Colostomy / Ileostomy

Call-aw-stow-me; Il-E-aw-stow-me

by Cynthia M. Johnson, MA

Definition

A colostomy creates an opening from the large intestine through the wall of the belly. An ileostomy creates an opening from the small intestine through the wall of the belly. It may be temporary or permanent.

The opening for both is called a stoma. It allows waste to pass from the intestines to a bag outside the body.

Reasons for Procedure

The intestines create a path for food to be digested and passed out of the body. A 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 removed
The remaining lower intestine or rectum cannot be repaired

The Digestive Tract

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
Skin irritation
Excess bleeding
Infection
Hernia at the incision site
Damage to nearby organs
Scar tissue
Bowel presses out of the stoma
Heart attack
Blood clots
Stoma falls into belly cavity
Blockage in bowel
Dehydration

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

Smoking
Drinking
Chronic disease such as diabetes or obesity

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-1 week depending on the reason for the procedure and your overall health. Your doctor may choose to keep you longer 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 to 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

Call your doctor if any of these occur:

Persistent ausea or vomiting
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 unexpected 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
https://www.niddk.nih.gov

United Ostomy Associations of America
https://www.ostomy.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

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

References:

Caring for your ileostomy or colostomy. Memorial Sloan Kettering Cancer Center website. Available at: https://www.mskcc.org/cancer-care/patient-education/caring-for-your-ileostomy-colostomy. Accessed January 26, 2021.

Colorectal surgery considerations. EBSCO DynaMed website. Available at: http://www.dynamed... . Accessed January 26, 2021.

Colostomy. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/colostomy_92,p07727. Accessed January 26, 2021.

Ostomy. American Society of Colon and Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/ostomy-0. Accessed January 26, 2021.

Ostomy surgery of the bowel. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/ostomy-surgery-bowel. Accessed January 26, 2021.

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 January 26, 2021.

Last reviewed November 2020 by EBSCO Medical Review BoardNicole S. Meregian, PA
Last Updated: 1/26/2021

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