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
- 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.
Read more about reversing a colostomy.
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.
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.
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 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.
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.
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 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.