What You Need To Know About Colostomy Surgery

Surgery To Remove All Or Part Of The Colon Is Done To Treat Digestive Disease

Anesthetic nurse in surgery
Colostomy surgery will be done under general anesthetic, and will likely take several hours. knape/Vetta/Getty Images

Colostomy surgery may be used to treat many digestive conditions including colon cancer, Crohn's disease, intestinal obstruction, birth defects, and diverticulitis. Many people may fear colostomy surgery, but it can often bring about a greater quality of life, extend a person's life, or even save life. Colostomy surgery, in simple terms, is when part of the colon is removed (called a colectomy), and an opening is created in the abdomen to allow stool to pass out of the body.


What "Ostomy" Means

An ostomy is a surgically-created opening from an internal organ to the body's surface. Colostomy, from "colon" and "ostomy," is the surgery where an opening is made from the colon (or large intestine) to the outside of the abdomen. In a colostomy, the surgeon may remove a segment of the colon, which results in the colon being in two separate parts (think of what a garden hose would look like if it were cut in half). One end of the colon is passed through a small hole in the abdominal wall. This section of intestine, or stoma, allows for waste to leave the body from the colon. The other end of the colon, which is attached to the rectum, may either be removed or closed off with sutures and left in the abdomen.

After the surgery, waste is collected on the outside of the body with an ostomy appliance. Today’s ostomy appliances come in a variety of shapes, sizes, colors, and materials to suit the wearer’s lifestyle.

The stoma and the surrounding skin (peristomal skin) will require special care that is taught to patients post-surgery by an enterostomal therapy (ET) nurse.

Colostomies Can Be Temporary Or Permanent

A temporary colostomy may be used when the part of the colon (typically the lower section) needs to heal, such as after trauma or surgery.

After the colon is healed, the colostomy can be reversed, returning the bowel function to normal. In a colostomy reversal, the two ends of the colon are reconnected and the area where the stoma was created in the abdomen is closed. The large intestine is made, once again, into a continuous tube between the small intestine and the rectum. Bowel movements are eliminated through the rectum.

A permanent colostomy (sometimes also called an end colostomy) is necessary for some conditions, including about 15% of colon cancer cases. This type of surgery is commonly used when the rectum needs to be removed because of disease or cancer. Most of the colon may also be removed, and the remaining portion used to create a stoma.

Types of Colostomies

There are several different types of colostomies including ascending, transverse, and descending.

  • Ascending. This colostomy has an opening created from the ascending colon, and is created on the right side of the abdomen. Because the stoma is created from the first section of the colon, stool passed through the stoma is more liquid and contains digestive enzymes that irritate the skin. This type of colostomy surgery is the least common.
  • Transverse. This surgery may result in either one or two openings in the upper abdomen, middle, or right side that are created from the transverse colon. If there are two openings in the stoma, (called a double–barrel colostomy) one is used to pass stool and the other is used to pass mucus. The stool that is eliminated through the stoma has passed through the ascending colon, so it tends to be liquid to semi-formed.
  • Descending or sigmoid. In this surgery, the descending or sigmoid colon is used to create a stoma, typically on the left lower abdomen. This is the most common type of colostomy surgery and generally produces stool that is semi-formed to well-formed because it has passed through the ascending and transverse colon.

Colostomy surgery is a major operation, and will require a hospital day of at least several days and six weeks or more of recovery at home.

The Days Before Surgery

You will receive instructions from your surgeon on how to prepare in the days leading up to your surgery. If you are taking other medications, your surgeon may ask you to contact the prescribing physician for instructions on either continuing, discontinuing or adjusting the dose of drugs during your surgery and convalescence.

It is important to make the surgeon aware of all medications as some may inhibit the healing process (such as prednisone) or interact with other drugs.

You also may need to have certain routine examinations prior to your surgery such as a physical and a chest x-ray. You should also meet with an enterostomal therapy (ET) nurse. An ET nurse will teach you how to take care of your ostomy. In the initial meeting, you may discuss where your stoma will be placed on your abdomen, what kind of supplies you will need immediately after surgery, and how to best fit your ostomy into your lifestyle.

Colostomy surgery will often require a bowel prep to clean out the colon. In the day or two prior to surgery, you will follow your surgeon's instructions to remove all stool from your bowel, much as if you were preparing for a colonoscopy. This may be accomplished through fasting, enemas, laxatives, any of the standard bowel preps such as GoLytely or Phospho Soda, or a combination of these.

You may also be asked to take antibiotics or other medications to prevent infections prior to, during, and after the surgery.

The Surgery

Directly before surgery you will receive an IV to receive fluids and anesthetic. The surgery itself will last several hours. When you awaken, a colostomy bag will be attached to your abdomen over your new stoma, and you may also have one or more drainage tubes.

After some time in recovery, you will be moved to your hospital room when the doctor determines that your vital signs (pulse, blood pressure, respiration) are stable.

Hospital Stay

For the first few days after surgery you will continue to receive pain medication through your IV. You will not receive any food until the doctors hear the bowel sounds from your abdomen that indicates your intestines are "waking up." Your nurses may get you out of bed and standing or sitting in a chair a few days after surgery, depending on your condition. Standing and walking as soon as possible is very important to the recovery process, even though it will be uncomfortable at first.

After the doctor hears bowel sounds and the stoma begins to function, you may be given some clear liquids to eat such as broth, gelatin, and juice. If the clear fluids are tolerated well, your doctor will let the staff know that your diet can progress to full liquids or solid food.

Your ET nurse may visit you before you leave the hospital to help you learn more about taking care of your stoma and changing your ostomy bag.

You will also want to know where you can obtain your colostomy supplies and any special instructions about your ostomy.

Recovery at Home

Recovery at home is generally about six weeks, although it may be longer for patients who are very ill before surgery or who have complications. Activity will be restricted at first, and lifting, housework, and driving are not recommended. The hospital staff will advise you about your diet when you first get home, which may be restricted to low fiber. Regular appointments with your surgeon will help ensure that your abdomen and the area around the stoma are healing well.

You will be learning to take care of your stoma during the first few weeks of recovery. Your ET nurse will answer any questions, and may help you with your first few bag changes.

Your doctor will let you know when you are ready to resume your regular activities at work, school or home. If your colostomy is going to be reversed, your surgeon will help you decide when that is possible based on your recovery as well as your own schedule.


McKesson Provider Technologies. "Colostomy and Ileostomy." University of Michigan Health System. 11 Nov 2006.

National Institute of Diabetes and Digestive and Kidney Diseases. "Ileostomy, Colostomy, and Ileoanal Reservoir Surgery." National Digestive Diseases Information Clearinghouse Aug 2014. 22 Dec 2015.

United Ostomy Association of America, Inc. "Frequently Asked Questions Following Ostomy Surgery." UOAA 2013. 22 Dec 2015.

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