What is colostomy?

A colostomy is surgery to make an opening in the skin on the belly and connect your bowel (colon) to that opening. The opening is called a stoma. The stoma may be needed for weeks to months. Or it may be needed throughout your life.

After surgery, stool will not leave your body through your anus. It will go through the stoma and into a plastic bag. The bag is attached to the stoma.

The surgery can be done in two ways. In open surgery, the doctor makes one large cut (incision) in the belly. In laparoscopic surgery, the doctor makes several small incisions in the belly. Then the doctor puts a thin, lighted tube and special surgical tools through the incisions. The tube is called a scope. It lets the doctor see your organs and do the surgery. In either surgery, the incisions leave scars. These will fade with time.

You may worry about life after this surgery. Many people with colostomies lead active, normal lives. It may help to know that the bags don't smell bad. They also don't show under clothes. Most people likely won't know that you have a colostomy unless you choose to tell them.

In the hospital, an ostomy nurse will help you learn to care for your colostomy. You will probably go home in a few days to a week. But it could take a month or so to fully recover.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia.
• Avoid strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay. When you are active again, a support belt can help secure the colostomy pouch.
• For at least 6 weeks, avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
• Ask your doctor when you can drive again.
• You may need to take a month or more off from work. It depends on the type of work you do and how you feel.
• Your doctor will tell you when you can shower after surgery. You can shower with or without the colostomy pouch. You do not need to worry about getting your stoma wet.
• Your doctor will tell you when you can have sex again. You may feel uncomfortable about sex after a colostomy. Talk to your doctor if you have problems. You can get special underclothing that holds the pouch in place during sex.

Diet

• You may not have much appetite after the surgery. But try to eat healthy foods.
• Eat a low-fiber diet for several weeks after surgery. It is best to eat many small meals throughout the day. Add high-fiber foods a little at a time.
• Your doctor will tell you if you need to take certain supplements, such as vitamins.
• Drink plenty of fluids to avoid becoming dehydrated (unless your doctor tells you not to).

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• Your doctor will tell you if you need to take some medicines in a different form now that you have a stoma. You may need to crush pills or take a liquid form of the medicine.

Incision care

• If you have strips of tape on the cut (incision) the doctor made, leave the tape on until it falls off.
• Gently wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it oozes or rubs against clothing.
• Change the bandage every day or if it gets wet or dirty.
• Keep the area clean and dry.

Other instructions

• If the skin under your pouch is red, irritated, or itchy, you need to treat your skin. Follow these steps.
  • Gently remove the pouch.
  • Clean the skin under the pouch with water.
  • Dry the skin.
  • Sprinkle ostomy protective powder on the skin, and then blot it off.
  • Reattach or replace the pouch.
  • If you continue to have skin irritation, consult your ostomy nurse or other health professional.
• Follow all instructions from your doctor or ostomy nurse.
• Empty and replace your colostomy bag as often as directed by your doctor or ostomy nurse.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Your doctor will tell you about any bowel prep to follow if needed, such as if you should take laxatives, an enema, and antibiotics before surgery. Or you may need to go to the hospital the day before surgery to prepare your intestine.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

The risks of colostomy surgery may include bowel blockage (obstruction), a twisted bowel near the stoma, or problems with the stoma. These problems may include bleeding, the stoma shrinking in or bulging out, a sore (ulcer) in the bowel or an infection occurring.

Colostomy surgery is done to treat problems that affect your intestines. The surgeon has removed the part of your bowel that isn't working during an operation called a bowel resection. The two healthy ends of your bowel will be sewn back together. Sometimes the bowel tissue needs more time to heal before the reattachment, so a temporary colostomy is needed. Sometimes the entire lower colon or rectum is removed because it is diseased. In those cases, the colostomy will be permanent.

To perform a colostomy, the surgeon makes an opening through the skin on your belly and connects your bowel to that opening. This opening is called a stoma or, sometimes, a colostomy. Your stool passes out of your body through the opening. A disposable bag is attached over the opening to collect stool.

A colostomy usually requires general anesthesia and a hospital stay of a few days to a week. You may have a colostomy right after other surgery. You can expect some discomfort during the first few days after surgery. This can often be controlled with home treatment and drugs.

After the colostomy, a plastic bag called a colostomy pouch is taped over the opening on the outside of your body. You will be taught how to take care of your pouch and how to watch for infection. With proper care, you should be able to return to normal but nonstrenuous activities within a few weeks.

After a colostomy, you can expect to feel better and stronger each day. But you may get tired quickly at first. Your belly may be sore, and you will probably need pain medicine for a week or two. Your stoma will be swollen at first. This is normal.

You may have very loose stools in your colostomy bag for a while. In time your stools may become firmer, but they will be less solid than before your surgery. You may also have a lot of gas pass into your colostomy bag in the weeks after surgery. This will decrease as you heal.

How quickly you get better depends, in part, on whether you had a laparoscopic or open surgery. But you may need a month or more to get back to your normal routine.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no surgical site errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 2 to 4 hours.
• You will have a colostomy bag attached to your stoma on your belly. Stool will leave your body through the stoma and go into the bag. Colostomy stool is usually softer and more liquid than normal stool.
• After surgery, the bowel usually "rests" for a few days before it starts to work again.
• You may have a thin plastic tube in your nose that goes into your stomach. It drains stomach juices and prevents nausea. The drainage usually looks green, brown, or even black with a bit of blood. This tube is usually removed after a few days. Then you can start to drink and eat again.

A colostomy is done when part of your colon or rectum has been removed. It may be temporary while the colon heals or permanent if it is not possible to restore a connection so that stool can leave the body as usual. It may be done for colorectal cancer, diverticulitis, or other colon problems.