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Colostomy

This page was reviewed under our medical and editorial policy by

Katherine Poruk, MD, Surgical Oncologist.

This page was updated on June 23, 2022.

Your colon, the link between your small intestine and rectum, digests food and absorbs the necessary nutrients and water. After food passes through the colon, what remains becomes waste to be eliminated through the rectum and anus.

If you have cancer and part of your colon is blocked, damaged or has to be removed, you may need to undergo a colostomy. During this surgery, the doctor will make an opening from the large intestine to the exterior of your abdomen. Called a stoma, this opening may be temporary or permanent. After this procedure, instead of passing through the rectum, your body’s waste and gas exit through the stoma, where it’s collected in a removable pouch, sometimes called a colostomy bag.

The portion of your colon and rectum beyond the site of your colostomy may or may not be removed.

Why a colostomy may be done

If you have colorectal cancer and all or part of your colon or rectum needs to be removed, you will have a surgery called a colectomy. If you have a colectomy or your colon becomes severely blocked due to the growth of cancerous tumors, you may need to also have a colostomy.

If the ends of your colon cannot be reattached, a permanent colostomy is performed. Some cancer-related colostomies are temporary. In instances where your colon simply needs time to heal, the colostomy is reversed two to six months post-operation during a surgical procedure called a colostomy reversal.

If the tumor involves the lower portion of the rectum or the anus, you may undergo a procedure known as an abdominoperineal resection, which removes the entire anus and rectum. In such situations, the colon cannot be reconnected, so you'll be left with a permanent colostomy.

Types of colostomies

If you have cancer, the type of colostomy depends on its location. The higher the colostomy site, the shorter your remaining colon. The name of each colostomy type is based on its location.

Transverse colostomy

This type of colostomy is located in the upper abdominal region, on the right side or the middle of the body. Transverse colostomies are usually performed on a temporary basis, but they may also be permanent.

Doctors will choose a transverse colostomy if the lower half of the bowel needs a rest or to be permanently bypassed.

Sigmoid colostomy

Located at the bottom of the large intestine, sigmoid colostomies are the most common. Because of its location near the rectum, there is still some functioning colon, so the waste produced is firmer and more normal in consistency than with other colostomy types. As with a descending colostomy, single-barrel is more common, though a double-barrel procedure is also a possibility. A loop-sigmoid colostomy is also a possibility.

Descending colostomy

This surgery is performed when the blockage or cancer is located on the lower left side of the abdomen (or descending colon). In this surgery, the stoma placement results in waste close to normal in firmness because it’s already traveled through most of the colon.

Ascending colostomy

Located on the right side of your abdomen, this type of colostomy is rare. During this procedure, most of your colon will likely be removed, so waste is liquid with this stoma.

How is a colostomy surgery performed?

Patients are asleep and under general anesthesia. The surgeon makes a large cut in the abdomen so that one end of the colon can be placed through the hole and attached to a stoma on the abdomen. The surgeon then attaches a colostomy bag to the stoma.

The surgeon removes the cancerous part of the colon and a small segment on either side of the diseased colon. Typically, about a quarter to a third of the colon is surgically removed. How much is removed depends on the size and location of the cancer. The sections of colon that remain are then reattached. In rare cases, the entire colon is removed if other conditions, such as hundreds of polyps or inflammatory bowel disease (IBD), make it necessary. At least 12 lymph nodes nearby will be also removed and sent to the pathology lab to look for signs of cancer.

It’s possible, in some cases, for the surgery to be performed laparoscopically. In this case, the surgeon will make several small incisions in the stomach to reach the colon and attach it to the stoma. The surgeon uses a laparoscope, which is a long tube that has a camera and light on its end. The laparoscope enables the surgeon to see inside the abdomen and insert additional instruments to be able to remove part of the colon and lymph nodes.

There are three types of transverse colostomies:

Loop colostomy: A loop colostomy results in two stomas, one that releases waste from the colon and another, called a mucus fistula, that releases mucus from the part of the colon that is still active.

Single-barrel colostomy: A single-barrel colostomy, which is permanent, may involve the removal of the colon below the surgical site, as well as the rectum and anus. You may need a permanent colostomy if the cancer is advanced.

Double-barrel colostomy: In a double-barrel colostomy, the bowel is usually divided into two parts, each with a separate opening. Similar to the loop colostomy, one releases waste and the other releases mucus. However, in some cases, only one stoma is created, and mucus leaves the body through the anus.

How to prepare for a colostomy

In addition to a physical exam, your doctor may order one or more of the following tests to assess your overall health prior to surgery:

  • Blood tests
  • Urinalysis
  • Chest X-ray
  • Electrocardiogram (ECG)
  • Other imaging tests

Your doctor will discuss any preoperative instructions, including whether you need to fast or follow a special diet.

Any surgery to the colon requires that your colon be clean. Your doctor will instruct you on the required bowel preparation protocol. Typically, you will be asked to take specific liquid laxatives in combination with enemas to clear the colon of all stool. If the surgery is being performed on an emergency basis, you may not have time or be required to undergo a bowel preparation.

What to expect during a colostomy

Immediately before your colostomy surgery, your care team will meet with you to discuss the procedure and mark the incision spot. Most of the time, the mark is made by a wound care specialist who specializes in identifying the best spot for an ostomy. The area, which may need to be shaved, will be cleaned with an antiseptic to decrease infection risk.

Next, an anesthesiologist administers general anesthesia to put you into a deep sleep for the duration of the surgery, and an endotracheal (ET) tube is inserted into your throat to allow you to breathe.

During the procedure, your surgeon attaches the end of your remaining colon to the exterior of your abdomen, creating a stoma for waste to leave your body. Finally, a temporary colostomy bag or pouch is placed over the stoma. 

After the surgery, you’re likely to remain in the hospital for two to five days, although it may take as many as two months for you to recover fully at home.

During your hospital stay:

  • Your doctor checks for signs that your digestive tract is working by verifying that the ostomy is producing stool and gas.
  • You’re encouraged to move around to promote circulation and improve wound healing.
  • You may be asked to perform breathing exercises.
  • At first, your diet is limited to clear foods and liquids; when the digestive tract is functioning again, expect to eat very specific foods as instructed by your doctor.
  • Your care team teaches you how to properly use colostomy bags or pouches, as well as how to keep your stoma clean.

Colostomy benefits and risks

Temporary colostomies allow infected, inflamed, damaged, cancerous or recently operated areas of your bowel time to heal—a process that may take weeks or years, depending on your situation.

Permanent colostomies are necessary when a portion of your bowel is permanently inactive or is removed, so that waste is still able to leave your body.

Risks associated with colostomy surgery include:

  • Bleeding
  • Damage to surrounding structures
  • Infection
  • Blockage
  • Bleeding from your new stoma
  • Hernia at the stoma site
  • Need for revision of the stoma due to narrowing

Colostomy results

After your colostomy, the surgical site may be covered with bandages and a temporary pouch. It’s normal to have bleeding or bruising in the area.

Over the course of a few weeks as your stoma heals, it shrinks, eventually becoming moist with a pinkish or red color.

You should consult with your care team immediately if you experience any of the following:

  • Cramping for more than two hours
  • Ongoing nausea and vomiting
  • No waste output for more than four hours, plus nausea and cramping
  • Extremely watery output for more than five hours
  • Bad odor for longer than one week
  • Cut or other injury in your stoma, including bleeding that doesn’t stop
  • Major skin irritation or sores around your colostomy
  • Moderate amount of blood in your pouch
  • Changes in size or color of your stoma, or other unusual changes

With your new colostomy, you won’t be able to control when you pass waste or gas, so you’ll need to wear a drainable pouching system over your stoma in order to contain the output. The consistency of your stool depends on the type of colostomy you’ve had, but what you eat may affect it as well.

With a transverse colostomy, your body releases waste regularly and you won’t be able to control the timing, but with sigmoid or descending colostomies, you may find that your body removes waste at regular times, making it easier to manage. Sometimes, eating specific foods on a certain schedule allows you to control the timing of your bowel movements.

With any colostomy, you may have several bowel movements a day, or you may only have a bowel movement once every few days; either is normal.

Types of colostomy pouches

The type of pouching system you choose is unique to you, so consult with your care team for help in finding the best option.

In one-piece systems, the pouch and the adhesive skin barrier that adheres it to your skin are one continuous unit.

Two-piece pouching systems have a skin barrier distinct from the pouch, so even when you change or clean the pouch, the barrier stays intact.

Whatever type of pouching system you decide to use, be sure it has the following features:

  • Accessibility: Your pouch should be fairly easy to put on and change.
  • Security: Your pouch should stay in place with a strong seal that won’t leak.
  • Privacy: Your pouch should be hard to see under your clothing.
  • Convenience: If you’d like to be able to bathe with it on, make sure the pouching system allows for this.
  • Odor-controlling: Pouches have different features for managing odor, so choose one that works best for you.

Living with a colostomy

Once you learn how to properly care for and protect your stoma, and you find a pouching system that works well for you, it’s possible to live a normal life—partaking in activities you enjoy.

Still, you’ll need to make some adjustments when it comes to daily tasks such as bathing and eating.

  • Bathing: You’ll be able to shower and bathe normally. Regular soap and water won’t hurt your stoma, but it may cause the skin barrier of your pouching system to disconnect, so try to only use soap on the area around it. It’s a good idea to leave your pouch in place when showering or bathing because you won’t be able to control your waste output.
  • Clothing: Because most colostomy pouches are designed to be invisible, you don’t need to invest in customized clothing. In most cases, normal waistbands don’t cause any issues with your stoma. You may choose to use supportive undergarments in order to feel more secure and comfortable.
  • Diet: You may experience excessive gas from your stoma, so it helps to take certain steps.
    • Avoid gas-producing foods such as:
      • Eggs
      • Legumes
      • Certain leafy vegetables
      • Dairy products
      • Carbonated beverages
      • Alcohol
    • Eat smaller amounts at regular intervals four to five times a day. It’s important not to avoid eating.
  • Odor control: You may experience body odor, which may be worsened by foods such as:
    • Coffee
    • Garlic
    • Dairy
    • Fish
  • Odor-controlling pouches are available to help with this issue, as are deodorant liquids and tablets that you place directly into your pouch. Regularly emptying your pouch and ensuring the skin barrier is firmly in place also may help. Ask your doctor about specific medications to reduce odor.
  • Activity: You’re still able to participate in many of the activities you enjoyed before your colostomy, but consult with your doctor first. If you swim, you may use waterproof tape to hold your pouch in place, choosing a bathing suit that disguises the pouch. You should be able to travel normally, too. Whether you’re engaging in a sport or traveling, be sure you have plenty of extra supplies.

Though you may experience other concerns after surgery, these may be managed. For example:

  • You may find undigested medication in your stool, which means it wasn’t absorbed properly. If this happens, ask about switching to a liquid version.
  • The skin around your colostomy may become irritated (red, sore or wet), preventing your pouch from sealing properly. There are medications you may be able to take to help heal the irritation.
  • You may experience a blockage, causing cramping, pain or nausea. If this happens, drink fluids and take a warm bath, or try changing your position, but don’t eat solids or take laxatives. It’s best to consult with your doctor.
  • You may develop diarrhea, which is a sign something is wrong. Diarrhea quickly causes electrolyte imbalances or dehydration. Contact your doctor right away if you’re experiencing continuous diarrhea.
  • Some patients experience a phantom rectum, the sensation that they need to have a bowel movement. It may help to sit on the toilet. Sometimes when this happens, you may pass mucus. This is normal.
  • If you’ve had a large portion of your small intestine removed, you may experience short bowel syndrome, requiring you to remain under the care of your doctor to be sure you’re getting the proper intake of nutrients. You may also need to watch out for diarrhea.

Though getting used to life with a colostomy may be a big adjustment, it’s still possible to live a healthy, happy life.

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