Let's Talk Colostomy


co·los·to·my
kəˈlästəmē/ 


noun
noun: colostomy; plural noun: colostomies
a surgical operation in which a piece of the colon is diverted to an artificial opening in the abdominal wall so as to bypass a damaged part of the colon.

Why might someone need a Colostomy?

  • Cancer - Colon and Rectal Cancer are the most prominent reasons one might need an ostomy.
  • Diverticulitis
  • Perforated bowel
  • Bowel obstruction
  • Crohn’s disease
  • Ulcerative colitis
  • Birth defects/Congenital Conditions
  • Accidental injury/Trauma

In some cases, rather than to save life, the reason may be to improve the quality of life, for example in those who suffer from:
  • Incontinence
  • Chronic constipation
  • Spinal injury
  • MS
  • Spina Bifida

Types of Colostomies:

      
Ascending Colostomy: The ascending colostomy is located on the right side of the abdomen. The discharge is very liquid. A drainable pouch is worn for colostomies of this type. This type of stoma is rarely used since an ileostomy is a better stoma when the discharge is liquid. When a colostomy is located in the right half of the colon, only a short portion of colon remains.


Transverse Colostomy:   The transverse colostomy is in the upper abdomen, either in the middle or toward the right side of the body. Diverticulitis, inflammatory bowel disease, cancer, obstruction, injury or birth defects can lead to a transverse colostomy. This type of colostomy allows stool to exit the colon before it reaches the descending colon.

When conditions such as those listed are present in the lower colon, it may be necessary to give the affected portion of the colon a rest. A transverse colostomy may be created for a period of time to prevent stool from passing through the area of the colon that is inflamed, infected, diseased or newly operated on, thus allowing healing to occur. Such a colostomy is usually temporary. Depending on the healing process, the colostomy may be necessary for a few weeks, months, or even years. Eventually given your good health, the colostomy is likely to be closed and normal bowel continuity restored.

A permanent transverse colostomy is made when the lower portion of the colon must be removed or permanently rested. This may also be the case if other health problems make it unwise for the patient to have further surgery. Such a colostomy provides a permanent exit for stool and it will not be closed at any time in the future.

There are two types of transverse colostomies:
  1. Loop Transverse Colostomy: This colostomy is created by bringing a loop of bowel through an incision in the abdominal wall. The loop is held in place outside the abdomen by a plastic rod slipped beneath it. An incision is made in the bowel to allow the passage of stool through the loop colostomy. The supporting rod is removed approximately 7-10 days after surgery, when healing has occurred that will prevent the loop of bowel from retracting into the abdomen. A loop colostomy is most often performed for creation of a temporary stoma to divert stool away from an area of intestine that has been blocked or ruptured.
  2. Double-Barrel Transverse Colostomy: This colostomy involves the creation of two separate stomas on the abdominal wall. The proximal (nearest) stoma is the functional end that is connected to the upper gastrointestinal tract and will drain stool.The distal stoma, connected to the rectum and also called a mucous fistula, drains small amounts of mucus material. This is most often a temporary colostomy performed to rest an area of bowel, and to be later closed.

Descending or Sigmoid Colostomy: Located on the lower left side of the abdomen. Generally, the discharge is firm and can be regulated. The sigmoid colostomy is probably the most frequently performed of all the colostomies.

The stool of a descending or sigmoid colostomy is firmer than that of the transverse colostomy and does not have the caustic enzyme content. At this location, elimination may occur on a reflex basis at regular, predictable intervals. The bowel movement will take place after a considerable quantity of stool has collected in the bowel above the colostomy. Spilling may happen between movements because there is no anus to hold the stool back. Many people use a lightweight, disposable pouch for security. A reflex will set up quite naturally in some people. In others, mild stimulation, such as juice, coffee or food is effective for elimination. Others may prefer the irrigation method of management.


​While many descending and sigmoid colostomies can be managed to move regularly, others cannot. You must realize that satisfactory management, with or without stimulation, is likely to happen only in those people who have had regular bowel movements before they became ill. If bowel movements have been irregular in earlier years, it may be quite difficult, or impossible, to have regular, predictable colostomy function. Spastic colon or irritable bowel are conditions in which the patient may have bouts of constipation or loose stool. A person, who has had such a condition in the past, before he became ill, may not achieve regularity.
It is often said that a person must have a bowel movement every day. Actually, this varies from person to person. Some people have two or three movements a day, others have one every two or three days or even less often. You must judge by what is usual for you, not what is usual for others.  



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Colostomy Fact Sheet

Colostomy: A surgically created opening in the abdominal wall through which digested food passes.
        
Temporary colostomy: May be required to give a portion of the bowel a chance to rest and heal. When healing has occurred, the colostomy can be reversed and normal bowel function restored.
        
Permanent colostomy: May be required when a disease affects the end part of the colon or rectum.

Reasons for surgery:
        Cancer, diverticulitis, imperforate anus, Hirschsprung's disease, trauma, etc. (see above)

Care of colostomy:
       
Pouching System: A pouching system is usually worn. Pouches are odor free and different manufacturers have disposable or reusable varieties to fit one's lifestyle. Ostomy supplies are available at drug stores, medical supply stores and through the mail.
        
Irrigation: Certain people are candidates for learning irrigation techniques that will allow for increased control over the timing of bowel movements.

Living with a colostomy:
        
Work: With the possible exception of jobs requiring very heavy lifting, a colostomy should not interfere with work. People with colostomies are successful business people, teachers, carpenters, welders, etc.
        
Sex and social life: Physically, the creation of a colostomy usually does not affect sexual function. If there is a problem, it is almost always related to the removal of the rectum. The colostomy itself should not interfere with normal sexual activity or pregnancy. It does not prevent one from dating, marriage or having children.
        
Clothing: Usually one is able to wear the same clothing as before surgery including swimwear.
        
Sports and activities: With a securely attached pouch one can swim, camp out, play baseball and participate in practically all types of sports. Caution is advised in heavy body contact sports. Travel is not restricted in any way. Bathing and showering may be done with or without the pouch in place.
        
Diet: Usually there are no dietary restrictions and foods can be enjoyed as before.

To Irrigate or Not to Irrigate...

For some colostomates, using a pouching system is the way to go. However, for others, irrigation is preferable. So how do you know if irrigation is right for you? Let's take a look.

Appropriate ostomates for irrigation are those who have a left-sided descending or sigmoid colostomy who had regular bowel habits before having an ostomy.

Contraindications:
  • stomal prolapse
  • stomal stenosis
  • peristomal hernia.

Who should not irrigate?
  • Individuals undergoing chemotherapy and/or radiation treatments to the abdominal/pelvic area
  • Those with Crohns’ disease 
  • Individuals taking diarrhea-causing medications
  • Children are not appropriate for this procedure except for prescribed diagnostic procedures
  • People with limited manual dexterity and limited ability to maneuver around their bathroom safely and with ease

Time spent irrigating, often considered a disadvantage, requires about one hour to perform at the same time of day every 1 to 2 days. Individuals who work varying schedules might not have the time to dedicate to this practice.

The willingness to perform the hour-long ritual every day at the same time of day is important to training your bowels. The individual must also be very comfortable with their stoma, able to touch it along with the dexterity to insert the irrigation cone and then instill the water. Some people are quite squeamish about this procedure and can’t stomach it. Colostomy irrigation is a personal choice that only you can make.

Irrigation is particularly 
good for spinal cord injured individuals or any person with disabilities that has limited ability to empty or change their ostomy pouching system. It’s easy for caretakers to do and can improve their quality of life, too! 
   
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For More Colostomy Information, please visit www.ostomy.org