The common symptoms of vaginal and cervical cancer are:
  • Unpleasant discharge from the vagina
  • Irregular bleeding
  • Bleeding after sex
  • Discomfort/pain during sex
• Anal cancer: Few symptoms of anal cancer are:
  • Bleeding from the anus
  • Mucus discharge from the anus
  • Inability to control bowel movement
  • Presence of small lumps near the anus
• Hirschsprung’s disease: Symptoms of this rare condition are:
  • Swollen abdomen
  • Difficulty in gaining weight
  • Abdominal pain
  • Constipation that persists even after treatment
• Crohn’s disease: The main symptoms of Crohn’s disease are:
  • Blood in your stool
  • Loss of weight 
  • Abdominal pain and cramps
  • Diarrhoea
• Bowel incontinence: Some of the signs and symptoms of bowel incontinence are:
  • Uncontrollable or instant urge to empty your bowel
  • Accidental leakage of stool
  • Diarrhoea
  • Constipation

This surgery is also performed when a part of the large intestine has been operated on. It allows the operated area of the large intestine to rest (at least 12 weeks) until it recovers from the surgery.

As this surgery requires general anaesthesia, individuals with the following conditions should consult a doctor to check their eligibility for surgery:

• Pregnancy
• Smokers
• Underlying medical conditions

Lung, heart, and kidney function will also need to be evaluated prior to surgery.

You will need to discuss the following with your surgeon before the procedure:

• Your medical and surgical history
• List of prescription and over-the-counter medicines, vitamins, minerals and herbal supplements that you take.
• Inform your doctor if you are pregnant.
• Inform the doctor if you are wearing any prosthetic devices or dentures.

Your doctor will tell you the risks and complications associated with the surgery.

You should adhere to the following instructions to prepare for the surgery:

• Avoid wearing contact lenses, nail polish, valuables and jewellery to the hospital and even before surgery.
• Discontinue the intake of blood-thinning drugs such as warfarin, aspirin and ibuprofen if requested by your doctor.
• Carry loose-fitting clothes to wear at the hospital.
• Stop smoking before surgery.
• Refrain from eating/drinking at least 12 hours prior to the scheduled time of the surgery. You may be given medicine to cleanse your bowel the night prior to the surgery.

Before the surgery, the doctor will also take a blood (or urine) sample for analyses, take your medical history and perform a physical examination.

Colostomy can be performed as an open surgery or a keyhole surgery. The procedure for open surgery (colostomy) usually involves the following steps:

• You will be asked to wear a hospital gown.
• An intravenous (IV) line will be placed into your arm to give you medicines and fluids. 
• An anesthesiologist will give you general anaesthesia.
• After you have fallen asleep, you will be taken to the operating room.
• A healthcare practitioner will clean the skin over your abdomen.
• The surgeon will mark the area of your abdomen where the cut or stoma is to be made and then he/she will make a long incision/cut.
• The surgeon will create an opening/cut in your intestines and remove the diseased portion of your intestine. 
• Then, he/she will pull the healthy part of your intestine towards the abdominal wall, through the stoma and stitch the part to the stoma
• The surgeon will insert a ring into your abdominal wall to hold the intestine in a fixed position. This ring is placed either permanently or temporarily to help the skin around the surgical site of the intestine for healing.
• The surgeon will then attach a pouch over the stoma to remove the intestinal waste and close the large cuts with stitches.

In a keyhole or laparoscopic surgery, instead of a large cut, the surgeon makes several tiny cuts to insert a tiny camera and other surgical instruments to access the large intestine.

Depending on what portion of the intestine is cut, colostomy is of four types:

• Ascending colostomy: This involves cutting the right side of the colon
• Transverse colostomy: This involves the middle portion of the colon and the hole for this type is usually temporary. 
• Descending colostomy: This includes the lower left side part of the colon.
• Sigmoid colostomy: This is done on the last part of the colon and is present beyond the descending colon 

The hospital staff will move you to the recovery room after the surgery. Colostomy requires you to stay hospitalised for three to seven days or longer if it is performed as an emergency procedure or based on your condition. You can expect the following events at the hospital after surgery:

• The hospital staff will continuously monitor your vital signs.
• You will have an IV line inserted into your arm for a few days.
• The doctor may place a small tube down your stomach. This tube will help in removing the contents of the stomach and aid in the recovery of your intestines.
• There may also be a tube inserted in your bladder to drain out the urine and you may be provided with an oxygen mask to assist you in breathing.
• The dressing over the wound will be changed on a regular basis during the initial days post-surgery. It helps in keeping the wound clean and prevents infection.
• You will be allowed to start with a light diet after the removal of the tube from your stomach.
• You will start passing stool from the stoma soon after surgery.
• The sutures from the operation site will be removed in five to six days.
• You will be allowed to shower a few days after surgery. If the wound has not healed, then you will need to have a bag or covering over the stoma. You can have a shower without the bag only if the operated area has healed completely.
• During your stay at the hospital, the nurse will instruct you on how to take care of yourself and the pouch that collects the stool.

A specialist will discuss the different types of bags, skin barriers, and powder you need to use after surgery to protect your skin. Some tips on how to take care of yourself at home post-surgery are as follows. Your healthcare provider will be able to guide you in this process:

• Keep the operated area clean. You can clean the area gently with warm water and pat it dry gently.
• Change the pouch when it is filled with waste up to one-third of its volume. It is a good practice to change the pouch at least once in three to four days.
• You need to irrigate the stoma with water (putting in water through the stoma to flush out the bowels) occasionally to prevent constipation.
• Avoid smoking/drinking.
• Dietary changes: The following dietary changes are required during the recovery period:
  • Avoid drinking through straw or chewing gum to prevent gas formation. Eating small meals frequently is a good practice.
  • In addition, you must also restrict the consumption of food such as onions, beans, cabbage and fizzy drinks.
  • Using anti-flatulent medicines or charcoal tablets will help in reducing the odour.
  • You must limit or restrict foods that could produce a strong odour, such as eggs, onions, fish, asparagus and cheese.
  • You will be free from any dietary restrictions once you have completely recovered from the surgery.
• Activities such as lifting heavy objects could place a strain on the surgical site and should be avoided.

About three months may be required for complete recovery from the surgery.

When to see the doctor?

You must contact the surgeon if you notice any of the following symptoms after surgery:

• Change in the colour or size of the opening
• Irritation in the surgical site
• Watery stools (occurring beyond five hours)
• Blocked opening
• Cramping in the abdomen (beyond two hours)
• Bleeding from the stoma
• Strange odour from the site (for more than one week)
• Cut or wound in the stoma

A colostomy is an uncomplicated surgery. However, like any other surgery, a few risks are associated with this procedure too. Some of the complications associated with this surgery are:

• Opening of the wound
• Bleeding
• Infection
• Constriction of the opening made during colostomy 
• Damage to the adjacent organs during surgery
• Complications of general anaesthesia such as allergic reaction and breathing problems
• Blockage in intestines due to formation of scar tissue
• Irritation in skin (near the surgical site or other regions)
• Bulging of the tissue or organs at the surgical site (hernia).

During the follow-up appointments, the healthcare practitioner will review your recovery, colostomy and your condition. If your colostomy is temporary, you might need a follow-up surgery to reattach the ends of the large intestine.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.