Colostomy - Introduction

A colostomy is a surgical procedure to divert one end of the large intestine (colon) through an opening in the abdominal wall (tummy).

The end of the bowel is called a stoma. A pouch is placed over the stoma to collect waste products that usually pass through the colon and out of the body through the rectum and anus (back passage).

A colostomy can be permanent or temporary.

It's estimated that around 6,400 permanent colostomies are carried out each year in the UK.

Why a colostomy may be needed

A colostomy may be used when there's a problem with an area of the colon. The colostomy diverts digestive waste away from the affected area, to give it a chance to heal.

In other cases, a colostomy is formed after a section of the colon has been removed and the bowel can't be joined back together. This may only be temporary, with a further operation to remove the colostomy at a later date, or it may be permanent.

A colostomy may be used to treat the following conditions:

Bowel cancer
Crohn's disease
Diverticulitis
Anal cancer ‐ In rare cases, a permanent colostomy may be needed to treat anal cancer. This is usually only necessary if other treatments, such as chemotherapy or radiotherapy, have been unsuccessful.
Vaginal cancer or cervical cancer ‐ In some cases, a major operation known as a pelvic exenteration is required to treat cancer that has spread into the pelvis. A permanent colostomy is required as part of the operation.
Bowel incontinence ‐ A colostomy can be formed as a last resort, if all other medical and surgical treatments prove unsuccessful.
Injury ‐ If a part of the colon needs to be removed following an injury, such as a knife or gunshot wound, a colostomy may need to be formed. The colostomy is usually temporary, but in some cases can become permanent.
Hirschsprung's disease ‐ In this rare disease, the bowel doesn't work because it lacks the necessary nerve cells. Surgery is sometimes required to prevent the colon from becoming blocked. During the operation, the section of the colon lacking the nerve cells is removed and a colostomy is formed, so stools can leave the body. Depending on how much of the colon is removed, the colostomy may be temporary or permanent.

Types of colostomy

There are two main ways a colostomy can be formed:

A loop colostomy‐ where a loop of colon is pulled out through a hole in your abdomen, before being opened up and stitched to the skin.
An end colostomy‐ where one end of the colon is pulled out through a hole in your abdomen and stitched to the skin.

Loop colostomies tend to be temporary and require a further operation at a later date to reverse the procedure. It's also possible to reverse an end colostomy, but this is less common. You'll usually have to stay in hospital for 3-10 days after a colostomy or colostomy reversal.

A similar procedure, known as an ileostomy, is sometimes used as an alternative to a colostomy. This involves creating a stoma by diverting the small intestine instead of the large intestine.

Living with a colostomy

It's natural to be concerned that your day-to-day activities will be restricted and that others will notice you're wearing a colostomy bag.

However, modern colostomy equipment is discreet and secure, and there's no reason why you shouldn't be able to do the activities you enjoyed before, without experiencing the symptoms that made the colostomy necessary in the first place.

Adjusting to life with a colostomy can be challenging, but most people become accustomed to it over time.

You'll usually see a specialist stoma nurse before and after having a colostomy, although you may not be able to see them before the procedure if it's carried out in an emergency. Specialist stoma nurses can offer support and advice to help you adapt to life with a colostomy.