Overview-Colostomy
A colostomy is an operation to divert one end of the colon (part of the bowel) through an opening in the tummy.
The opening is called a stoma. A pouch can be placed over the stoma to collect your poo (stools).
A colostomy can be permanent or temporary.
When a colostomy is needed
A colostomy may be needed if, as the result of an illness, injury or problem with your digestive system, you can't pass stools through your anus.
You may have a colostomy to treat:
- bowel cancer
- Crohn's disease
- diverticulitis
- anal cancer
- vaginal cancer or cervical cancer
- bowel incontinence
- Hirschsprung's disease
A colostomy is often used after a section of the colon has been removed and the bowel can't be joined back together.
This may be temporary and followed by another operation to reverse the colostomy at a later date, or it may be permanent.
How a colostomy is carried out
A colostomy is carried out under general anaesthetic, using either:
- open surgery (laparotomy) – where a long cut (incision) is made in the tummy to access the colon, or
- laparoscopic (keyhole surgery) – where the surgeon makes several smaller incisions and uses a tiny camera and surgical instruments to access the colon
Generally, keyhole surgery is the preferred option because recovery is quicker and the risk of complications is lower.
There are two main types of colostomy: a loop colostomy and an end colostomy. The specific technique used will depend on your circumstances.
A loop colostomy is often used if the colostomy is temporary as it's easier to reverse.
Loop colostomy
In a loop colostomy, a loop of colon is pulled out through a cut in your tummy. The loop is opened up and stitched to your skin to form an opening called a stoma.
The stoma has two openings that are close together. One is connected to the functioning part of your bowel, where waste leaves your body after the operation.
The other opening is connected to the "inactive" part of your bowel, leading to your rectum.
In some cases, a support device (a rod or bridge) may be used to hold the loop of colon in place while it heals. It's usually removed after a few days.
End colostomy
With an end colostomy, one end of the colon is pulled out through a cut in your tummy and stitched to the skin to create a stoma.
An end colostomy is often permanent, but temporary end colostomies are sometimes used in emergencies to treat bowel obstructions, colon injuries or bowel cancer.
The stoma
The position of the stoma will depend on the section of your colon that's diverted, but it's usually on the left-hand side of your tummy, below your waist.
If the operation is planned in advance, you'll meet a specialist stoma nurse to discuss the positioning of the stoma.
The stoma will be red and moist and may bleed slightly, particularly in the beginning – this is normal. It shouldn't be painful as it doesn't have a nerve supply.
Stomas can vary in shape and size – some are fairly flat, while others protrude slightly.
Recovering from a colostomy
After having a colostomy, you'll need to recover in hospital for a few days.
You may have:
- a drip in your vein to provide fluids
- a catheter to drain urine from your bladder
- an oxygen mask to help you breathe
A clear colostomy bag will be placed over the stoma so it can be easily monitored and drained. The first bag is often quite large – it'll usually be replaced with a smaller bag before you go home.
Stoma nurse
While you recover in hospital, a stoma nurse will show you how to care for your stoma, including how to empty and change the bag.
The nurse will teach you how to keep your stoma and surrounding skin clean and free from irritation, and give you advice about preventing infection.
They'll also explain the different types of equipment available and how to get new supplies.
When you leave hospital, a local stoma nurse will visit you at home, or you may be asked to go to a stoma care clinic.
Going home
Most people are well enough to leave hospital 3 to 10 days after having a colostomy.
Once home, avoid strenuous activities that could place a strain on your abdomen, such as lifting heavy objects.
Your stoma nurse will give you advice about how soon you can go back to normal activities.
In the first few weeks after your operation, you may have more wind than usual (flatulence), and a discharge from your stoma.
This should start to improve as your bowel recovers from the effects of the operation.
Living with a colostomy
Adjusting to life with a colostomy can be challenging, but most people get used to it in time.
You may be concerned that your day-to-day activities will be restricted and other people will notice you're wearing a colostomy bag.
Modern colostomy equipment is discreet and secure, and you should be able to do most of the activities you enjoyed before without experiencing the symptoms that made the colostomy necessary in the first place.
Your specialist stoma nurse will be able to give you further support and advice to help you adapt to life with a colostomy.
Colostomy UK
Colostomy UK provides support, reassurance and practical advice to anyone who's had, or is about to have, stoma surgery.
Their website has information about products you may find useful, and also provides details of stoma support groups in your area.
Reversal-Colostomy
If you have a temporary colostomy, you'll need another operation to reverse it at a later date.
A colostomy reversal will only be carried out when you're in good health and have fully recovered from the effects of the initial operation. This will usually be at least 12 weeks after the initial colostomy surgery.
The reversal may need to be delayed for longer if you need further treatment, such as chemotherapy, or you haven't recovered from the original operation.
But there's no time limit for having a reversal, and some people live with their colostomy for several years before it's reversed.
How a colostomy reversal is carried out
Reversing a loop colostomy is a relatively straightforward process. A cut (incision) is made around the stoma so the surgeon can access the inside of your abdomen.
The upper section of your colon is then reattached to the remaining section of your colon.
An end colostomy can also be reversed, but involves making a larger incision so the surgeon can locate and reattach the two sections of colon.
It also takes longer to recover from this type of surgery and there's a greater risk of complications.
Recovering from a colostomy reversal
Most people are well enough to leave hospital 3 to 10 days after having colostomy reversal surgery.
It's likely to take some time before your bowel movements return to normal. Some people have constipation or diarrhoea, but this usually gets better with time.
You may have a sore bottom after the reversal, but this should improve as you get used to passing stools through your anus again.
After every bowel movement, it may help if you:
- wash the skin around your anus with warm water
- pat it dry with a soft cloth
- apply a barrier cream
Avoid using baby wipes, talcum powder or scented toilet tissues as they can cause further irritation.
Other possible problems include needing to go to the toilet more often or more urgently than usual, excessive wind (flatulence), and some bowel incontinence or leakage.
Although a colostomy reversal is usually a smaller procedure than the initial colostomy operation, it still takes several weeks to recover and return to normal activities.
What to eat after a colostomy reversal
Your digestive system may be sensitive after a colostomy reversal. It may help to avoid eating large meals and eating late at night, and to eat little and often.
Certain foods are also more likely to irritate the gut.
It may help to limit or avoid:
- citrus fruits – such as grapefruits and oranges
- spicy food – such as curries
- large fatty meals
- vegetables that increase flatulence – such as cabbage and onions
- large amounts of alcohol or fizzy drinks
Living with-Colostomy
Adjusting to a colostomy can be difficult at first, but it doesn't mean you can't enjoy a full and active life.
Modern colostomy equipment is discreet and secure, and you should be able to do most of the activities you enjoyed before.
Colostomy bags and equipment
A colostomy bag is often used to collect your poo (stools). It needs to be removed and replaced when full, usually one to three times a day.
There are also drainable bags that only need to be replaced every one or two days. These may be suitable for people who have particularly loose stools.
A specialist stoma nurse, who usually sees you before and after the colostomy operation, will help you choose the most suitable colostomy equipment.
There's a wide range of colostomy appliances available, including:
- a one-piece pouch – the bag and flange (part that sticks to your skin) are joined together; the appliance is removed when full and then disposed of
- a two-piece pouch – the bag and flange are separate, but can be connected; the flange can be left on your skin for several days, and the bag removed and disposed of several times a day
Colostomy appliances are made from non-allergic (hypoallergenic) materials to reduce skin irritation. They also contain special filters to prevent any unpleasant odours.
If you have regular and predictable bowel patterns, you may not always need to wear a colostomy bag. But as occasional leakages can happen, it's recommended that you wear a small stoma cap.
Additional products that can make living with a colostomy more convenient include:
- support belts and girdles
- deodorisers that can be inserted into your appliance
- protective skin wipes
- sprays to remove adhesive
- protective stoma rings
- specially designed underwear and swimwear
Your stoma care nurse will be able to give you more information and advice about equipment.
Ordering supplies
You'll be given an initial supply of colostomy appliances, as well as your prescription information, before you leave hospital. You can get further prescriptions from your GP.
Your prescription can either be taken to the chemist or sent to a specialist supplier, who will deliver the products.
You won't have to pay prescription charges for permanent colostomy equipment. But you'll have to pay prescription charges for a temporary colostomy, unless you're over 60 or being treated for cancer.
If you have to pay prescription charges, it'll probably be more cost-effective for you to buy a prescription prepayment certificate (PPC), which entitles you to a discount on repeat prescriptions.
Colostomy irrigation
Irrigation is an alternative to wearing a colostomy appliance. It involves washing out your colon with water either every day or every other day.
To do this, you gently insert a small device into your stoma and attach it to a bag full of water.
You slowly move water into your colon so it washes it out. The equipment is then disposed of once the process is complete. A cap is used to cover your stoma in between irrigations.
Advantages of irrigation include:
- you choose when you want to perform irrigation
- you don't have to wear a colostomy appliance (but may have to wear a small cap)
- you should be able to enjoy a more varied diet
- you should have less gas (flatulence)
Disadvantages of irrigation include:
- it's a time-consuming process that takes 45 to 60 minutes to complete, usually on a daily basis
- for the best results, irrigation should be carried out at the same time every day, which may be difficult when you're away from home on holiday or with work
Irrigation isn't always possible. For example, it's not suitable for people with Crohn's disease or diverticulitis, or if you're having radiotherapy or chemotherapy.
Irrigation probably isn't advisable for young children as it's quite time-consuming.
Diet
In the first few weeks after having a colostomy, you'll probably be advised to have a low-fibre diet.
This is because a high-fibre diet can increase the size of your stools, which can temporarily block your bowel. After around eight weeks, you'll usually be able to go back to a normal diet.
As you recover, you can start to eat a healthy, balanced diet that includes plenty of fresh fruit and vegetables.
You should be able to return to the diet you previously enjoyed. If you previously had a restricted diet, you should be able to reintroduce the restricted foods.
Smell and wind
Many people worry that their colostomy will give off a smell that others will notice.
All modern appliances have air filters with charcoal in them, which neutralises the smell.
Most people will be aware of the smell of their colostomy because it's their own body. But someone standing next to you won't be able to smell the stoma.
You'll have more wind than usual immediately after having a colostomy, but this will slowly reduce as your bowel recovers.
Your stoma nurse can advise you about products you can use to help reduce any smell and give you dietary advice to reduce wind.
Medication
Many medicines are designed to dissolve slowly in your digestive system. Having a colostomy shouldn't alter the effectiveness of your usual medication.
If you notice any tablets in your appliance, tell your pharmacist or GP, who will recommend an alternative medication.
Exercise
In the weeks after surgery, some gentle exercise is usually recommended to help recovery.
How well you recover will determine how much exercise you can do. If you feel any pain, stop immediately.
Once you've recovered from the operation, you should gradually be able to return to your previous exercise routine.
Most types of exercise are possible with a stoma, including swimming, as all colostomy bags are waterproof.
Colostomy UK has more information about sport and exercise after a colostomy.
Work
Once your bowel has healed, there's no reason why you can't return to work.
If your job is particularly strenuous and involves a lot of heavy lifting, you may need to wear a support belt or girdle. Your stoma nurse can advise you about this.
It's likely to take several months before you're ready to return to work. It depends on how well you recover and the type of work you do.
You may find it very tiring when you return, so to start with it may be possible for you to work fewer hours than normal and do lighter duties.
Discuss the potential options with your employer before having the operation.
You don't have to tell your work colleagues about your colostomy unless you want to. Some people find it's a good idea to tell one person in the workplace in case they need any support or advice.
Travel
There's no reason why you can't travel after having a colostomy, but you'll probably need to plan extra time into your journey.
Most stoma companies have a small information leaflet you can carry with you at all times, available in several different languages.
One essential item for people with a colostomy is a RADAR key. This gives you access to public disabled toilets so you can change your colostomy appliance when you need to.
You can get a RADAR key by contacting Colostomy UK.
Sex
There are several practical issues that could have an impact on your sex life and your relationships.
Women
Women who've had their rectum removed may find having sex in the traditional "missionary position" painful because the rectum supports the vagina during sex. Trying different positions may help.
After surgery, many women find their vagina is much drier, which can make sex uncomfortable. Applying a lubricating jelly before sex may help.
Having weight placed on your stoma during sex can be painful, so you may want to avoid positions that could cause pain. Alternatively, you could protect the stoma with a cushion or pillow.
Your stoma nurse can give you more advice.
Men
Having a colostomy can affect the blood supply and nerve endings to the penis. This can make it difficult to get or maintain an erection (erectile dysfunction).
There are many treatments for erectile dysfunction, including a medication called sildenafil (Viagra), which helps increase blood supply to the penis.
Other sex-related issues
As well as the practical issues, you may be concerned about body image, self-confidence and how your partner may react to your colostomy, which can also have an impact on your sex life.
It's important to stress that many people with a colostomy enjoy a good sex life, but it can take several months to build up the confidence and trust to make this possible.
If you have a long-term partner, you may want to see whether they'd like to look at your stoma and colostomy equipment.
Some people want to take an interest, but others find it too upsetting, at least in the short term. There's no right or wrong way to react, so try not to take a refusal as a personal rejection.
If the appearance of your stoma and colostomy equipment is off-putting during sex, you can always cover them.
Other tips that may improve your sex life include:
- changing your appliance before having sex
- changing your appliance to a small stoma cap before having sex
- covering the appliance if the feel of the appliance against your skin is a distraction
- keeping your sense of humour
You should avoid having anal sex (if the rectum hasn't been removed) after a colostomy because it can cause painful tearing and bleeding. Speak to your stoma nurse for more information and advice about this.
Complications-Colostomy
There are a number of possible problems you may experience after having a colostomy.
Rectal discharge
If you've had a colostomy but your rectum and anus are intact, you may have some mucus discharge from your bottom. Mucus is produced by the lining of the bowel to help the passage of stools.
The lining of the bowel continues producing mucus, even though it no longer serves any purpose. The longer the remaining section of your bowel, the more likely you are to have rectal discharge.
The mucus can vary, from a clear "egg white" to a sticky, glue-like consistency. It can either leak out of your bottom or build up into a ball, which can become uncomfortable.
Some people have rectal discharge every few weeks, while others have several episodes a day.
Contact your GP if there's blood or pus in the discharge – it may be a sign of infection or tissue damage.
Managing the discharge
You may find it helps if you sit on the toilet every day and push down as if passing a stool. This should remove any mucus and stop it building into a ball.
But some people find this difficult because surgery can reduce the sensation in the rectum. Contact your GP if this is the case, as you may need further treatment.
Glycerine suppositories that you insert into your bottom can often help. When the capsules dissolve, they make the mucus more watery, so it's easier to get rid of.
The mucus can sometimes irritate the skin around your bottom. Using a barrier skin cream should help. You may need to try a few before you find one that works for you. Ask your pharmacist for advice.
Some people find that eating certain foods increases mucus production. While there's no scientific evidence to support this, you may want to try keeping a food diary for a few weeks to see whether certain foods could be linked to an increase in mucus production.
Parastomal hernia
A parastomal hernia is where the intestines push through the muscles around the stoma, resulting in a noticeable bulge under the skin.
To reduce your risk of getting a parastomal hernia:
- wear a support garment (belt or underwear)
- avoid heavy lifting and straining
- maintain a healthy weight – being overweight can place additional strain on your abdominal muscles
A parastomal hernia isn't usually painful, but it may be more difficult to hold the colostomy appliance in place and change it.
Most hernias can be managed with the help and support of your stoma nurse. In some cases, surgery may be needed to repair the hernia. But the hernia can come back, even after surgery.
Stoma blockage
Some people develop a blockage in their stoma as the result of a build-up of food.
Signs of a blockage include:
- not passing many stools, or passing watery stools
- bloating and swelling in your tummy
- tummy cramps
- a swollen stoma
- nausea or vomiting, or both
If you think your stoma is blocked, you should:
- avoid eating solid food for the time being
- drink plenty of fluids
- massage your tummy and the area around your stoma
- lie on your back, pull your knees up to your chest, and roll from side to side for a few minutes
- take a warm bath for 15 to 20 minutes to help relax your tummy muscles
When to get medical help
After trying these steps, if there's no improvement within two hours, you should contact your GP or stoma nurse immediately as there's a risk your colon could burst.
Preventing a blockage
To reduce your risk of developing a stoma blockage:
- chew your food slowly and thoroughly
- drink plenty of fluids
- avoid eating large amounts of food at one time
Also, avoid eating foods known to cause blockages, such as corn, celery, popcorn, nuts, coleslaw, coconut macaroons, grapefruit, dried fruit, potato skins, apple skins, orange pith, and Chinese vegetables like bamboo shoots and water chestnuts.
Other complications
Other problems you can have after a colostomy include:
- skin problems – where the skin around the stoma becomes irritated and sore; your stoma care team will explain how to manage this
- stomal fistula – where a small channel or hole develops in the skin alongside the stoma; depending on the position of the fistula, appropriate bags and good skin management may be all that's needed to treat this problem
- stoma retraction – where the stoma sinks below the level of the skin after the initial swelling goes down, which can lead to leakages because the colostomy bag doesn't form a good seal; different types of pouches and appliances can help, although further surgery may sometimes be needed
- stoma prolapse – where the stoma comes out too far above the level of the skin; using a different type of colostomy bag can sometimes help if the prolapse is small, although further surgery may be required
- stomal stricture – where the stoma becomes scarred and narrowed; further surgery may be needed to correct it if there's a risk of blockage
- leakage – where digestive waste leaks from the colon on to the surrounding skin or within the abdomen; trying different bags and appliances may help an external leak, but further surgery may be needed if the leak is internal
- stomal ischaemia – where the blood supply to the stoma is reduced after surgery; further surgery may be needed