It is perhaps axiomatic that humans are generally more comfortable with the experience of their daily lives being familiar or “normal” rather than having to embrace that which is new or different. We see evidence of this every day, from the success of endlessly rebooted movie franchises to the outrage over an interface change on our favorite app or website; people often stick with what they know and avoid things they don’t.
This seems especially true when it comes to matters of health and our bodies. People who look externally “different” in some way tend to make others uncomfortable and a little skittish. That discomfort can become compounded when the topic is perceived to be taboo or embarrassing, and gastrointestinal problems can often fall into this category. After all, isn’t the long history of poop and fart jokes just a way to make light of bodily functions that tend to be very private?
Every day bodily functions, however, can be more easily understood than the kinds of conditions that require specialized care. A prime example of this is a colostomy. Even though a colostomy procedure can save lives or reduce the agonizing symptoms of an underlying medical problem, the idea of it can sometimes invoke disgust in those who don’t understand. Indeed, many patients who have a colostomy report feelings of psychological distress or fears of being rejected if they are honest about their condition or if someone unexpectedly discovers the equipment.
The United Ostomy Associations of America (UOAA) estimates that there are between 750,000 and 1 million people in the United States who have an ostomy, and part of their mission is to provide support and advocacy for those who have to make this physical and emotional life adaptation (they even provide a “Colostomy Guide” that offers useful information about the procedure). Moreover, their work highlights the ongoing need to educate the public on this topic so that the stigma can be reduced or eliminated.
What is a Colostomy?
The term ostomy can be used interchangeably to refer to either the external pouching system used for waste collection or the procedure used to integrate the pouching system into the body. The different versions of an ostomy are based on the location in the body, but the basic principle is that an opening in the abdomen (referred to as a stoma) is surgically created in order to allow waste materials to pass directly from the digestive system to a collection pouch outside the body.
Two common types of ostomy are a urostomy and an ileostomy. In an ileostomy, a part of the small intestine is accessed through a stoma to collect waste; this is usually done in conjunction with a colectomy, the full removal of the colon. A urostomy involves the same kind of procedure but for the urinary tract instead, typically in situations where normal urinary drainage is not possible.
One of the most common types of ostomy is the colostomy, where waste materials pass from the colon into a colostomy bag. These can be either temporary or permanent, and they typically follow some other kind of bowel surgery or an injury.
Types of Colostomy
In the same way that different types of ostomy are defined by their location in the digestive system, so also are the different types of colostomy defined by their location in the large intestine and the underlying problem they are remedying:
- Ascending Colostomy: In this type, the stoma is connected to the first part of the colon, which receives waste from the small intestine. Because at this point the colon hasn’t had the chance to absorb much water, the waste product is mostly liquid.
- Transverse Colostomy: Named for the section of the colon that crosses the abdomen, a transverse colostomy is often temporary and is used to prevent waste from entering the descending colon.
- Descending Colostomy: Located on the lower left side of the abdomen, the descending colon is typically where the stool begins to become solid.
- Sigmoid Colostomy: This is the most common type of colostomy. The sigmoid colon refers to the lowest end of the colon and the final stop for waste before it enters the rectum. The waste collected is usually pasty or nearly formed, almost what would pass through the anus.
In addition to being defined by the part of the colon, colostomies also can be categorized by the way the stoma is formed:
- Loop Colostomy: A “loop” of the colon is brought through the abdomen wall that creates two openings in the same stoma; one is for the diversion of waste and the other is to vent the lower part of the colon. This is usually temporary.
- Single-Barrel Colostomy: Also known as an end colostomy, this type is almost always permanent; it involves a single opening in the abdominal wall and the removal of the remaining portion of the colon below the stoma.
- Double-Barrel Colostomy: Similar to the loop colostomy, this type involves the creation of two separate stomas. The active side of the colon diverts fecal matter into the collection pouch while the inactive side continues to produce the normal mucous that protects the colon’s lining; this mucous is then passed through the anus.
Why Do I Need a Colostomy?
There are many different reasons why a colostomy might be necessary, but the common factor is when the large intestine can no longer safely function in processing waste products and dispense with them through the anus. The following are some of the typical reasons why a gastroenterologist could look to a colostomy as a solution:
- Inflammatory bowel disease (IBS)
- Intestinal blockage (either total or partial)
- Birth defects such as an imperforate anus where the anus is missing or blocked
- Injury to the colon or rectum due to trauma
- Diverticulitis, an inflammation of abnormally formed sacs on the lining of the colon
- Other bowel infections
- Colorectal cancer
- Fistula, an abnormal “tunnel” between a part of the bowels and an external opening on the skin
The determination of whether the colostomy will be temporary or permanent is dependent on the nature of the original condition. In some cases, doctors have a reasonable hope that “resting” a particular section of the large intestine will allow it to heal; in these cases the stoma can be sewn shut and bowel function will return to normal.
In more serious cases, when it is determined that a part of the colon must be removed, the colostomy and stoma will need to become a permanent part of the patient’s life. A permanent colostomy can also be necessary for situations where a patient is experiencing fecal incontinence and no other treatments are effective.
Colostomy Surgery and Care
The type of surgery involved in a colostomy procedure varies depending on the individual patient, but it can be done either open or laparoscopically. In either case, the surgeon will perform the surgery while the patient is under general anesthesia. The surgery itself is relatively simple, but it does typically require a hospital stay of at least three days.
The colostomy procedure is a relatively low-risk surgery. However, as with any surgery, there can be some complications; this can include bleeding, infection, scar tissue, skin irritation, or a narrowing of the stoma opening.
Because of the nature of a colostomy and the active engagement it requires on a day-to-day basis from the patient, care of the stoma and the collection pouches are very important. The typical maintenance regimen involves regular cleaning of the skin around the stoma as well as routinely changing the pouch system in order to prevent leaks and irritation.
In descending and sigmoid colostomies, the stoma can be managed through a process called colostomy irrigation. In colostomy irrigation, water is sent through the stoma and into the colon in order to help aid smooth bowel movements. Though this procedure is becoming less common because of improvements in pouch systems, there are many people who still use it.
Living With a Colostomy
For the hundreds of thousands of people who have to live with a colostomy, adjusting to the new way of life can be a challenging process. Fortunately, there are now support groups all over the country, and the advocacy of organizations like the UOAA have helped bring this issue to light and educate the public. Facing the prospects of a colostomy can be difficult but the skilled and caring physicians at GI Associates are ready to help. If you would like to talk to an experienced gastroenterologist about concerns with your digestive health, contact GI Associates to make an appointment.