is an artificial opening of the colon onto the anterior
abdominal wall. There are two types of colostomy: end (defunctioning),
and loop (decompressing).
colostomy is a defunctioning colostomy. It is commonly
sited in the sigmoid colon (in the left iliac fossa). It is
usually permanent (for example, following abdominoperineal
resection for cancer of the rectum).
colostomy can be created from any segment of the colon
(but usually the transverse or sigmoid colon). It is a
decompressing colostomy to relieve obstruction. It is usually
temporary (although in advanced cancer an emergency loop
colostomy to relieve obstruction may remain as a definitive
procedure). A loop of colon is brought to the surface and
supported for 5 to 7 days on a bridge. The stoma tends to be
large and irregular. Leakage can be a problem. A loop
colostomy does not always totally prevent the passage of feces
into the distal colon.
for the stoma must be carefully chosen and the method of care
discussed and explained. A stoma therapist should always be
involved. The type of ostomy pouch must be carefully selected
to suit the patient. Provided they have the manual dexterity,
patients are encouraged to manage their own colostomy as soon
as possible. In the postoperative period the stoma tends to be
swollen and the effluent thin. During this phase a drainable
bag can be useful so it does not have to be changed frequently
resulting in soreness.
care Inflammation of the peri-stomal skin affects 50% of
patients at some time.
There are two causes:
reaction to the appliance causes itching and redness with a
distinct margin. Change the type or brand of appliance.
dermatitis is due to prolonged contact with intestinal
contents. Desquamation and secondary infection can occur,
which may require steroid and antifungal creams. Inflamed skin
is protected with a layer of stomahesive paste. Irregularities
in the skin contour can be filled with Karaya gum, if
Fecal consistency Stomal diarrhea is managed by:
constipate include potatoes, white bread, rice, noodles,
cheese, bananas and peanut butter.
constipation is diagnosed by digital examination and can be
managed by an oil or phosphate enema followed by regular oral
laxatives and increased intake of fluid and dietary fiber.
A colostomy will not retain suppositories.
flatus and smell, modify diet. Reduce or banish onions,
cabbage, cucumbers, beans, lentils, fizzy drinks and
(sometimes) milk products. Fish, eggs and cheese also tend to
produce smell. Oral chlorophyll tablets can reduce smell.
Activated charcoal or unscented deodorizers can be added to
the bag. Odor-proof disposable bags are available, or flatus
can be allowed to escape through a charcoal filter fitted to
is seen most often with a temporary loop colostomy. The stoma
suddenly increases in size and protrudes. It can be reduced
manually as a temporary measure. It seldom recovers
spontaneously and requires surgery (to close or re-fashion).
If the protruding mucosa becomes purple or black the patient
will die of intestinal ischemia and necrosis without prompt
Parastomal hernia causes a bulge near the stoma on
straining. It can be left alone unless it causes difficulty
fitting the appliance or intermittent intestinal obstruction.
The stoma is best re-sited unless the patients prognosis is
Obstruction can be due to impacted feces, adhesions or
is quite common and usually trivial, due to mucosal
irritation. It stops with local pressure from a gauze pad. It
can (rarely) be due to a stomal secondary deposit, and local
cryosurgery can be helpful.
Rehabilitation The psychological implications of a stoma
are immense. Anxiety, depression, awareness of altered body
image and sexual problems are all common. Counseling by a
stoma therapist is important before and after surgery to
overcome the psychological problems.
The author and publisher have taken
precautions to ensure that the information in this book is
error-free. However, readers must be guided by their own
personal and professional standards of good practice in
evaluating and applying recommendations made herein. The
contents of this book represent the views and experience of
the author, and not necessarily those of the publisher.