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Colostomy and ileostomy

A colostomy is a surgical procedure to create an opening from the colon (the longest part of the large intestine) to the outside of the body through the abdominal wall. An ileostomy creates an opening from the ileum (the last part of the small intestine) to the outside of the body through the abdominal wall. The opening created by colostomy or ileostomy is called a stoma.

A colostomy or ileostomy can be temporary or permanent. The doctor may do a temporary colostomy or ileostomy to allow the intestine to rest and heal after surgery. A colostomy or ileostomy will be permanent if the lower part of the rectum and anal sphincter are removed.

A colostomy or ileostomy may also be called a bowel diversion.

Why a colostomy or ileostomy is done

A colostomy or ileostomy is done when the doctor needs to remove or bypass part of the intestine. These procedures may be done as part of treatment for:

  • colorectal, anal or ovarian cancers
  • an inflammatory bowel disease (IBD) such as ulcerative colitis or Crohn’s disease
  • familial adenomatous polyposis (FAP)
  • a blockage in the intestine (called bowel obstruction)
  • injury that damages the intestine
  • small pouches that form on the lining of the intestine and become inflamed (called diverticulitis)
  • birth defects

Where a colostomy or ileostomy is created

Where the doctor does a colostomy or ileostomy will depend on the part of the intestine that is affected by the disease. The different types of colostomies are named based on where they are in the colon.

Sigmoid colostomy is done in the sigmoid colon, which is the last part of the colon that connects to the rectum. It is the most common type of colostomy.

Descending colostomy is done in the descending colon, which is the part of the colon that goes down the left side of the abdomen.

Transverse colostomy is done in the transverse colon, which is the middle part of the colon that goes across the upper abdomen.

Ascending colostomy is done in the ascending colon, which is the first part of the colon. It starts at the cecum and goes up the right side of the abdomen. An ascending colostomy is not commonly done because doctors prefer to do ileostomy.

 

Ileostomy is done in the ileum, which is the last part of the small intestine.

Diagram of colostomy sites

Where the colostomy or ileostomy is done will affect the type and consistency of stool. Your colon normally absorbs water. When some or all of the colon is removed or bypassed, water may not be absorbed from stool as usual. For example, the stool from an ileostomy is mostly liquid because it doesn’t travel through the colon, which would normally remove most of the water. If you have a descending or sigmoid colostomy, your stool will be formed and solid as usual.

Types of colostomy and ileostomy

A colostomy or ileostomy can be done in different ways depending on why it is needed. Your doctor will decide which type of colostomy or ileostomy is best for you.

End colostomy or ileostomy

An end colostomy or ileostomy attaches one end of the colon or ileum to an opening in the abdominal wall. An end colostomy is often made in the sigmoid colon. An end ileostomy is often made in the last part of the ileum. The rest of the colon may be completely removed.

Diagram of an end colostomy

End colostomy or ileostomy with rectal stump

An end colostomy or ileostomy can be made with a rectal stump. This surgery may also be called the Hartmann procedure.

The rectum and anus are left in place, and the cut end is closed with staples or stitches. The rectal stump is not functional (stool doesn’t pass through it), but it may still make mucus that passes out of the body through the anus.

This type of colostomy or ileostomy can be temporary. After the intestine has healed, the doctor can join the remaining intestine to the rectum.

Diagram of an end colostomy with a rectal stump

End colostomy with mucus fistula

An end colostomy with mucus fistula is also called a double-barrel colostomy. It is usually done when part of the transverse colon or descending colon is removed and the sigmoid colon, rectum and anus are not removed.

This type of colostomy is created with 2 stomas. Part of the colon is removed, and each cut end of the colon is attached to a separate opening in the abdominal wall. One stoma is created from the first part of the colon on the right side of the body. This is called a functional stoma, or end stoma, because stool passes through it. A second stoma, called a mucus fistula, is created from the last part of the colon. The mucus fistula passes mucus out of the body.

Diagram of an end colostomy with a mucus fistula

Loop colostomy or ileostomy

A loop colostomy or ileostomy is usually temporary. It is done so that stool leaves the body before it reaches the diseased or injured part of the intestine. The intestine can be connected again after it has healed.

To create a loop colostomy or ileostomy, the doctor brings a loop of the colon or ileum out through a cut, or incision, in the abdomen. The doctor places a plastic rod through the loop to hold it in place and keep it from slipping back into the abdomen. Sometimes flaps of skin are used instead of a plastic rod.

The doctor then makes a cut in the colon or ileum to open it, but doesn’t cut all the way through it. The 2 sides of the opening become a stoma on the abdomen. Stool and mucus will leave the body through the stoma. Some stool and mucus may also leave through the anus.

Diagram of a loop colostomy

Preparing for a colostomy or ileostomy

Before surgery, your healthcare team will usually do tests to check your general health and make sure you can have surgery. For example, blood tests, a chest x-ray and electrocardiogram (ECG) may be done to check the health of certain organs. Find out more about these tests and procedures.

Your doctor or healthcare team will tell you if you need to follow a special diet before surgery. Your healthcare team will also tell you when to stop eating and drinking before surgery.

You may need to clean the intestine before surgery. This usually includes taking a cleansing preparation, made with a type of laxative, 1–2 days before surgery. Cleansing enemas may be given at the hospital to make sure the colon is as empty as possible.

Your surgeon will usually mark the abdomen where the stoma will be to make sure it is in a convenient and comfortable place. Your surgeon or healthcare team may also discuss the type of pouch (also called ostomy appliance) that you will need to use after the surgery. You may be given antibiotics just before surgery to help prevent infection.

How a colostomy or ileostomy is done

A colostomy or ileostomy is done in a hospital under general anesthesia.

The surgeon can use an open or laparoscopic technique. With the open technique, the surgeon makes a cut, or incision, in the abdomen to reach the intestine. With the laparoscopic technique, the surgeon makes small cuts in the abdomen and then inserts an endoscope (a thin, tube-like instrument with a light and lens) and tools to do the surgery. The open technique is used more commonly than the laparoscopic technique for colostomy or ileostomy.

During the surgery, some parts of the intestine need to be mobilized. This means that the surgeon cuts membranes holding the intestines in place so they can be moved and stretched.

Depending on why the surgeon needs to do the colostomy or ileostomy, a bowel resection may be done first. A bowel resection is used to completely remove the diseased or damaged part of the intestine. Find out more about bowel resection.

To create an end colostomy or ileostomy, the surgeon brings one end of the colon or ileum to an opening on the surface of the abdomen. The surgeon stitches the edges of the cut part of the colon or ileum to the skin of the abdomen to make the stoma. The surgeon closes the other cut end of the colon or ileum with stitches or staples. For an end colostomy or ileostomy with mucus fistula, the other cut end of the colon or ileum is attached to another part of the abdomen to make a second stoma.

For a loop colostomy or ileostomy, the surgeon stitches the cut edges of the colon or ileum to the skin on the abdomen to make the stoma with 2 openings.

The surgeon may place a tube in the abdomen to drain fluids. This helps prevent infection and allow the area to heal properly.

A special pouch, called an ostomy appliance, is placed around the stoma. This pouch collects stool that passes out of the body through the stoma.

Side effects

Side effects can happen with any type of surgery, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Side effects of a colostomy or ileostomy include:

  • pain
  • bleeding
  • infection
  • blood clots
  • hernia near the stoma
  • stoma falling into the abdomen (called retraction)
  • intestine coming out of the stoma more than expected (called prolapse)
  • damage to nearby organs
  • dehydration, which is more likely to happen with an ileostomy
  • blockage in the intestine (called bowel obstruction) caused by scar tissue

Find out more about side effects of surgery and managing symptoms and side effects.

After surgery

After surgery, you will need to stay in the hospital for several days. You will be given pain medicines, epidural anesthetic or both to keep you comfortable. These medicines are usually given through a needle in a vein (intravenous, or IV) or an epidural catheter.

You will be offered clear fluids for 1–2 days after surgery. Solid foods and meals will be introduced slowly.

The stoma is usually swollen right after surgery. It is soft, moist and reddish-pink in colour, much like the lining in the mouth. There is no feeling in the stoma so it will not hurt if you touch it. There are many blood vessels on the surface of the stoma, so it may bleed a little if you rub or wipe it too hard.

When you have a colostomy or ileostomy, you can’t control bowel movements. You will need to wear a pouch over the ostomy all the time.

While you are in the hospital, a specially trained healthcare professional, called an enterostomal therapist, will teach you how to live with and care for the colostomy or ileostomy. Before you go home, the healthcare team or enterostomal therapist will talk to you about:

  • changing the bandages or dressing
  • showering and bathing
  • how and when to take any medicines you need
  • eating and drinking
  • physical activity
  • what to do if you have problems
  • when to visit the surgeon for follow-up

If a bowel resection was done to remove cancer, you may need more treatments. You may be referred to a doctor who specializes in treating cancer (called an oncologist).

If the colostomy or ileostomy is temporary, your healthcare team will talk to you about how long you need to have it. A temporary colostomy or ileostomy is usually in place for a few months. Once the rest of the large intestine has healed, you will have another surgery to rejoin the 2 ends of the ileum or colon. This procedure is called anastomosis. The surgeon will also close the opening on your abdomen. After this second surgery, you will be able to pass stool from the anus normally.

Find out more about living with an ostomy.

Managing your diet

Most people with a colostomy or ileostomy can eat as they did before surgery. You may need to make some changes to your diet to help you manage the following problems.

Gas

Gas can be caused by certain foods and drinks. It can be difficult to control and is sometimes embarrassing.

You can help control gas by eating regular meals and chewing your food slowly. You may also want to limit foods that can cause gas, including:

  • dried beans and peas
  • broccoli
  • cabbage
  • cauliflower
  • onion
  • melons
  • strong cheeses
  • carbonated drinks

Odour

Certain foods can cause odour from the pouch or ostomy appliance. You may want to limit foods that can cause odour, including:

  • onion
  • cabbage
  • turnip
  • garlic
  • dried peas and beans
  • eggs
  • fish
  • fried foods

Some foods, including yogurt, buttermilk and parsley, can help control odour. You can also add deodorants to the pouch to control odour.

Talk to your enterostomal therapist if you are concerned about odour from the pouch.

Blocked or irritated stoma

Sometimes the colon or ileum can become narrow near the stoma. Certain foods may get stuck in the narrowed part of the colon or ileum and cause a blockage, or obstruction. These same foods could also make the stoma swollen and irritated. An obstruction is more likely to happen with an ileostomy than with a colostomy.

Drinking lots of fluids can help prevent a blockage. You may also want to limit foods that tend to block or irritate the stoma, including:

  • foods with seeds, such as raspberries, strawberries and tomatoes
  • nuts
  • popcorn
  • coconut
  • corn
  • celery
  • pineapple
  • apples with the skin

Tell your doctor or healthcare team right away if you have nausea or vomiting and nothing is coming from the stoma. These symptoms may mean that you have a blockage.

familial adenomatous polyposis (FAP)

An inherited condition that causes hundreds to thousands of polyps to develop, mainly on the lining of the colon and rectum.

People with FAP have a higher risk of developing colorectal cancer and some other cancers

epidural anesthetic

A type of regional anesthetic (a drug that causes the loss of some or all feeling) that is injected into the space around the spinal cord and causes loss of feeling or awareness in the abdomen and lower body.

Also called spinal anesthesia.

epidural

Referring to or having to do with the space between the dura matter (the outermost layer of the meninges, which are the membranes that cover and protect the brain and spinal cord) and the surrounding bone.

For example, an epidural anesthetic is injected into the space surrounding the spinal cord.

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