Colostomy, Fecal Diversion

The colon, rectum and anus are the last sections of the body's digestive system. Although they are an important part of the system, they have little to do with digesting food or absorbing nutrients. In fact, the large intestine can be thought of as the body's trash compactor. As leftover liquid flows through the colon, it becomes solid waste (feces). The waste material is passed through the various sections of the colon, then moves onward to the rectum. From there, it is eliminated from the body through the anus.

When the colon, rectum or anus is unable to function normally because of disease or injury or needs to rest from normal function, the body must have another way to eliminate the waste. A colostomy is an opening in the large intestine that is brought out onto the surface of the abdomen. This provides a new path for waste material and gas to leave the body. The colostomy is also called a stoma. It can be permanent or temporary.

There are many reasons why a colostomy becomes necessary. Some of the conditions that may require a colostomy include:

• Colorectal cancer
• Traumatic injury
• Intestinal obstruction
• Diverticulitis (an inflammation or infection of small sacs or outpouchings, called diverticula, of the inner lining of the intestine)
• Crohn's disease (a chronic inflammatory disease that involves all layers of the intestinal wall and can disrupt normal bowel function)
• Incontinence or constipation

How is a colostomy performed?

A colostomy results from a surgical procedure performed under general anesthesia. During the surgery, the healthy colon is brought through an opening in the abdominal wall and stitched to your skin. Unlike the anus, the opening (stoma) has no sphincter muscle, so you cannot control the exit of waste. You will need to wear a pouch (called an ostomy collecting device) to collect the waste flow.

A colostomy can be permanent or temporary, depending on the condition being treated and the surgery performed. A temporary colostomy may be done to allow part of the intestine to rest and heal.

For most patients, a colostomy will not be needed. Today's modern surgical techniques and instruments have decreased the number of operations that require a colostomy. Only 10% of patients with rectal cancer and less than 1% with colon cancer will ever need a permanent colostomy. If you do need to have a colostomy, there will be some changes in your lifestyle, but you will receive education to help manage and adjust to these changes.

While in the hospital after your surgery, you will be educated about the care of your colostomy and given some tips to help make the necessary adjustments. Some patients find the advice and support of other colostomy patients helpful. There are ostomy support groups available to provide additional information and emotional support.

Once you have learned how to care for your colostomy, you will have to regulate your diet to avoid constipation and diarrhea. Some patients find that a process called colostomy irrigation, which uses an enema through the stoma, clears the colon for the day so a pouch may not be necessary. Medical supply stores and some drug stores carry supplies to help you care for your colostomy. You will need to check with your insurance carrier to determine if they cover colostomy supplies.

Here are some additional tips to help you adjust to your colostomy:

• Monitor your medications - Some medicines can cause constipation or diarrhea.
• Eat a well-balanced diet Avoid foods that cause excessive gas, such as cabbage, beans, eggs, or carbonated beverages. A dietitian can help you choose a balanced diet that will not interfere with your colostomy.
• Live your life Modern colostomy supplies are odor proof, designed to lie flat, and are not noticeable under clothing. Most colostomy patients are able to return to work and to many of the activities including sex they enjoyed before surgery.

Be sure to talk with your doctor or nurse about resuming your normal activities and about any concerns you have about living with your colostomy.