How A Colostomy Is Done

Overview

A colostomy is an operation that makes a new path for stool (poo) to leave your body. During the operation, a surgeon brings a piece of your large bowel — the colon — out through a small opening made in the wall of your tummy. That opening is called a stoma. It looks a bit like a small, pink, fleshy button. Because the stoma has no nerve endings, it does not hurt to touch. Stool now comes out through the stoma instead of through your bottom, and it collects in a soft, leak-proof bag that sits over the opening. Some colostomies are temporary and are closed later; others are permanent. Your surgeon will tell you which type you are having and why.

Yes. Colostomies and other types of stoma are done every day in hospitals around the world. Many thousands of people of all ages live full, active lives with a stoma, and most say the idea is much scarier before surgery than the reality afterwards.

Anyone can need a colostomy — babies, children, adults and older people. It is most often done in adults who have bowel cancer, a long-term bowel disease, or a serious problem such as a blocked or damaged bowel. In babies and children it is usually done for problems they were born with.

Symptoms

Common symptoms

• This article is about an operation, so 'symptoms' here means two things: the problems that can lead to needing a colostomy, and what you may notice afterwards.
• Problems that may lead to surgery: a change in bowel habit lasting several weeks, such as looser stools, constipation or needing to go more often.
• Blood in your stool, or bleeding from your bottom.
• Ongoing tummy pain, cramping or bloating that does not settle.
• A feeling of not emptying your bowel fully, or losing control of your bowels (incontinence).
• Feeling very tired, losing weight without trying, or feeling generally unwell with bowel changes.
• After the operation you may notice: a swollen stoma that slowly shrinks over about six to eight weeks, extra wind, and stools that change in thickness as your bowel settles.

Symptoms in children

• In babies and children, a colostomy is usually done for conditions present from birth, such as an anus that has not formed properly or a section of bowel that does not work normally.
• Signs can include not passing the first poo in the first day or two of life, a swollen tummy, vomiting green fluid, or poor feeding.
• Children recover quickly and often adapt to a stoma better than adults expect. A specialist children's stoma nurse will support the whole family.

Symptoms in older adults

• Older adults are more likely to need a colostomy because of bowel cancer, bowel pouches (diverticular disease) or a blocked bowel.
• Other health conditions, weaker skin and multiple medicines can affect healing, hydration and how easily the bag sticks, so planning with a stoma nurse matters.
• Confusion or a sudden change in alertness after surgery needs to be checked straight away, as it can be an early sign of infection or dehydration.

Causes

Main causes

• Bowel (colorectal) cancer — removing the affected part of the bowel sometimes means the ends cannot simply be joined back together straight away.
• A blocked bowel that cannot be unblocked, from cancer, scarring or a twisted bowel.
• Diverticular disease that has caused serious inflammation, bleeding or a hole in the bowel.
• Inflammatory bowel disease such as Crohn's disease or ulcerative colitis, when other treatments are not enough or the bowel is badly damaged.
• A damaged or torn bowel after injury or after a burst (perforated) bowel.
• Conditions present from birth, such as an anus that has not formed properly, or a section of bowel with no working nerve cells (Hirschsprung's disease).
• Severe loss of bowel control in someone for whom other treatments have not worked.
• To protect a join in the bowel lower down while it heals — a temporary colostomy is sometimes used for this.

Risk factors

• A family history of bowel cancer or a personal history of bowel polyps.
• Long-standing inflammatory bowel disease.
• Getting older — most bowel cancer and diverticular disease is found in people over 50, though it can happen at any age.
• A low-fibre diet, little physical activity, smoking and drinking a lot of alcohol are linked to bowel problems that may need surgery.
• Being very overweight (obesity).
• Needing emergency abdominal surgery, where the bowel cannot safely be joined back together at that moment.

When to see a doctor

See a doctor urgently if:

• A change in bowel habit lasting more than three weeks, especially if you are also losing weight or feeling very tired.
• Blood in your stool, on the toilet paper, or a persistent change in the colour of your stool.
• A hard, swollen tummy with vomiting and no stool for more than a day.
• After surgery: a stoma that stops working with pain and vomiting, a stoma that changes colour, or signs of infection in the wound.

Book a routine appointment if:

• Ongoing bloating, cramping or discomfort in your tummy that keeps coming back.
• Needing to pass stool very urgently, or finding it hard to control wind or stool.
• Feeling that your bowel never fully empties, or needing to strain a lot.
• A new lump or swelling near your stoma, or repeated leaks and sore skin around it.
• Questions about diet, exercise, travel, work or intimacy with a stoma — your stoma nurse is there for these.

Diagnosis

A colostomy is not diagnosed — it is planned. Your care team works out what is wrong with your bowel, decides whether an operation is the safest option, and then plans the details of the surgery, including exactly where on your tummy the stoma will sit. Before the operation you will usually meet a stoma nurse specialist. They talk you through what to expect, show you the bags and equipment, and mark a good spot on your skin for the stoma — usually away from belt lines, folds and old scars, and somewhere you can see and reach easily.

Tests that may be done

• A colonoscopy or flexible sigmoidoscopy — a thin, flexible tube with a camera checks the inside of your bowel; you are usually given sedation to keep you comfortable.
• A CT scan or MRI scan of your tummy and pelvis to see the bowel and plan the operation.
• Blood tests, including a full blood count and sometimes tests of how your liver and kidneys are working.
• A sample of stool to check for infection, if you have diarrhoea.
• A fitness check for surgery ('pre-assessment') — heart tracing, blood pressure, breathing tests and a review of your medicines.
• In some cases a photograph or x-ray taken with a small amount of dye to plan the surgery.

What to expect at your appointment

You will normally be asked not to eat for several hours before the operation, and you may be given a drink or bowel preparation to clear your bowel. Most people have the operation under a general anaesthetic and wake up in a recovery area. You will have a drip for fluids, possibly a small tube in your bladder, a dressing on your wound, and a bag over your new stoma. When you wake, the stoma may be swollen and may not work straight away — that is normal. A member of your team will explain what they did and why, and the stoma nurse will visit you on the ward.

Treatment

The colostomy itself is the treatment — it lets stool leave your body safely when the normal route is not working or cannot be used. The operation is done in hospital under a general anaesthetic. If you are having an end colostomy, the surgeon brings the upper end of the bowel through the skin and stitches it in place; the lower part is closed off or removed. If you are having a loop colostomy, a loop of bowel is brought up and opened on the surface. Some operations can be done by keyhole surgery, which usually means less pain and a faster recovery. Either way, the stoma is fixed in place and a bag is fitted over it before you leave the operating theatre.

Self-care at home

• Learn to look after your stoma with your stoma nurse before you go home — practice with their guidance while you are still in hospital.
• Change the bag regularly and use warm water and a soft cloth to clean the skin around the stoma; pat dry, then let the skin air for a minute or two before fitting a new bag.
• Use only products made for stomas. If your skin is sore, ask your stoma nurse rather than trying lots of creams yourself.
• Drink plenty of fluid — six to eight glasses a day — especially in hot weather or if the output is loose. Stool from a colostomy is usually soft but formed, so staying well hydrated keeps it comfortable.
• Eat small, regular meals to begin with, chew well, and reintroduce foods gradually so you can see what suits you.
• Empty the bag when it is about one-third full so it does not become heavy or leak.
• Keep moving. Gentle walking soon after surgery helps your circulation and helps your bowel settle, but avoid heavy lifting for the first few weeks — ask your team for a safe time to start lifting again.
• Keep the skin around your stoma dry and check it each time you change the bag. Take a photo of any change to show your nurse.

Medical treatments

There are no medicines that do the job of a colostomy, but your care team may use other treatments alongside it. These can include medicine to slow down very loose output or to treat pain and infection, all chosen and adjusted by your own doctors. Your stoma nurse is the main person to help with equipment — they can fit bags of different shapes and sizes, advise on pastes and powders that protect the skin, and show you how to flush the bowel through the stoma (irrigation) if that suits your type of colostomy. Some people join an irrigation programme so they can choose when the bowel empties and wear a smaller pouch. Regular follow-up appointments check your stoma, your skin, your recovery and, if you had bowel disease or cancer, your ongoing care.

When is surgery considered?

A colostomy may be planned in advance (for example, when cancer has been found and surgery is being organised), or it may be done as an emergency (for example, when the bowel is blocked, torn or badly inflamed and cannot safely be repaired at that moment). An emergency operation is often done as soon as possible, and the team may decide on the day whether you need a stoma. If you know in advance, you will have time to talk it over with a stoma nurse, plan your recovery and ask questions — there is no such thing as a silly question here.

Living with this condition

At first, looking after a stoma takes time — perhaps 20 to 30 minutes to change the bag. Most people find it much quicker after a few weeks. The bag is designed to hide under clothing and is usually scented and made of a quiet material, so no one else will know you have it unless you tell them. Stool usually comes out in a predictable way, and many people empty or change the bag at a regular time each day. Wind can be a nuisance at first, especially in the early months, but it tends to settle. Showers are fine — water will not harm the stoma, and you can shower with or without the bag on. You can swim, travel and return to work or study. Give yourself time and be kind to yourself while you learn.

Lifestyle tips

• Get back to normal routines gradually — walking first, then your usual activity. Aim for gentle exercise most days once your team says it is safe.
• Avoid heavy lifting, core-heavy gym work and contact sports until your surgeon or stoma nurse gives the go-ahead.
• Wear clothes that feel comfortable over the pouch; high-waisted or loose styles often work well, and many people use a pouch cover or support belt.
• Keep a spare kit with you — a bag, wipes, a small disposal bag and a little water — so you feel confident away from home.
• Tell your travel insurer about your stoma, and carry supplies in your hand luggage if you fly.
• It is safe to swim and bathe. Empty the bag before you go in and use a waterproof cover if you like.
• Intimacy is possible. A pouch cover, a smaller bag or emptying beforehand often helps. Talk with your partner and your nurse — they can suggest positions that avoid pressure on the stoma.

Diet and exercise

You do not need a special diet, but eating well helps you feel better. Eat regular meals with plenty of vegetables, fruit and whole grains, chew food well and eat slowly. After surgery, softer, low-fibre foods are often easier for the first few weeks, then you can build up. Some foods may cause wind or a smell (for example beans, cabbage, onions or fizzy drinks) and some may make the stool thicker (for example bananas, rice or pasta) — everyone is different, so try one thing at a time. Drink plenty of fluids, especially with meals, and more in hot weather. For exercise, walking, gardening, cycling and swimming are all fine once you have healed. A strong tummy helps prevent a bulge around the stoma (parastomal hernia), so ask your nurse about safe core exercises you can start a few months after surgery.

Mental health and emotional wellbeing

It is very normal to feel shocked, anxious or upset before and after a colostomy. You may worry about how your body looks, about smell or leaks, or about whether other people will notice. Many people also feel relief once they are no longer unwell. These feelings usually ease with time, practical know-how and support, but if low mood, worry or poor sleep is lasting more than a couple of weeks, or if you are having thoughts of harming yourself, please reach out to your doctor, your stoma nurse or a crisis service right away. You do not have to manage this alone, and help is available.

Prevention

You cannot usually prevent needing a colostomy, because it is done to treat a problem rather than being a problem itself. What you can do is lower your risk of the bowel diseases that most often lead to one. That means eating plenty of fibre, staying active, keeping a healthy weight, not smoking and drinking alcohol within sensible limits. If you have inflammatory bowel disease, keeping it well controlled with your doctor's guidance reduces the chance of serious damage. If you have a temporary colostomy, following your team's advice about recovery gives the best chance that it can be reversed successfully.

Screening programmes

Bowel cancer screening is the single most useful thing you can do. Screening programmes are offered in many countries, usually to people in their 50s or 60s, and can find problems early, often before any symptoms appear. If there is a strong family history of bowel cancer, speak to your doctor — you may be offered screening earlier or extra checks. Changes in bowel habit lasting more than three weeks are always worth checking, whatever your age.

Complications

If left untreated

• If the underlying problem (such as a blocked, torn or badly inflamed bowel) is not treated, it can lead to a hole in the bowel, infection inside the tummy, or a serious whole-body infection (sepsis), which is life-threatening.
• A long-term blockage can cause vomiting, severe pain and dehydration.
• Ongoing inflammation or bleeding can lead to anaemia and poor general health.
• After the operation, possible problems include skin irritation around the stoma, a bulge beside the stoma (parastomal hernia), the stoma sinking or sticking out more than before, narrowing of the stoma, or a blockage from food. Most of these can be managed with help from your stoma nurse.

Long-term outlook

Most people recover well from a colostomy and get back to work, hobbies, family life and travel. It takes time to adjust — usually a few months rather than a few days — and everyone gets there at their own pace. Many people say that once they have got used to the bag, it becomes just another part of their routine, like brushing their teeth. If you have a temporary colostomy, your team will talk to you about when it can be reversed; if yours is permanent, modern equipment and support make a full life very achievable. Your healthcare team is there for the practical questions as well as the medical ones, so keep asking.

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