What is a colostomy?
A colostomy is surgery to create an opening for the colon, or large intestine, through
the belly (abdomen). A colostomy may be short-term (temporary) or lasting (permanent).
It's often done after bowel surgery or injury. Most permanent colostomies are "end
colostomies," while many temporary colostomies bring the side of the colon up to an
opening in the abdomen.
During an end colostomy, the end of the colon is brought through the abdominal wall.
Then it may be turned under, like a cuff. The edges of the colon are then stitched
to the skin of the abdominal wall to form an opening called a stoma. Stool drains
from the stoma into a bag or pouch attached to the abdomen. In a temporary "loop colostomy,"
a hole is cut in the side of the colon and stitched to a matching hole in the abdominal
wall. This can be more easily reversed later. This is done by removing the colon from
the abdominal wall and closing the holes so that stool flows through the colon again.
Why might I need a colostomy?
Colostomy surgery may be needed to treat several different diseases and conditions.
Birth defect, such as a blocked or missing anal opening, called an imperforate anus
Serious infection, such as diverticulitis, inflammation of little sacs on the colon
Inflammatory bowel disease
Injury to the colon or rectum
Partial or complete intestinal or bowel blockage
Rectal or colon cancer
Wounds or fistulas in the perineum. A fistula is an abnormal connection between internal
parts of the body, or between an internal organ and the skin. A woman's perineum is
the area between the anus and vulva. In men it is between the anus and scrotum.
The reason for the colostomy helps the healthcare provider decide if it will be short-term
or permanent. For example, some infections or injuries require giving the bowel a
rest, then reattaching it. A permanent colostomy may be needed for a more serious
or incurable problem. This includes cancer that requires removal of the rectum, or
a failure of the muscles that control elimination.
The digestive system
A colostomy won't change the way your digestive system works. Normally, after you
chew and swallow your food, it goes through your esophagus, or swallowing tube, into
From there, it travels to your small intestine and then to your large intestine, or
colon. Hours or days later, the indigestible residue leaves the storage area of your
rectum through your anus, as stool. Stool typically stays loose and liquid during
its passage through the upper colon. There, water is absorbed from it, so the stool
gets firmer as it nears the rectum.
The ascending colon goes up the right side of your body. The stool here is liquid
and somewhat acidic, and it contains digestive enzymes. The transverse colon goes
across your upper abdomen, and the descending and sigmoid colon go down the left side
of your body to your rectum. In the left colon, the stool becomes progressively less
liquid, less acidic, and contains fewer enzymes.
Where your colon is interrupted determines how irritating to the skin your stool output
will be. The more liquid the stool, the more important it will be to protect your
abdominal skin after a colostomy.
What are the risks of the procedure?
Getting a colostomy marks a big change in your life, but the surgery itself is not
complex. It will be done under general anesthesia, so you will be asleep and feel
no pain. A colostomy may be done as open surgery, with one main cut. Or it may be
done laparoscopically, with several tiny cuts.
As with any surgery, the main risks for anesthesia are breathing problems and poor
reactions to medicines. A colostomy carries other surgical risks:
Damage to nearby organs
After surgery, risks include:
Narrowing of the colostomy opening
Scar tissue that causes intestinal blockage
Getting a hernia at the incision
How do I get ready for a colostomy?
Before surgery, discuss your surgical and postsurgical options with a doctor and
an ostomy nurse. This is a nurse who is specially trained to help colostomy patients.
It may also help to meet with an ostomy visitor. This is a volunteer who has had a
colostomy and can help you understand how to live with one. And, before or after your
surgery, you may want to join an ostomy support group. You can find out more about
such groups from the United Ostomy Associations of America or the American Cancer
If the colostomy surgery is not done as an emergency procedure, your healthcare team
will give you specific pre-surgery instructions about diet and medicines. Follow all
pre-surgery directions and contact your provider if you have questions.
What happens during the colostomy?
Depending on why you need a colostomy, it will be made in one of 4 parts of the colon:
ascending, transverse, descending, or sigmoid.
Transverse colostomy. This is done on the middle section of the colon. The stoma will be somewhere across
the upper abdomen. This type of surgery is often temporary. It's typically done for
diverticulitis, inflammatory bowel disease, cancer, blockage, injury, or a birth defect.
In a transverse colostomy, the stool leaves the colon through the stoma before reaching
the descending colon. Your stoma may have one or two openings. One opening is for
stool. The second possible stoma is for the mucus that the resting part of your colon
normally keeps producing. If you have only one stoma, this mucus will pass through
your rectum and anus.
Ascending colostomy. This goes on the right side of your abdomen. It leaves only a short part of the colon
active. It's generally done only when blockage or severe disease prevents a colostomy
further along the colon.
Descending colostomy. This goes on the lower left side of the abdomen.
Sigmoid colostomy. This is the most common type. It's placed a few inches lower than a descending colostomy.
What happens after the colostomy?
You may be able to suck on ice chips on the same day as your surgery. You'll likely
be given clear fluids the next day. Some people eat normally within 2 days after a
A normal stoma is moist and pink or red colored. When you first see your colostomy,
it may look dark red and swollen, with bruises. Don't worry. In a few weeks, the color
will lighten and bruises should disappear.
The bandage or clear pouch covering your colostomy right after surgery likely won't
be the same type that you'll use at home. Your colostomy will drain stool from your
colon into this colostomy pouch or bag. Your stool will probably be more liquid than
before surgery. Your stool consistency will also depend on what type of colostomy
you have and how much of your colon is still active.
In the hospital
A colostomy requires a hospital stay of about 3 days to a week. Your stay will probably
be longer if the colostomy was done for an emergency. During your hospital stay, you'll
learn to care for your colostomy and the appliance or pouch that collects your stool.
Your nurse will show you how to clean your stoma. After you go home, you'll do this
gently every day with warm water only. Then gently pat dry or allow the area to air
dry. Don't worry if you see a little bit of blood.
Use your time in the hospital to learn how to care for your colostomy. If you have
an ascending or transverse colostomy, you will need to wear a slim, lightweight, drainable
pouch at all times. There are many different types of pouches, varying in cost and
made from odor-resistant materials.
Some people with a descending or sigmoid colostomy can learn over time to predict
when their bowels will move and wear a pouch only when they expect a movement. They
may also be able to master a process called irrigation to stimulate regular, controlled
Before going home, talk with an ostomy nurse or other expert who can help you try
out the equipment you'll need. What works best will depend on what type of colostomy
you have, the length of your stoma, your abdominal shape and firmness, any scars or
folds near the stoma, and your height and weight.
Sometimes the rectum and anus must be surgically removed, leaving what's called a
posterior wound. In the hospital, you'll use dressings and pads to cover this wound.
You may also take sitz baths--shallow, warm-water soaks. Ask your doctor and nurse
how to care for your posterior wound until it heals. If problems occur, contact your
The skin around your stoma should look the same as elsewhere on your abdomen. Exposure
to stool, especially loose stool, can be irritating. Here are some tips to protect
Make sure your pouch and skin barrier opening are the right size.
Change the pouch when it is about1/3 full to avoid leakage and skin irritation. Don't
wait until your skin begins to itch and burn.
Remove the pouching system gently, pushing your skin away instead of pulling.
Barrier creams may be used if the skin becomes irritated despite these measures.
Tell your doctor if you have any of these:
Severe cramps that last more than 2 hours
Blocked stoma or stoma collapse
Excessive bleeding from the stoma or a moderate amount of blood in the pouch (Note:
eating beets will lead to some red discoloration in the stool)
Severe injury or cut to the stoma
Ongoing skin irritation
Continuous nausea or throwing up
Bad or unusual odor for more than a week
Change in your stoma size or color
Blocked or bulging stoma
Bleeding from the stoma opening or in the pouch
Wound or cut in the stoma
Serious skin irritation or sores
Watery stool for more than 5 hours
Inability to wear the pouch for 2 to 3 days without leaking
Anything unusual that concerns you
A good rule is to empty your pouch when it's 1/3 to half full. And change the pouch
before it leaks. Different pouching systems are made to last different lengths of
time, anywhere from every day to every week. Ask your healthcare team about what financial
resources may be available if you need help paying for colostomy supplies.
A colostomy represents a big change, but you will soon learn to live with it. Even
though you can feel the pouch against your body, no one else can see it. Don’t feel
the need to explain your colostomy to everyone who ask. Only share as much as you
For some people and their immediate family members, a colostomy causes emotional issues.
Ask for mental health resources if you or your immediate family is having a hard time
adjusting to the surgery. Don’t feel you have to explain your colostomy to everyone
who asks. A short explanation would simply be that you had abdominal surgery. Think
about joining a support group to help adjust to the colostomy. Your ostomy nurse or
healthcare team can provide support group resources.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure