What is a colostomy?

A colostomy, or stoma, is an artificial opening created when a healthy part of your large bowel is brought out onto the surface of your abdomen.

What does the large bowel do?
Your bowel is a hollow tube coiled up in your abdomen. It is a part of the gut, which breaks down the food you eat into protein for growth, and energy.

When the food has been digested, waste products pass into the large bowel. In the colon, the first part, water is absorbed back into the body. The waste products become more solid and are passed out of the body through the rectum (back passage) as faeces or stools.

What happens when a colostomy is formed?
When a colostomy is formed your stools will be passed through the stoma instead of through your rectum. The stoma has no muscle control and you will wear an appliance (bag) to collect the stools.

What does a colostomy look like?
The colostomy may be oval or round in shape. It is similar in colour to the lining to the lining of your mouth. The stoma will be about two finger breadths across - three to four centimetres. It may be swollen at first but this will settle in about seven to 10 days.

Although the stoma may stand out a couple of centimetres from the surface of your abdomen, other people won't notice this when you are dressed.

Are there different types of colostomy?
Yes, a colostomy may be temporary or permanent.

A temporary colostomy may be formed to:

  • relieve a blockage in the bowel. Other treatment may be given to remove the blockage and start the bowel working normally again.
  • rest your bowel and allow healing to take place after an operation.

A permanent colostomy will be formed if a cancer is sited low in your rectum and there isn't enough bowel left to join together after the tumour has been removed.

Examinations of your bowel
There are several ways in which the doctor can examine your bowel. Whatever examination is used your bowel will need to be prepared. It must be as empty as possible so that the doctor can get a clear view inside.

The preparation may vary but will usually include:

  • eating a low fibre (roughage) diet for a day or so before the test to clear your bowel of any residue. You may also be asked to drink clear fluids only the day before the examination.
  • taking laxatives to clear your upper bowel.
  • an enema to make sure the lower part of the bowel is empty

Sigmoidoscopy or Colonscopy: During these investigations the doctor passes a scope, a tube with a small camera on the end, into your bowel. A sigmoidoscopy looks at the lower part of your large bowel, while a colonscopy looks further up the colon.

The doctor can see if there is part of the lining of the bowel which looks different, for example there may be a polyp (a small smooth growth) or an ulcer.

If the doctor sees something unusual, a biopsy (a sample of tissue) will be taken from this area. The tissue will be sent to the laboratory for examination under the microscope.

Before these examinations you will be given something to make you more relaxed and prevent any discomfort. If you have any questions, please ask your doctor or nurse.

Barium Enema: This is an x-ray examination using barium which brightens the x-ray picture. The barium is given as an enema and will outline the lower part of your bowel. The procedure lasts about 15-30 minutes and you should try to hold on to the contents of the enema for the length of the examination.

Afterwards you will be able to empty your bowels. You may be prescribed a mild laxative because barium can cause constipation. Barium can also be very difficult to flush away in the toilet. If you have any questions, please ask your doctor or nurse.

What happens before the operation?

You will usually be admitted to hospital two or three days before your operation. This gives you time to get used to the ward and to meet the staff who will be looking after you.

You will usually be given a light diet for 24 hours, followed by fluids only for the next 24 hours in the two days before your operation. You will then be asked not to eat or drink for several hours.

You will be given a laxative and / or enema to make sure your bowel is empty

A stoma care nurse will visit you. S/he is a specialist nurse trained to help people with colostomies. The nurse will mark the site of your colostomy on your abdomen with a pen. The site will be discussed with you to make sure it is an easy place for you to manage, for example to change your appliance. The nurse will also make sure that the site is away from your naval, hip bones and creases.

The stoma care nurse will show you some of the available appliances and may leave you a general information booklet. S/he can also discuss all aspects of your operation and any concerns you may have about how having a colostomy will affect your life.

What happens after the operation?

After your operation you will be taken to the recovery room. Here the nurses can check you closely while you are waking up. When the anaesthetist is satisfied with your condition, you will be taken back to your ward.

People experience pain in different ways and at different levels. If you do feel sore or uncomfortable, please tell the nurses straight away. They can give you some analgesia (pain relief) and, if you are felling sick, some anti-emetic (anti-sickness) drugs.

During your operation the surgeon has to handle your bowel and, because of this, it takes some time to start working normally again. You won't be able to drink or eat at first but gradually you will begin to take fluids and food again. You will probably be eating normally seven to ten days after your operation.

You will also have a thin tube inserted up your noise and down into your stomach. This is to drain off any fluid and stop you from being sick. It won't affect your ability to speak.

You will be given fluids, and any drugs you need, by an infusion ('drip') into a vein, usually in your arm. This will stay in place for a few days until you are able to drink normally again.

A catheter (tube) will be placed in your bladder to drain away urine and prevent you from becoming uncomfortable. This won't be left in place any longer than necessary.

When any tissue is cut it is normal for blood and fluid to be produced. You may have a wound drain (tube) in place to remove this. Your wound will be stitched together and your nurse will tell you when the stitches can be removed.

If you have had your rectum removed, your back passage may be stitched together or a wound drain may be in place. The drain will be removed after a few days. A little discharge or bleeding may continue for several weeks while the area is healing.

You will be encouraged to get up and move around, with help, within 24 hours of your operation.

Care of your colostomy

Your colostomy may be swollen for the first week or 10 days because your bowel was handled during the operation. For the same reason your colostomy may not function for a few days. However, you may pass wind in the bag which means your bowel is recovering.

At first the nurses will look after your colostomy and then they will teach you to do this. Gradually you will learn how to change your bag, dispose of used ones and care for your skin. You will be able to select an appliance which suits you.

You will be able to go home when you feel confident changing your bag and looking after your colostomy, and after your stitches have been removed.

Your colostomy will continue to shrink in size during the six weeks after your operation.

How am I likely to feel?

Many people find it takes time, and support from others, to adjust to living with a stoma. As well as this, you may be experiencing many different emotions following your diagnosis of cancer.

Your feelings may change from day to day and it isn't unusual to have 'up' days and 'down' days. It may take several weeks or months to feel you have really adjusted physically and emotionally to what has happened. After any operation people often feel tired and sometimes depressed or low. This is normal.

Some people say they lost their self confidence at this time, either related to life in general or feelings about the change to their body caused by the formation of the stoma. If you feel like this, talk to your partner or others close to you. A lot of people say this has helped them to regain their confidence and to realise they are the same person as before their operation and valued as such.  All these reactions are normal.

Will I look different?

You may be concerned that you'll look different after the formation of your stoma. Don't worry, it's unlikely that people will know about your operation unless you tell them.

There is no reason why you should need to change your wardrobe or buy different clothes. Occasionally some change may be necessary if you have a transverse colostomy because of the position of the stoma.

Specialist swim wear is available but, again, may not be necessary.

What about my usual activities?

Having a colostomy shouldn't prevent you from doing many of the things you did before your operation. In fact the formation of your stoma may relieve symptoms and you may be able to do more. However, other effects of your cancer and your general health may limit your activities.

During the first few weeks after your operation don't overdo things. Don't do energetic activities such as shopping, lifting heavy items, using a vacuum cleaner or gardening for at least six weeks. Accept offers of help from family and friends.

Try to take some gentle exercise each day and increase this gradually, for example walking. Take care not to overtire yourself and make sure you get enough rest.

If you used to play sports regularly, you shouldn't start again for at least six weeks. Ask your doctor or stoma care nurse what you can and can't do.

If you were working before your operation, you will probably be able to return after six or eight weeks. You may choose to work part-time at first. If you're not sure about when you can return, perhaps because of the type of job you do, check with your doctor.

After any big operation it takes a while for your concentration and reflexes to return as normal. Don't start driving again without checking with your doctor that it's all right to do so.

You should be able to go on holiday as before, including travelling abroad. Remember to take extra supplies of your appliances in case you develop "holiday tummy". Always carry supplies in your hand luggage in case of emergency.

What about eating and drinking?

You should be able to eat a wide variety of foods although you may find that some foods upset you. Most people do make some changes to their diet.

Your cancer, previous treatment or the reasons why you needed a stoma may mean you have to follow a special diet. You will be given advice as necessary.

There is no reason why you shouldn't drink alcohol in moderation. However some people choose to avoid beer and other carbonated (fizzy) drinks because these can cause wind.

If you have any problems or questions about diet, speak to your stoma care nurse or ask to see the dietician.

What about sex?

Your general health, the stress of your illness or the after effects of your operation may affect your ability to have intercourse. If you have questions about his, speak to your stoma care nurse.

You may resume sexual activity about six weeks after your operation, if you wish to. Many people find their libido (sex drive) decreases. If you do lose interest in sex, don't worry - this isn't unusual.

You may be more tired than usual. If this is a problem, you may want to set aside time for physical intimacy after a period of rest.

Following your operation you may need to try different sexual positions until you find one which is comfortable for both of you.

Loss of confidence and a change in the way you see yourself may affect your sexual relationship. Again, this isn't unusual - you may find it helps to talk to your partner about your feelings.

If you have had your rectum removed the tissues nearby may be affected. You may find it difficult to have intercourse.

For men: You may have difficulty gaining or maintaining an erection. This can be embarrassing and difficult to discuss such a personal subject or try to ignore the problem. However, your doctor or stoma care nurse is used to discussing these problems and even if they are unable to help you themselves, they can refer you to someone who can. Your partner can also be present, if you wish.

For women: Your vagina may be scarred and narrowed. This may make intercourse difficult and painful. You may find it embarrassing to talk about such a personal subject. However, your doctor or stoma care nurse is used to discussing these problems and even if they are unable to help you themselves, they can refer you to someone who can. Your partner can also be present, if you wish.

Remember enjoyable sex needn't depend on intercourse alone. There are other ways of showing love and sharing pleasure.

USEFUL INFORMATION POINTS

British Colostomy Association
15 Station Road
Reading
RG1 1LG

Tel: 0033 173 439 1537 WEBSITE

An information and advisory service. Emotional support on a personal and confidential basis. Free leaflets and a list of local contacts.

Useful booklets

 

Understanding Colostomy

Among other things, this booklet gives detailed information on appliances and care of the skin around the stoma following a permanent colostomy. There is also a section on diet giving common-sense advice on eating a wide variety of foods.

Available from:

ConvaTec Limited - A Squibb Company
Harrington House
Milton House
Ickenham
Uxbridge
UB10 8BRTel: 00 33 1895 628400

http://www.convatec.com

The Transverse Colostomy

This booklet explains in more detail what a transverse colostomy is and the fact that, at a later date, the surgeon may be able to close it and restore your gut to normal. It also has helpful advice, for example on appliances and diet.

Available from:

Coloplast Ltd
Peterborough Business Park
Peterborough
Cambs
PE2 0FX

Tel: 00 33 1733 392000

http://www.coloplast.co.uk/

An ostomy is an artificial opening on the abdominal wall through which waste material passes out of the body from the bowel or urinary tract.

A colostomy indicates that the opening is from the colon. When the colostomy is in the left colon, only a pad may be needed to cover the opening. When the opening is in the right side of the colon, some type of appliance or bag is required. There are various types of colostomies. The physician and surgeon recommend the appropriate one for each patient.

An ileostomy involves bringing the ileum (the last portion of the small intestine) to the abdominal surface. When waste matter reaches the ileum it is liquid, so an appliance is needed to collect it. However, a type of ileostomy called a Koch's pouch or continent ileostomy does not require an appliance. The physician and surgeon discuss these choices with the patient.

 

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