Ileostomy, Colostomy, and Ileoanal Reservoir Surgery

What is a colostomy?

A colostomy is a procedure which involves diverting a portion of the colon to a aperture in the wall of the abdomen, known as a stoma. A colostomy procedure may be carried out if part of the bowel or rectum is damaged as a result of an illness, injury or obstruction. The stoma is usually attached to a pouch, which collects stools. Other parts of the digestive system, such as the ileum, can also become damaged and require surgery to create a stoma, which is known as an ileostomy.

A colostomy can be a temporary or permanent procedure. Temporary colostomies are performed if a section of the colon is damaged or infected or following an operation, while a permanent colostomy will be performed if the rectum and colon have been removed, which is most common among people with bowel cancer.

Colostomies are relatively common and in the UK more than 6,000 permanent colostomy operations are carried out each year.

How is a colostomy performed?

There are two types of colostomy operation, which include:

• Transverse colostomy: this procedure involves diverting the upper section of the colon and attaching it to an opening (stoma) in the upper abdomen. In most cases the stoma is located either in the middle or right hand side of the abdomen. The colon is then either sealed and left alone or removed, depending on the individual. The colon will be removed if the colostomy is permanent. Discharge from the stoma following a transverse colostomy tends to be watery, because absorption occurs only in the upper section of the colon. Most people need to change their bag or pouch 2-3 times per day.
• Descending (or sigmoid) colostomy: this procedure involves diverting the lower section of the colon to a stoma on the left-hand side of the abdomen. Descending colostomies can be either temporary or permanent. Discharge following a descending colostomy tends to be firmer than after a transverse colostomy, as more absorption can occur.

If you have a temporary colostomy surgery will be required to reverse the operation, which involves reattaching the colon and closing the stoma (known as stoma reversal). This procedure is relatively simple and most people are able to leave hospital and go home after around 3-7 days.

Why would I need a colostomy?

There are several illnesses that may cause damage to the colon and require treatment followed by a colostomy, in addition to obstruction of the bowel and injuries. Possible reasons for needing a colostomy include:

• Bowel cancer: in many cases of bowel cancer part of the colon is removed and the rectum may also be taken out in advanced cases. If the rectum is removed it is likely that you will need a permanent colostomy. Bowel cancer is one of the most common forms of cancer in the UK and experts predict that rates will rise in the future, meaning that colostomies will become more common.
• Crohn’s disease: Crohn’s disease is a digestive disorder which causes parts of the digestive system to become inflamed. In some cases, when an individual does not respond to other treatments, surgery may be carried out to remove part of the colon. In most cases a temporary colostomy will be required.
• Diverticulitis: diverticulitis is a condition which occurs when small pouches that protrude from the wall of the colon (known as diverticula) become swollen and infected. If you suffer from repeated bouts of symptoms associated with diverticulitis, including fever, vomiting and stomach pain, you may be advised to have surgery to remove part of the colon and this will be followed by a temporary colostomy procedure.
• Bowel obstruction: in some cases it may be necessary to remove part of the colon if the bowel has become obstructed.

Alternatives to colostomy

There are alternatives to a colostomy. The two main alternatives include:

• Ileostomy: an ileostomy involves attaching the small intestines to the stoma. This procedure has a lower risk of complications, but it does increase the risk of dehydration.
• Ileo-anal pouch (also known as ileoanal reservoir surgery): this procedure effectively involves using pieces of the small intestine to build an artificial rectum. The ileo-anal pouch is beneficial because you do not have to have a stoma or use a pouch to collect your stools and you can go to the toilet in the normal way. However, there is a risk of the ileo-anal pouch becoming infected.

Your doctor will explain the treatment options to you and answer any questions you may have and will also help you to decide which treatment will be best for you.

Living with a colostomy

It can be difficult to come to terms with the fact that you will not be able to go to the toilet normally and you may understandably feel worried about having a colostomy. However, you will soon get used to it and changing your bag will become part of your daily routine. Most people find it useful to establish set times to change their bag and there are odour-free bags if you are worried about the smell. You will be advised about diet and exercise after your operation and if you want to return to work once you have recovered this should be fine. If you need information you can contact your care team or get in touch with the Colostomy Association. If you are worried about needing to go to the toilet suddenly, you can obtain a RADAR key, which gives you access to disabled toilets and will be available from the Colostomy Association.