opening in the large intestine so that it can discharge
its contents through the abdominal wall. Colostomies can be temporary
A temporary colostomy may be performed when cancer has attacked the bottom end of the intestine and the surgeon wishes to divert the bowel contents to facilitate treatment. Persons suffering from severe inflammation of the intestinal wall also may require a temporary colostomy. If the disease is so severe that the rectum must be removed, a permanent colostomy is unavoidable.
In the operation to form a temporary colostomy, the surgeon makes an opening in the abdomen and brings to the surface the tip of a loop of the transverse colon (the middle portion of the large bowel). Once the disease responsible for the temporary colostomy has been successfully treated, the opening is closed. Usually about three months elapse before closure is possible.
In a permanent colostomy the lowest section of healthy intestine is fastened to the skin of the abdomen. The opening, or stoma, is positioned to one side of the midline so that the colostomy appliance (collection bag) will be in a comfortable site.
In the first few days after the operation, the discharge is fluid and collects in a transparent disposable bag attached to the stoma by an adhesive seal. The bag must be changed at least once daily. Later, when the feces become more solid, one may want to switch to bags attached by a plastic flange. These need to be changed less often and are less likely to cause skin irritation. Cosmetic factors are of great importance, and “stoma therapists” can advise one on the use of aids to improve security of adhesion and reduce odor.
Once the immediate postoperative period is over, one may find that one’s colostomy empties only two or three times a day. Often the timing is so regular that the bag can be emptied before one leaves for work in the morning. By paying careful attention to one’s diet, problems with excess gas production or diarrhea can be minimized. A permanent colostomy need hardly restrict one’s normal physical and social activities.