Colostomy

Walk into a crowded bus station or supermarket, and there's bound to be somebody who has had a colostomy. The thing is, you probably won't know who it is. People who have had a colostomy can work, exercise, and have sex -- in short, many are just as active as ever.

What many people don't know is how highly effective a colostomy is. It restores a vital body function that has become more difficult as a result of disease: getting rid of waste. Fortunately, with a little education, most patients can learn to live well after the operation.

What is a colostomy?

If part of your colon or rectum is diseased or damaged from disease, then your waste can't go the normal route out of your body. It will have to take a detour through another opening. For many patients, a colostomy is the best option. In this procedure, a surgeon cuts through the colon and sews the top part to an opening or "stoma" in your abdomen. The end of your colon attaches to a small, flat bag that catches the waste, which fits underneath your clothes.

If the entire colon is damaged or has to be removed, waste will be routed through the ileum, the bottom part of the small intestine. This procedure is called an ileostomy.

Both colostomies and ileostomies can be temporary or permanent. If, for instance, part of your lower colon is inflamed because of Crohn's disease or ulcerative colitis, a temporary colostomy can give the colon a chance to heal. Once the inflammation dies down, the surgeon can reattach the two pieces of colon, and your digestive system will return to normal. If a large part of your colon becomes obstructed or needs to be removed, as sometimes happens with colon cancer, the colostomy (or ileostomy) will be permanent.

Fortunately, not all people with damaged colons need to have a permanent colostomy. Only about 10 to 15 percent of people with colorectal cancer, for example, will need one. Your doctor will be able to tell you what your options are.

How do I manage my colostomy?

Every colostomy comes with special equipment: a bag that collects waste, a clamp that keeps the bag sealed tight, and an adhesive strip that connects the bag to the skin. Some bags have a clamp or a spout on the bottom that can be opened for easy emptying. Others are simply thrown out whenever they get full.

Every colostomy also comes with a long list of questions and concerns. Will the bag smell? How do I keep it in place? Will it leak? Will other people notice it? Will I be able to stay active? Will I have to change my diet? Perhaps you have others. Be sure to share every question with a doctor or nurse. Don't hesitate to ask even the most minor question. Many nurses, namely specialists known as enterostomal therapists, are trained to answer questions and demonstrate how to manage things like changing a bag or washing out your stoma.

Fortunately, today's colostomy bags are convenient and discreet. When clamped properly, they hold odors tight and rarely spill or leak. Some come with charcoal filters to trap any stray odors. You can also spray a liquid deodorizer on the outside of the pouch. If odor is still a concern, you may want to cut back on certain foods such as fish, cabbage, and eggs.

The bags are easy to manage. If you have a reusable bag, you can empty it simply by holding it over a toilet and opening the spout or clamp at the bottom of the bag. To lower the risk of spills or leaks, it's best to empty it when it's one-third or one-half full. Your doctor or nurse can show you how to keep the bag clean. You'll have to switch to a new bag when the adhesive starts to wear off, usually three to seven days.

Colostomy bags are also easy to hide no matter what type of clothing you wear. No one will suspect you have had a colostomy unless you tell them. Best of all, a colostomy doesn't have to change your life. About two or three weeks after the operation you can get back to your normal schedule. And depending on how extensive your operation was and how well you're recovering, you can even go back to swimming, bicycling, jogging, dancing -- practically anything you want to do besides contact sports. (Contact sports like football are out, and you shouldn't lift heavy items until you're completely healed from the surgery.)

You may have to watch your diet at first, but after that, most colostomy patients don't have to make any changes to their diet. If you've had an ileostomy, however, you may need to cut back on fiber for a few weeks to prevent swelling in the small intestine.

And remember: Help isn't far away. If you ever have any problems with leakage, contact your doctor or nurse. You should contact them if the skin around your stoma becomes red, irritated, or sore. Chances are, you can solve any problems simply by trying a different adhesive or a different type of bag.

References

Thompson J. A Practical Ostomy Guide. RN. Vol. 63(11): 61-66.

O'Brien B. Coming of age with an ostomy. American Journal of Nursing. Vol. 99(8): 71-75.

United Ostomy Association. Frequently asked questions following ostomy surgery.

Ileostomy, Colostomy, Ileoanal Reservoir Surgery, NIDDK.

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