Some of the most common reasons for having a colostomy are explained below.
Bowel cancer
Bowel cancer is one of the most common cancers in England, with an estimated 36,000 new cases occurring in the UK each year.
Most bowel cancers develop inside the colon or the rectum (colorectal cancer). A widely used treatment is to surgically remove the affected part of the bowel.
If a section of the colon is removed, a temporary colostomy is often used to allow the rest of the colon to heal. The healed colon is then reattached and the colostomy and stoma can be removed.
If the rectum is removed, it is likely that you will need to have a permanent colostomy.
Diverticulitis
Diverticulitis is a condition where small pouches in the wall of the colon, called diverticula, become infected and inflamed. This can cause symptoms such as:
- severe stomach pain
- a high temperature (fever) of 38°C (100.4°F)
- vomiting
Isolated episodes of diverticulitis can be treated using antibiotics. If you have repeated episodes of diverticulitis, it is usually recommended that the affected section of the colon is removed and the remaining colon reattached. You may require a temporary colostomy while waiting for the remaining colon to heal.
Crohn’s disease
Crohn’s disease is a poorly understood condition that causes inflammation of the digestive system and symptoms of abdominal pain and diarrhoea.
In cases of Crohn’s disease that do not respond to treatment, it may be necessary to remove a section of the colon and perform a temporary colostomy.
Bowel obstruction
Some circumstances can cause the passageway of the bowel to become obstructed. For example:
- severe constipation
- bowel cancer
- scarring of the lining of the bowel due to infection or inflammation
- hernia (a condition where part of an organ pushes through a weakness in the surrounding muscle)
A bowel obstruction is a medical emergency because there is a risk that the bowel could rupture (split) causing widespread infection and internal bleeding.
In some cases of bowel obstruction, it may be necessary to remove some or all of the colon and perform either a temporary or permanent colostomy.
Bowel incontinence
Bowel incontinence is a condition where people are unable to control their bowel movements, leading to episodes of soiling.
A colostomy can be used as a ‘treatment of last resort’ if all other medical and surgical treatments prove unsuccessful.
Injury
If you experience a severe, penetrating injury to your colon, such as a knife or gunshot wound, some or all of your colon may need to be removed and either a temporary or permanent colostomy performed.
Alternatives to colostomy
There are several alternative treatments that can sometimes be used instead of a colostomy.
The first alternative treatment is an ileostomy. This is similar to a colostomy, but involves the small intestines, rather than the colon, being connected to the stoma. The main drawback of having an ileostomy is that it increases your risk of becoming dehydrated because your colon is no longer absorbing water. However, rates of complications seem to be lower for ileostomies compared with colostomies.
The second alternative treatment is an ileo-anal pouch. This is essentially an artificial rectum that is constructed from pieces of the small intestine. The main advantage of an ileo-anal pouch is that you do not have to have a stoma, or use pouches on a long-term basis, and you can go to the toilet in the usual way.
The main drawback of having an ileo-anal pouch is that the pouch can become infected. This is a common complication associated with ileo-anal pouches. Some people also find that they have to empty the pouch six to eight times a day, and experience occasional leakages.
In some cases, you may be able to choose between having a colostomy, an ileostomy or an ileo-anal pouch. However, this is not always possible for certain medical conditions.
If you are uncertain about which type of treatment is best for you, your surgical team will be able to give you more detailed information about the advantages and disadvantages of each treatment option.
