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What is a Colostomy? and Types of Colostomy

A colostomy is a surgical procedure that creates an opening in the abdominal wall to bring a portion of the large intestine out. The resulting stoma serves to attach the ostomy bag and collect stool. This occurs due to the removal of a part of the colon that works improperly. The first portion of the colon is called the “secum” (where the small intestine ends). Following that, the “ascending colon” (right part of the abdomen), then the “transverse colon” (horizontal above the abdomen), the “descending colon” (left part of the abdomen), and finally the “sigmoid colon” where it connects to the rectum.

“Colostomy is one of the commonest lifesaving procedures done worldwide with an intention of either decompression of an obstructed colon or diversion of stool.” 1

Purpose of a Colostomy 

 “A colostomy is a type of ostomy bowel diversion. It is a surgical procedure that involves partially resecting and disconnecting the colon (the large intestine). The colon is about four to six feet long. 

The colon has two main purposes: 

  1. To absorb water from your stool 
  2. To store your stool until you have a bowel movement.”2

The colon aids digestion, to solidify unused food, and turn it into stool. It receives everything the small intestine cannot absorb. The colon is responsible for absorbing water, nutrients, electrolytes, and certain vitamins. It processes, stores, and evacuates indigestible matter in the form of feces through the anus. A colostomy creates a hole (an ostomy) to expel stool without reaching the rectum and the anus.

“Colostomy may be done for emergency or elective surgical conditions for the management of wide ranges of congenital and acquired benign or malignant gastrointestinal conditions, for two main purposes: Diversion of the colon or decompression of the colon. 

Diversion is done to protect contamination of the distal large bowel segment by stool and it’s attending complications. Diversion is done commonly for trauma or distal rectal elective surgeries.

Decompression is done to relieve obstructed large bowel. Examples include sigmoid volvulus and malignant left side tumors. Benign condition predominates, including sigmoid volvulus traumas and ileosigmoid knotting. Colorectal cancers also take a good share.”3

Causes of a Colostomy

The main causes of a colostomy are rectal cancer, diverticulitis, necrotizing enterocolitis (acute inflammatory bowel disease), Crohn’s disease, puncture accidents, and congenital defects such as Hirschsprung’s disease (abnormal bowel nerve control) and imperforate anus (lacking anus). A colostomy is the most common stoma, accounting for 53% of the total. Different types of colostomy involve a particular section of the colon. The most common one occurs on the descending colon and displays on the left side of the abdomen.

Colon removal occurs when a section of the intestine dies. Colon disconnection ensues and may cause either a Temporary or a Permanent Colostomy. In both cases, the end part of the colon that remains connected to the digestive system finds an output through an incision on the abdominal cavity (an ostomy). 

 

Colostomy Procedure
Colostomy Procedure

 

The portion of the colon that protrudes through the ostomy is called the stoma.

“Your stoma (the part of the bowel you see opening onto your skin) has no feeling when you touch it, but it will bleed if rubbed or wiped too hard during cleaning. 

  • The first week after your surgery your stoma may: 
  • Look dark or bruised 
  • Have spongy or yellow tissue around it 
  • The dark or yellow tissue will peel off in a few days, and start to look more normal. 
  • Normal healthy stomas look: 
  • Soft 
  • Moist 
  • Red or pink 
  • Shiny 

The skin around your stoma should look like the rest of the skin on your abdomen. 

It should be free of: 

  • Rashes 
  • Redness 
  • Scratches 
  • Bruising 
  • Burning.”4

“Since nutrients are absorbed in the small intestine, a colostomy does not affect the body’s ability to be nourished. When a colostomy interrupts the passage of stool, storage becomes more difficult. The higher up in the colon the colostomy is made, the less time the bowel has to absorb water and the more liquid (or soft) the stool is likely to be. Therefore, a colostomy in the transverse colon will discharge a softer and more voluminous stool and will require the use of a collection pouch.”5

Types of Colostomies

“The types of colostomies are usually identified by the location of the stoma: ascending, transverse, descending/sigmoid.

Ascending Colostomy 

The ascending colostomy is located on the right side of the abdomen. The discharge is very liquid. A drainable pouch is worn for colostomies of this type. This type of stoma is rarely used since an ileostomy is a better stoma when the discharge is liquid. When a colostomy is located in the right half of the colon, only a short portion of colon remains. Caring for an ascending colostomy is similar to caring for a transverse colostomy. 

Transverse Colostomy 

The transverse colostomy is in the upper abdomen, either in the middle or toward the right side of the body. Diverticulitis, inflammatory bowel disease, cancer, obstruction, injury or birth defects can lead to a transverse colostomy. This type of colostomy allows stool to exit the colon before it reaches the descending colon. 

A permanent transverse colostomy is made when the lower portion of the colon must be removed or permanently rested. This may also be the case if other health problems make it unwise for the patient to have further surgery. Such a colostomy provides a permanent exit for stool and it will not be closed at any time in the future. 

A double-barrel ostomy is a surgical procedure that creates two end stomas usually in close proximity. The proximal stoma is a functional opening that expels stool and the distal stoma functions simply as a mucous fistula. 

Generally, a transverse colostomy will be placed higher on the abdomen so concealing the pouch may be more of a challenge.

 

Types of Colostomy
Types of Colostomy

 

Descending or Sigmoid Colostomy

 Located on the lower left side of the abdomen. Generally, the discharge is firm and can be regulated. The sigmoid colostomy is probably the most frequently performed of all the colostomies. 

The stool of a descending or sigmoid colostomy is firmer than that of the transverse colostomy and does not have the caustic enzyme content. At this location, elimination may occur on a reflex basis at regular, predictable intervals. The bowel movement will take place after a considerable quantity of stool has collected in the bowel above the colostomy. Spilling may happen between movements because there is no anus to hold the stool back. Many people use a lightweight, disposable pouch for security. A reflex will set up quite naturally in some people. In others, mild stimulation, such as juice, coffee or food is effective for elimination. Others may prefer the irrigation method of management. 

While many descending and sigmoid colostomies can be managed to move regularly, others cannot. You must realize that satisfactory management, with or without stimulation, is likely to happen only in those people who have had regular bowel movements before they became ill. If bowel movements have been irregular in earlier years, it may be quite difficult, or impossible, to have regular, predictable colostomy function. Spastic colon or irritable bowel are conditions in which the patient may have bouts of constipation or loose stool. A person, who has had such a condition in the past, before he became ill, may not achieve regularity.”5

 

Descending or Sigmoid Colostomy
Descending or Sigmoid Colostomy

 

Another Classification

“Depending on the way constructed, colostomies are classified into four main types:

  • Hartman’s 
  • Loop 
  • Double barrel and 
  • Spectacle.  

The choice of the type of colostomy depends on the indication, the experience of the surgeon and the patient’s general condition during surgery. 

Hartman’s end colostomy and loop colostomy are constructed frequently

Hartmann’s colostomy 

A Hartmann’s colostomy is made when stool needs to be re-routed or diverted to: 

  • Relieve a blockage 
  • Rest diseased bowel 
  • Bypass bowel that has been operated on after the diseased bowel is removed 

During this surgery, the active bowel is brought to the surface of the skin to make 1 stoma. The bowel connected to the rectum is closed over and left in the abdomen for possible reconnection later. 

  • The stoma will pass stool. 

The bowel connected to the rectum is inactive and rests. 

You may pass some mucus from your rectum. 

 

Hartmann’s colostomy
Hartmann’s colostomy

 

Loop colostomy (Transverse colostomy)

A loop colostomy is made when stool needs to be re-routed or diverted to: 

  • Relieve a blockage 
  • Rest diseased bowel ρ
  • Bypass bowel that has been operated on after the diseased bowel is removed 

During this surgery a loop of bowel is brought to the surface of the skin. 

The bowel is opened so that 2 stomas appear side by side. 

  • One stoma will pass stool 
  • The other stoma is connected to the rectum. 
  • This stoma is called a mucous fistula. The stoma and bowel connected to the rectum is inactive and rests. You may pass some mucus from your rectum, or mucous fistula. ∙ A catheter or rod may be positioned under the stoma to support it until it heals. 

This is removed by the surgeon or ET nurse 10 to 14 days after surgery. 

 

Loop colostomy (Transverse colostomy)
Loop colostomy (Transverse colostomy)

 

Colostomy with a mucous fistula 

A colostomy with a mucous fistula is made when stool needs to be re-routed or diverted to: 

  • Relieve a blockage 
  • Rest diseased bowel 
  • Bypass bowel that has been operated on after diseased bowel has been removed 

During this surgery, the 2 ends of the bowel are brought to the surface of the skin to make 2 separate stomas. 

  • One stoma will pass stool 
  • The other stoma is connected to the rectum 

This stoma is called a mucous fistula. 

The stoma and bowel connected to the rectum are inactive and rest. 

You may pass some mucus from your rectum, or mucous fistula.” 6

 

Ostomy with a Mucous Fistula
Ostomy with a Mucous Fistula

 

Colostomies can be Temporary or Permanent

“Temporary colostomies will be reversed after sometime when the patient’s condition and the reason for the colostomy allow.”6

In a Temporary Colostomy, once the bowel heals from the surgery (at least 4 months), it requires a new surgery to eliminate that colostomy and reconnect the colon. The procedure joins the stoma with the part of the colon that connects with the rectum, so the colostomy patient can secrete stool through the rectum and the anus again. The patient will no longer need colostomy bags.

“Permanent colostomies are indicated when abdominoperineal resection is done, the cancer is unrespectable or the sphincter is damaged beyond repairable.” 6 

In the case of a Permanent Colostomy, the stoma is the channel for disposal and the patient will always need colostomy bags for collection.

“Permanent colostomies are not reconnected at a later date. Sometimes the rectum is removed. If the rectum is left, you may feel the urge to have a bowel movement and pass some mucus from your rectum. Your doctor will talk to you about the reason your bowel cannot be reconnected. Ask your surgeon what type of colostomy you are likely to have. Each person’s problem and reason for surgery is different.” 6

 

Retained and Removed Rectum
Retained and Removed Rectum
Stoma Positioning
Stoma Positioning

 

“Although it is a lifesaving procedure, both its construction and reversal have significant morbidity and mortality. Complications can be related to the colostomy itself or the indication for it. Common early complications include surgical site infection, wound dehiscence, colostomy necrosis, and retraction.  

Awareness of the common indications plus the types and the complications may help in improving outcomes of patients.”7

Evacuation Frequency and Stoma Placement

“Where the stoma is placed on your abdomen depends on which part of the bowel is brought through the skin. At some hospitals, a nurse may mark your abdomen for the best location of the stoma.

It is often said that a person must have a bowel movement every day. Actually, this varies from person to person. Some people have two or three movements a day, others have one every two or three days or even less often. You must judge by what is usual for you, not what is usual for others.”8

How a Colostomy Affects Everyday Life

“Because a colostomy does not have a sphincter muscle, you have no voluntary control over bowel movements. Instead, you will wear a disposable pouch to collect the stool. Each stoma is unique. Chances are, your stoma will look different from someone else’s. The stoma should not be painful.

After colostomy surgery, many people worry that the pouch will be visible under their clothing. Some people think they won’t be able to wear “normal” clothes, or that they will have to wear clothes that are too big for them. You should be able to wear the same type of clothes you wore before your surgery. In fact, today’s pouches are so thin and fit so close to the body, chances are no one will know you’re wearing a pouch – unless you tell them.”9

Seek for Help

“Colostomy surgery is one step to help you regain your health. Accepting and adjusting to your colostomy surgery takes time. 

People who can help you 

Support from your family and friends will help during this time. 

There are many people who can help you learn to care for your colostomy. Some of them are your surgeon, family doctor, enterostomal therapy nurse, hospital nurses and community nurses. 

After your surgery, you will be expected to start learning how to care for your colostomy. The nurses will teach and help you to care for yourself. 

You will be expected to empty and rinse your pouch before you go home. A visiting nurse will come to your home to help you until you are able to manage the ostomy bag changes on your own. 

Many towns and cities have Ostomy Associations where you can meet other people with ostomies. Talking to other people who live with a colostomy is helpful in your recovery.”10

A WOC Nurse will Assist You Before Discharge

“During your hospital stay, you will be visited by a Wound, Ostomy, and Continence (WOC) nurse. 

A WOC nurse is trained and certified in the complete care of ostomy patients. This nurse will work with your doctor and staff nurses to aid you in your recovery. Once you leave the hospital, the WOC nurse will continue to be a resource for you.”11

Each person has a different intestinal rhythm, which they can control with diet or other circumstances. Therefore, it is convenient to know how intestinal behavior can change to select the appropriate stool collection system for each case. Seek an ostomy nurse or an ostomy association for more details and information.

 

María Laura Márquez
13 October, 2018

Written by

María Laura Márquez, general doctor graduated from The University of Oriente in 2018, Venezuela. My interests in the world of medicine and science, are focused on surgery and its breakthroughs. Nowadays I practice my profession...read more:

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