Colostomy: Purpose, Procedure and Care Tips

March 3, 2025

What is Colostomy?

A colostomy is a surgical procedure in which a portion of the large intestine (colon) is redirected through an opening in the abdominal wall, known as a stoma. This procedure allows waste to exit the body into a colostomy bag, bypassing the rectum and anus. It is a safe procedure for a variety of diseases like inflammatory bowel disease (IBD), colorectal cancer, trauma, and perineal fistulas, etc. It can either be temporary or permanent, depending on the underlying condition and the possibility of bowel restoration. Certain lifestyle changes are necessary after colostomy, which includes taking care of a stoma, dietary modifications, and adjustments to daily activities.¹

A woman looking at her colostomy bag

The colon is responsible for absorbing water and forming stool, which is typically excreted through the rectum and anus. However, in patients requiring a colostomy, this natural route is altered, and stool is expelled through the stoma into an external collection bag. The texture of the stool depends on the location of the colostomy—closer to the rectum results in more solid stool, while a higher position produces softer stool.²

Why is a Colostomy Performed?

This procedure is performed in lower bowel pathologies or diseases in which new pathways for passing the stool are required. Some of the indications are listed below:

Inflammatory bowel disease – severe cases of Crohn’s disease or ulcerative colitis requiring bowel rest
Diverticulitis
Abdominal abscess
Injury to the bowel or rectum
Obstruction or blockage of intestines.
Cancer of the colon
Hirschsprung disease – a congenital condition where stool builds up due to missing nerve cells in part of the colon
Fistulas in perineum
Fecal incontinence

Types of Colostomy

A colostomy may be temporary (for a few months) or permanent (for a lifetime), depending on the reason for surgery.³

Temporary Colostomy

Surgeons perform temporary colostomies to allow the colon to heal after injury or surgery. By diverting stool away from the affected area, the bowel gets time to recover. Once healing is complete, they may reverse the colostomy.

Permanent Colostomy

When the part of the colon is not salvageable, surgeons perform a permanent colostomy. For example, in the case of cancer, a permanent colostomy is useful because they resect the damaged bowel and form the stoma.

Loop Colostomy vs. End Colostomy

A loop colostomy is typically temporary. The surgeon brings a loop of bowel through an abdominal incision and opens it, forming two stoma openings—one for stool and the other for mucus drainage. This allows the lower bowel to rest while still maintaining continuity.

An end colostomy is usually permanent. The bowel is cut, and the active portion is stitched to a stoma for stool elimination, while the remaining inactive bowel is sealed. If the anus remains intact, it may continue to drain mucus naturally.⁴

Double Barrel Colostomy

This involves creating two separate stomas in the abdominal wall after completely dividing the bowel. One stoma expels stool, while the other (mucous fistula) drains mucus from the inactive bowel. Unlike a loop colostomy, the bowel is fully divided in this procedure.⁵

Procedure of Colostomy

Before the Procedure:

A colostomy is a major surgical procedure that has certain prerequisites. Before the surgery, the patient undergoes a pre-assessment in which he meets the surgeon. The healthcare provider provides the patient with all information about the procedure, its risks, lifestyle changes, and possible complications. The patient then signs the consent forms. Blood samples and an EKG might be taken to check health.
The patient will need to avoid eating or drinking anything six hours before the operation.
Once the patient reaches the hospital on the day of the operation, the hospital staff changes him into a gown and takes him to the pre-op room to wait for his turn. Once in the operating room, the medical team administers anesthesia before starting the surgery.

During the Surgery:

This procedure can be done in two ways:

Open surgery

The surgeon gives an abdominal incision to access the abdominal organs. It is highly invasive and has a longer recovery time

Laparoscopic surgery

It is a less invasive method involving small incisions. A surgeon inserts a laparoscope through one incision, typically near the umbilicus. Surgeons use the laparoscope, a tiny lighted camera, to visualize the abdominal cavity, while they employ other incisions to introduce additional surgical instruments.

The surgeon determines the type of colostomy (end, loop, or double-barrel) based on the underlying condition. Depending on the specific part of the bowel that the surgeon cuts, the colostomy is classified as ascending colostomy (involving the ascending colon on the right side), transverse colostomy (involving the transverse colon), and descending or sigmoid colostomy (involving the descending colon on the left side).

After the Procedure:

A stoma bag collects stool, and the stool’s consistency varies based on the location of the colostomy:

Ascending colostomy – Produces loose, liquid stool, as it comes from the small intestine and has not had time to solidify.
Transverse colostomy – Stool is semi-formed but still softer than usual.
Descending and sigmoid colostomies – Stool is more solid, resembling normal bowel movements.

All about Stoma

A stoma is a surgically created opening in the abdominal wall, lined with intestinal tissue.
Stoma is normally moist due to mucus production, and it is pink or red in color due to increased blood flow in it. On rubbing and irritation, it might bleed a little. When a stoma gets pale, or dark, it indicates reduced blood supply. Immediately report to your medical professional in such cases.
Some stomas protrude (budded stomas) to ensure stool empties directly into the bag without leaking onto the skin. Ileostomies, in particular, often require a protruding stoma due to the enzymatic nature of small bowel contents, which can irritate the skin.
Stoma might hurt a little immediately after the operation until it heals. Stomas are not normally painful afterwards and no other sensations are felt in the stoma. The discomfort arises from the leakage or sore skin around the stoma.
Having a stoma has an impact on the emotional and social life of a person. Talking to a health professional and getting the required psychological and emotional help is necessary.

Taking Care of Stoma & Colostomy

Living with a colostomy bag requires lifestyle changes and special care.⁶

Change the colostomy bag every 5-7 days or as needed, depending on the type of appliance and stool output.
Any changes or irritation of surrounding skin should be reported to the doctor.
Wash hands and put gloves on before changing the bag.
After removing the bag, empty its contents.
Clean the area of colostomy and surrounding skin with fresh water.
The stoma should be moist and pink to red and the surrounding skin should be normal.
Dry the surrounding skin before applying the new bag.
Safely dispose of the previous bag, wash your hands, and document the whole process.

Mental health support is another necessary element in individuals with permanent colostomies. Reassurance and behavioral therapies might be needed.

Benefits vs. Risks of Colostomy

Temporary colostomy allows the proper healing of infected, cancerous, damaged, inflamed, ulcerated, and operated bowel areas. Healing typically takes weeks to months, though rarely longer. If the path of bowel contents is not diverted by a stoma, appropriate healing is not possible.
Permanent colostomy is beneficial when a part of the gut is irreversibly damaged and can not be saved. Keeping dead and ischemic tissue inside the body is harmful.
The risks associated with the procedure are as follows:

Bleeding
Damage to surrounding structures
Infection
Anesthesia complications
Stoma complications (e.g., necrosis, retraction, or leakage)

Recovery & Outlook
After surgery, patients gradually transition back to a normal diet, starting with liquids, then soft foods, before resuming solid foods. To prevent gas and discomfort, doctors advise avoiding high-fiber and gas-producing foods initially.
Immediately after the operation, the stoma looks bruised and red with discomfort and pain. It settles gradually with pain medications as the soma heals.
It takes a few days for the bowel movements to get regular.
Most people are able to feel when the contents are about to come out of the stoma but unlike the anus, there is no voluntary control over it.
Some people with colostomy continue to feel bowel movements, which are called Phantom Bowel Movements. They are similar to phantom limb syndrome. Sitting on the toilet helps in subsiding these phantom movements. Moreover, if the anus is intact, mucus might come out after the phantom bowel movements.
Most people wear colostomy bags all the time as modern bags are easy to hide under clothes. People who are able to tell when the content will come out might choose to wear the bag at that time only.

Colostomy Reversal

Surgeons reverse temporary colostomies once the bowel has healed appropriately. It is a simple process. They assess the abdomen by making an incision around the stoma. Then stitch the two cut ends of the gut back together. While an end colostomy can also be reversed, it requires a more complex surgery with a larger incision and a longer recovery period.⁷

Complications of Colostomy

The patient may develop the following complications after undergoing colostomy.⁸

Early Complications

The early complications (within 30 days of operation) of stoma include:

Skin irritation
More than 1500ml output in the stoma
Necrosis of stoma
Bleeding
Stoma retraction (pulling inward)
Parastomal abscess
Mucocutaneous separation
Fluid and electrolyte imbalance
Bowel obstruction

Late Complications

The late complications include:

Stomal stenosis (narrowing of the stoma opening)
Parastomal hernia (bulging of intestines around the stoma)
Fistula formation (abnormal connections between organs)
Granuloma formation (inflammatory tissue growth)
Stomal varices (abnormal blood vessels around the stoma)
Stoma prolapse (stoma protruding excessively)
Bowel obstruction due to adhesions
Ischemia of the stoma (restricted blood supply)

In case of any symptoms, consult your doctor immediately

Colectomy vs. Colostomy

A colectomy refers to the surgical removal of a portion or the entire colon. It is often performed due to conditions like IBD, colorectal cancer, or bowel obstruction. A colostomy is often done after a colectomy.⁹ If the remaining colon after colectomy is attached to the abdominal wall through an opening, it is called a colostomy. However, not all colectomies result in a colostomy—some may allow for direct reconnection of the intestines.

Colostomy vs. Ileostomy

A colostomy is an operation that connects the colon to the abdominal wall. A colostomy bag collects the semi-solid contents of the large bowel. Generally, medical practitioners place the stoma in the left lower quadrant of the abdomen. However, an ileostomy involves bringing the ileum (the final portion of the small intestine) to the abdominal wall, typically placed in the right lower quadrant. Because the small intestine absorbs fewer fluids than the colon, ileostomy output is liquid to semi-liquid.

In conclusion, a colostomy is a surgical procedure that diverts stool by creating an opening, or stoma, in the abdominal wall after removing or bypassing a section of the bowel. While it is generally safe and offers significant benefits, it is not without risks. Proper post-operative care and timely medical attention for potential complications are essential to ensure a smooth recovery and an improved quality of life for patients.

Refrences

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2
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Krishnamurty D, Blatnik J, Mutch M. Stoma complications. Clin Colon Rectal Surg [Internet]. 2017 [cited 2023 Nov 26];30(03):193–200. Available from: https://pubmed.ncbi.nlm.nih.gov/28684937/ PMID: 28684937
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