Colostomy: Indications, Procedure, and Life with a Stoma

A colostomy diverts the colon through an abdominal wall opening (stoma) for stool evacuation into an external pouch. It may be temporary or permanent.

Common Indications

• Colorectal cancer: Resection with diversion (often temporary for low anterior resection).
• Diverticulitis: Perforation, abscess, stricture (Hartmann's procedure).
• Trauma: Colon injury requiring diversion.
• Obstruction: Malignancy, volvulus, stricture.
• Inflammatory bowel disease: Refractory ulcerative colitis, Crohn's colitis.
• Anorectal malformations: Congenital (imperforate anus).
• Radiation proctitis: Severe chronic injury.

Types by Location

• Ascending/Transverse: Liquid output, higher enzyme content → skin protection critical.
• Descending/Sigmoid (most common): Formed stool, predictable, easier management.

Procedure Overview

1. General anesthesia
2. Colon mobilized, divided
3. Proximal end brought through abdominal wall (usually left lower quadrant)
4. Stoma matured (everted, sutured to skin)
5. Distal end: closed (Hartmann's pouch) or mucous fistula

Living with a Colostomy

• Pouching system (1-piece or 2-piece) changed every 3–7 days
• Diet: individualized; chew well, hydrate, avoid blockage risks (nuts, corn, mushrooms initially)
• Irrigation (sigmoid only) for regulated evacuation
• OSTOMY NURSE (WOCN) essential for education, troubleshooting
• Support groups (UOAA) invaluable

Most people resume full, active lives. Modern pouches are discreet, odor-proof, and secure.