Before carrying out a colostomy, it is first necessary to remove the section of the colon that is affected.
The surgery can be carried out in two ways:
- as an open operation (laparotomy), where the surgeon makes an incision in the abdomen to remove the affected section of colon
- as laparoscopic (or keyhole) operation, where the surgeon makes smaller incisions and uses a miniature video camera and surgical instruments to remove the affected section of colon
Where possible, keyhole surgery is the preferred treatment option because research has shown that patients recover more quickly from it and have a reduced risk of complications.
However, in emergency situations, such as a bowel obstruction, the staff and equipment that are needed for a keyhole operation may not be available, so an open operation will need to be performed.
Types of colostomy
There are two main types of colostomy operations.
They are:
- a loop colostomy
- an end colostomy
These are described in more detail below.
Loop colostomy
During a loop colostomy, the colon above the affected area is diverted and a loop of colon is pulled out into your abdomen as a colostomy (stoma). The stoma will have two openings but you may not be able to see both.
One opening will be the active end, where the waste products come from, and the other opening is the other end of the bowel that goes down to your rectum. This stoma is usually on the left-hand side of your abdomen, below your belt line.
These stomas are created by cutting a hole in the skin of your abdomen, pulling through a small section of your colon and stitching it into place. This is done under a general anaesthetic so you will be asleep during surgery and will not feel any pain.
The stoma will appear quite large at first as it will swell due to the effects of surgery. The stoma will usually shrink in size for six to eight weeks. After eight weeks it will stay this size.
It will be red in colour and moist. The stoma has no nerve endings so it isn't painful to touch. The stoma may bleed when it is touched, but this is entirely normal and no cause for concern. The stoma will have sutures securing it in place. These are designed to dissolve and will fall out over time.
A loop colostomy is usually a temporary procedure which is used to treat conditions such as diverticulitis, Crohn’s disease and bowel cancer.
The remaining section of colon is either sealed and left in place or, if the colostomy is permanent, removed.
End colostomy
During an end colostomy, the colon above the affected area is diverted and one end of the colon is pulled out onto your abdomen as a colostomy (stoma). The stoma will have one opening and the waste products will pass through this opening. The other end of the colon which goes down to your rectum is left inside your abdomen. This stoma is usually on the left-hand side of your abdomen, below your belt line.
End colostomies are often permanent, although temporary end colostomies are sometimes performed as an emergency to treat bowel obstructions, colon injuries or bowel cancer.
The waste products produced by an end colostomy or loop colostomy are often very similar. The waste comes in the form of soft faeces (poo), which has been softened by water absorbed in the remaining part of the colon. The consistency of the waste can be affected by diet, so if you are dehydrated your faeces may be harder.
You can still experience constipation and diarrhoea. As the waste is formed you will use a closed appliance which cannot be emptied. You will have to change the colostomy appliance between one to three times a day.
If you have a transverse colostomy the output will be quite loose. If this is the case you may have to use a drainable appliance which will need emptying several times a day and changing every day or two days.
Some people who have a colostomy have a regular and predictable output in the same way that many people often experience regular bowel movements. If this is the case, you may not need to always wear a standard size colostomy bag. However, as occasional leakages can occur, it is recommended that you wear a small stoma cap.
Irrigation is an alternative to using a colostomy bag. This is where you wash your colon out with water every one to two days and collect the waste products in a sleeve. Read more about irrigation in Living with a colostomy.
