• Colostomy / Ileostomy

    Definition

    An ostomy is a surgical procedure that connects an internal organ to the surface of the body. An artificial opening (called a stoma) is created to allow waste to exit the body and pass into an external bag.
    The 2 types of ostomies discussed here include:
    • Colostomy—brings the large intestine to the wall of the abdomen
    • Ileostomy—brings the small intestine to the wall of the abdomen
    An ostomy may be temporary or permanent.
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    The intestines create a path for food to be digested and passed out of the body. An colostomy or ileostomy may be needed if the path through the intestine is interrupted. The interruption may be due to injury or illness of the intestine, such as:
    • Cancer
    • Serious inflammation or infection
    • Trauma to the colon or rectum
    • Intestinal or bowel blockage that cannot be relieved with other methods
    • Inflammatory bowel disease
    A temporary ostomy may be done to allow the intestine to rest after surgery, trauma, or illness.
    A permanent ostomy may be needed if:
    • A large area of the intestine is needed to be removed
    • The remaining lower intestine or rectum cannot be repaired
    The Digestive Tract
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Possible Complications

    Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
    • Adverse reaction to anesthesia
    • Nausea and vomiting
    • Soreness in throat
    • Skin irritation
    • Excess bleeding
    • Infection
    • Wound opening
    • Hernia at the incision site
    • Damage to nearby organs
    • Scar tissue
    • Bowel presses out of the stoma
    • Heart attack
    • Blood clots
    Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:

    What to Expect

    Prior to Procedure

      Your doctor may do the following:
      • Physical exam
      • Blood and urine tests
      • Imaging tests
    • Arrange for someone to drive you home from the hospital.
    • Do not eat or drink anything after midnight the night before the procedure.
    Certain medications may cause complications during the procedure or recovery. These medications may need to be stopped up to one week before the procedure. Talk to your doctor before the procedure about all medications, herbs, and supplements you are taking.

    Anesthesia

    General anesthesia will be used. It will block pain and keep you asleep through the procedure.

    Description of the Procedure

    The exact steps will differ based on the specific reason for the surgery. Other work may need to be done before the ostomy is created. The surgery may be:
    • Open—a larger incision is made in the abdominal wall so that the surgeon can view inside the abdomen
    • Laparoscopic—a few small incisions are made that allow surgical instruments to pass into the abdominal cavity
    An opening will be made through the muscle and skin of the abdominal wall.
    If a section of the intestine has been removed, part of the remaining intestine will be pulled through the opening. The intestine end is secured outside the opening with sutures. This creates the stoma.
    If the intestine remains intact, a section of the intestine will be placed next to the opening in the abdominal wall. Incisions will be made in the intestine wall to create an opening. The open area of the intestine will be pulled through the opening of the abdominal wall. The inner lying tissue of the intestine will create the stoma.
    In both options the stoma is secured with sutures.

    Immediately After Procedure

    After the operation, you will be taken to the recovery room for observation.

    How Long Will It Take?

    How long the procedure takes depends on the reason you need to have the ostomy.

    How Much Will It Hurt?

    Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

    Average Hospital Stay

    The usual length of stay is 3 days to 1 week depending on the reason for the procedure and your overall health. Your doctor may choose to keep you longer or if complications occur.

    Post-procedure Care

    At the Hospital
    Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Care for the remainder of your hospital stay may also include:
    • Pain medications
    • Antibiotics to prevent infection
    • Medication to prevent blood clots
    • Learning how to care for your ostomy, stoma, and pouch
    • Receiving information about diet and activity
    The hospital staff may ask you to:
    • Walk often after surgery
    • Suck on ice chips after your surgery.
    • Start with clear fluids and slowly advance to a regular diet.
    During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
    • Washing their hands
    • Wearing gloves or masks
    • Keeping your incisions covered
    There are also steps you can take to reduce your chances of infection, such as:
    • Washing your hands often and reminding visitors and healthcare providers to do the same
    • Reminding your healthcare providers to wear gloves or masks
    • Not allowing others to touch your incisions
    At Home
    It will take about 6-8 weeks for the stoma to fully heal. There will be some changes needed to care for your stoma and ostomy bag, but with practice it should not interfere with daily activities. Regular contact with your medical care team will make sure you are healing as expected and help manage any complications.

    Call Your Doctor

    Contact your doctor if your recovery is not progressing as expected or you develop complications, such as:
    • Nausea and/or vomiting that you cannot control with the medications you were given
    • Signs of infection, including fever and chills
    • Lightheadedness
    • Skin irritation
    • Change in stool consistency
    • Not passing any stool
    • Blood in your stool, or black, tarry stools
    • Severe abdominal pain or cramps
    • Change in the appearance of your stoma, including narrowing or changes in color
    • Bleeding from the stoma opening or in the pouch
    • Blocked or bulging stoma
    • New or worsening symptoms
    If you think you have an emergency, call for emergency medical services right away.

    RESOURCES

    National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

    United Ostomy Associations of America, Inc. http://www.ostomy.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    International Ostomy Association http://www.ostomyinternational.org

    References

    Colostomy. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test%5Fprocedures/gastroenterology/colostomy%5F92,p07727. Accessed December 2, 2014.

    A guide for patients with an ileostomy or colostomy. Memorial Sloan Kettering Cancer Center website. Available at: https://www.mskcc.org/cancer-care/patient-education/guide-patients-ileostomy-colostomy. Updated August 4, 2014. Accessed December 2, 2014.

    Ostomy. American Society of Colon and Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/ostomy-0. Updated October 2012. Accessed December 2, 2014.

    Ostomy surgery of the bowel. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ostomy-surgery-bowel/Pages/ez.aspx. Updated August 13, 2014. Accessed December 2, 2014.

    What is a colostomy or ileostomy? American College of Surgeons website. Available at: https://www.facs.org/~/media/files/education/patient%20ed/your%20colostomy.ashx. Accessed December 2, 2014.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Daus Mahnke, MD
    • Review Date: 03/2017
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