Colostomy

Dot Goodman, RN, MSN, WOCN
Inova VNA Home Health
Wound Ostomy Specialist, Outpatient Ostomy Clinic
Inova HealthPlex

Q. Does everyone who has surgery to treat colon cancer have a colostomy?
No. Only a small percentage of people have colostomies after surgery for colon cancer. Colostomies are done if the surgeon determines that a portion of the bowel needs to be rested in order to heal better. A colostomy would divert the bowel movement or feces away from this area until it could properly heal. These are usually temporary colostomies, they can be reversed, and normal bowel movements can resume. When the rectum, the end of the colon, is involved, a permanent colostomy is done to either permanently rest the area or to be the exit for the feces if the rectum is removed.

Q. What is a colostomy?
A colostomy is a surgical opening of the colon brought to the abdominal skin surface. A colostomy is a change in the anatomy. This change allows the bowel elimination through the abdominal opening. The opening is called a stoma. The word colostomy is the combination of the word colon and stoma.

Q. How large is the opening on the abdomen and what is it made out of?
The opening or stoma is the actual bowel tissue or lining of the colon. It is the same material as the inside of the mouth. The GI (gastro-intestinal) track begins at the mouth and ends at the rectum and the lining is the same all the way down. The opening or stoma size depends on what part of the bowel is brought to the outside and how much swelling there is at the time of surgery. The swelling decreases gradually the first several weeks after surgery. The stoma can be as large as 1½ - 2½ inches in diameter and then decrease to 7/8 to 1¼ inches.

Q. How is the bowel content collected and will there be an odor?
The output from the stoma is collected in a pouch, (also called "bag", or an appliance). There are many different types of appliances to choose from, there is something for everyone. The appliances are made to protect the skin and they are odor proof. The bowel movement exits the stoma into the pouch that is securely attached to the skin. The fecal material has a natural odor, but the odor should not escape when the appliance is sealed. If the pouch or appliance is the proper size and shape and changed at regular intervals then leakage and skin irritation can be avoided.

Q. Is a special diet required if you have a colostomy?
Initially, until the bowel heals from the surgery, the diet is low residue - foods that do not irritate or aggravate the bowel. The nurses and the nutrition experts in the hospital will explain this to you. After that you can return to a well-balanced healthy regular diet. The entire bowel from the mouth to the colostomy is usually normal. The digestive process is intact because the colon or the large bowel only absorbs water, stores stool and makes mucous to keep the stool lubricated to move. The water absorption can be done by whatever bowel remains. Therefore the essentials of digestion and nutrition are not impaired.

Q. How will gas be expelled?
Gas will be expelled through the stoma. There is usually more gas in the first few weeks after surgery. The excess gas comes from swallowed air and bowel irritability. Eating slowly, chewing food well, and avoiding carbonated beverages, chewing gum, and certain foods can keep gas under control.

Q. Is it possible to return to my normal life of family, friends and work?
After recovering from the surgery, people who have colostomies resume most physical activities. It takes a few weeks to a few months to feel secure with self care of the colostomy. Once a person gets some confidence, being with friends, going out for pleasure, and resuming an intimate physical relationship will follow. Initially, this will be difficult to imagine, but with time, physical strength, and emotional support, it is a normal natural progression. Anyone who is not resuming the normal roles of life needs to seek help from the health care team.

Q. Is sex and intimacy possible after having surgery, which results in an ostomy?
Intimacy and sexual relationships are a normal part of life and need to resume. The person who has the ostomy sets the tone for the relationship. Being comfortable with yourself is an important factor in helping others to be comfortable. Sexual functioning in women is usually not impaired. Men sometimes have initial changes with sexual function. This is usually temporary. The Wound, Ostomy, Continence Nurse and physicians are available and encourage discussion about sexual concerns.

Q. Can I still travel if I have an ostomy?
There are no restrictions on traveling. Some pre-planning concerning supplies is essential. It is recommended that equipment is kept with the person rather then checked, and twice as much is packed for travel as used at home. Equipment should be kept in a cool place at home as well as with travel. Some people have used coolers during travel by car in the summer. More tips and hints are available through the United Ostomy Association and the Wound, Ostomy, Continence Nurses. It is always safe to discuss long distance and/or remote traveling with your physician or your nurse practitioner so that prevention of disease and being prepared for problems - diarrhea or constipation - can be addressed.

Q. Who should I tell about my ostomy?
Tell your spouse or significant other, and others who are involved in your recovery as well as all members of your health care team about your ostomy. Your children can receive information appropriate with their age and your comfort. Only those you tell will know about your colostomy, others can be informed you had abdominal surgery. If you are anticipating an intimate relationship with someone, the discussion about the colostomy is often a part of the discussion about safe sex, birth control, and other beliefs and practices.

Resources:
Frequently asked questions about ostomy surgery
Patient information from colon and rectal surgeons on ostomy and related topics