| 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
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