A colostomy is a procedure to create a new way for bowel movements to leave your body. This is generally done after removal of part or all of the colon, and can be done for numerous reasons (colon cancer, diverticulitis, obstruction or twisting of the colon, etc.).
During surgery, your doctor will make a small hole on one side of your abdomen. Then he or she will bring out the open end or your large intestine (also called the colon) through this hole, then he or she will sew the end of the intestines to the skin to keep it in place. Your bowel movements will then come out this hole and collect in a bag that is adhered to your skin. This hole in your abdomen is called a “stoma.” You will no longer have bowel movements out of your anus.
An ileostomy is another procedure that creates a new way for bowel movements to leave your body. It is like a colostomy, but the doctor connects the end of the small intestine (also called the ileum) instead of the large intestine (colon) to the hole.
Management of an Ileostomy or Colostomy
The management of a colostomy and an ileostomy is generally the same; however, an ileostomy does tend to have higher volume of more liquid output compared to a colostomy which has less volume of thicker, more “pasty” output. This is because the role of your colon is to absorb excess water from the stool, this is what makes stool more firm consistency.
If you have an Ileostomy, the body does not have a chance to reabsorb the excess water, and as a result people with an ileostomy can loose a lot of body fluids and can become dehydrated easily.
You will probably have about 4 to 8 bowel movements a day. Your bowel movements will probably not be as solid as they used to be, they will be more of a liquid or pasty consistency.
A special nurse (called an ostomy nurse) will teach you how to manage your colostomy while you are in the hospital after surgery. He or she will tell you:
- When and how to empty the bag that collects your bowel movements
- When and how to put on a new bag to collect your bowel movements
- How to check your stoma for problems and how to manage any problems that may occur
There are different types of colostomy bags that you can use. Some bags are emptied, cleaned, and reused. Other bags are thrown out each time you use them. Your ostomy nurse, along with your team of doctors and nurses, will ensure that you have the proper supplies and the help that you need to go home with before you are discharged from the hospital.
Some people worry that their bag will leak, or that other people will be able to smell their bowel movements. But these things rarely happen. The bags are made so that they do not leak or smell.
If you have a certain type of colostomy, you might be able to manage your colostomy using a process called “irrigation.” This is a way to make your bowel movements regular. It involves squirting water into your stoma on a regular basis to cause a bowel movement.
Potential Problems with a Colostomy
Different problems can happen with a colostomy, either right away or years later. Let your doctor or nurse know if you have any of the following symptoms or problems. That way, you can get treatment if needed.
- Your stoma is swollen or larger than usual.
- Your stoma is smaller than usual.
- Your stoma turns purple, black, or white.
- Your stoma leaks more than usual.
- You have a rash or sores on the skin around your stoma.
- You have diarrhea.
- You have sudden abdominal pain, cramps, or nausea.
- You are dehydrated. Dehydration is when the body loses too much water. It can cause people to have dark yellow urine and feel thirsty, tired, dizzy, or confused. If you have an ileostomy, this can happen easily as your body is loosing a significant amount of liquid out of the ileostomy that it would normally reabsorb. You should drink about twice as much as your normal daily fluid intake to compensate for this (goal of about 4 liters of water and other liquids per day).
- You haven’t had any gas or bowel movements for 4 to 6 hours (during the day). These symptoms could mean that your stoma is blocked.
Other Concerns with a Colostomy or Ileostomy
- Medications - If you have a colostomy or an ileostomy, your body might not absorb certain medicines as well as it should. When possible, use liquid medicines instead of pills. You should not use pills that are labeled “enteric coated,” because your body will not absorb these types of pills. Also, your body might not absorb birth control pills well (if you use birth control pills). If your body doesn’t absorb your birth control pills, the pills might not prevent pregnancy. Ask your doctor about medications that you take.
- Diet - You will need to be on a low fiber diet, especially if you have an ileostomy. Fiber is not digested well and can cause blockages in the colostomy or ileostomy. The foods you eat can affect the odor of your bowel movements, and how solid or loose they are. Certain foods can also make you have more gas and may cause some abdominal discomfort.
- Avoid constipation - Many patients with a colostomy have liquid stools, but other patients can have problems with constipation just as people without a colostomy. If your stool becomes too thick, the body is not able to expel is as it would if you were having bowel movements out your anus; this can cause a blockage of the colostomy. Speak to your doctor if your stools are thick or if you have not had any gas or bowel movement out of the stoma for 4-6 hrs.
This is generally not an issue with an ileostomy.
Living with a colostomy
You should be able to live an active and normal life with your colostomy. But you might be worried about the following:
- Clothes – You do not need to wear special clothes. Other people should not be able to see your bag under your clothes.
- Bathing and showering – You can bathe or shower with or without your bag on.
- Sports – You should be able to play most sports with your bag on. You might want to wear a special belt to protect your bag and keep it in place. Your doctor will probably recommend that you not play certain contact sports (such as football) or lift weights.
- Swimming – You can swim, but be sure to empty your bag beforehand.
- Sex – You should be able to have sex if you have a colostomy. But you might want to wear special clothes to protect your bag during sex.
- Traveling – Bring extra supplies for managing your colostomy when you travel. If you fly, keep your supplies with you in your carry-on luggage.
It is normal to feel sad, upset, or worried when you have a colostomy. If you have these feelings, talk to a family member, friend, your doctor, or a counselor. Some people also find it helpful to go to a support group for people with a colostomy.
Learn more about colostomy.