A colostomy, or ileostomy, is a connection between the colon or small intestine and the skin created to divert stool away from areas of injury and anastomosis further down from the colostomy or ileostomy. They are also used to divert stool away from an obstruction or from open wounds in the perineum. Ostomies may be created when an emergency colon operation is needed and it is unsafe to put the intestine back together in the abdomen. Severe wound problems in the perineal or rectal area, such as pressure sores, sometimes need to have stool diverted in order to allow healing. Some cancer operations require an ostomy.
A colostomy is a connection between the colon and the skin. An ileostomy is a connection
between the small intestine (ileum) and the skin. An end ostomy is when the end of
the intestine is connected to the abdominal wall. A loop ostomy is when a portion
of the side wall of the intestine is connected to the abdominal wall and is usually
more easily reversible than an end ostomy. A loop ostomy may be used when the condition
requiring the ostomy is expected to resolve soon.
Colostomy reversal involves reconnecting the intestine and removing the ostomy from the skin. For loop ostomies, this can usually be done through a small incision only around the site of the ostomy. For end ostomies, reversible may be able to be done laparoscopically, but often requires an open operation.
Prior to colostomy creation, you will be asked not to eat or drink anything after midnight prior to your surgery. You will be given specific instructions from your surgeon or anesthesiologist about which medications you should or should not take prior to your surgery. You should not take any blood thinning medications at least 5 days prior to your operation. This should be discussed with your surgeon at your preop visit.
You may be prescribed a bowel prep in order to clean the stool from your colon before surgery. There are several different types of bowel prep and this is not always needed, depending on the exact operation you are having and the preference of your surgeon. If you are given a bowel prep, it is very important you take the full prep as directed.
Your recovery will vary depending on the type of colostomy operation you have and the disease you have. Elective colostomy operations are often done laparoscopically and your hospital stay may be as little as 1-3 days. Urgent or emergency operations are sometimes needed, which are more likely to have a longer recovery time and are a higher risk for developing other complications, usually related to the underlying illness and not the ostomy itself.
For ostomy reversals, recovery will also vary depending on the type of colostomy being closed and whether it can be done laparoscopically or open.
You may resume activity gradually beginning shortly after surgery. You should begin walking the night of surgery or the following morning and continue to increase as you are able. Increased activity reduces the risk of blood clots, and improves breathing to prevent pneumonia.
While in the hospital, you will be asked to walk several times a day, beginning no later than the morning after surgery in most cases. You will usually need assistance to get out of bed, especially the first time, since you will likely have IV tubing and sometimes drains or catheters that need to be disconnected in order for you to get around. A Physical Therapist often helps you get out of bed and regain your strength after major surgery. Walkers, canes or crutches will be made available as needed. In some cases a short stay in a rehabilitation center or short-term nursing home may be needed. This is uncommon and usually only needed for people who had to have emergency operations or had some other complications and a long hospital stay.
After discharge from the hospital, avoid lifting more than 10 pounds for 4 weeks and excessive bending or twisting for 1-2 weeks following surgery. This is to allow healing of the incisions, specifically the fascia (the strongest layer of the abdomen wall) and decrease the risk of a hernia developing. For laparoscopic colostomy surgery there may be less risk developing a hernia and it may be safe to return to unrestricted activity sooner.
Avoid driving until you no longer need narcotic pain medication and you feel you can make rapid movements unimpaired by pain. Driving while taking narcotics can impair your ability to drive safely.
You should be able to return to work in 2-4 weeks, depending on the operation you had and whether or not you need additional treatment or rehabilitation. If your job involves heavy lifting and light duty is not an option, you may need up to 4 weeks off work to recover
Wound Care, Drain Care, Ostomy Care.
If your colostomy operation was done laparoscopically, small gauze and clear tape dressings or a small white dressing is typically placed over each incision. These dressings can be removed 48 hrs (2 days) after the operation. These will probably be removed before you leave the hospital. Below this dressing are small brown or white pieces of tape (called Steri-Strips); these will fall off on their own within 1-2 weeks or be removed at your follow-up visit with your surgeon. If your surgeon gives you specific instructions other than this, please follow those instructions.
If your colostomy operation was done open, you will probably have a long white dressing or gauze and tape dressing over your incision. This dressing can be removed 48 hrs (2 days) after the operation and will probably be removed before you leave the hospital. Your incision will probably be closed with small metal staples. These will be removed at your postop visit, usually 10-14 days after your operation. If you are in the hospital more than a week, these may be removed before you go home.
After an ostomy is created, you will see a specialized nurse (call a stoma therapist) during your hospital stay. They will help you to understand how to use the appliances and bags needed to control your stool output from the ostomy and be able to provide you with the necessary supplies. Many ostomies are reversible, meaning your colon may be able to be put back together to get rid of the ostomy. Talk to your surgeon about the risk of getting an ostomy prior to elective operations. If you had an emergency operation that required an ostomy, talk to your surgeon about the possibility of closing the ostomy.
If you had a loop ostomy created, you will have some sort of bar below the intestine that holds the intestine in place as it heals. This is usually removed in 3-6 weeks in your surgeon's office.
After surgery to close an ostomy, the portion of the skin incision where the ostomy used to be is left open to decrease the risk of infection. Having a colostomy reversal operation also increases your risk of infection of other incisions, which may require the incision to be opened. In either case, a damp gauze dressing is placed in the wound and will need to be changed 2-3 times a day. While in the hospital, this dressing change will be done by your surgical team or nursing staff. You and your family will be given instructions on how to perform dressing changes before going home. Incisions that need to be treated this way usually take 2-4 weeks to completely heal, depending on the size of the wound. In some cases, you may qualify for assistance from a nurse who will come to your home to help supervise these dressing changes. You may be seen by a specialized wound care nurse who will help educate you wound care.
You may shower after 48hrs (after the gauze and clear tape dressing is removed). It is okay to get soap and water on the incisions. Pat the area dry. You will be able to shower in the hospital after 48hrs as well. Your nursing staff can assist you if needed. It is not recommend that you submerge underwater (in a bathtub, pool, or hot-tub) for at least two weeks post-op. Even if you have an open wound that needs dressing changes, you can still shower normally. Simple remove the dressings, let soap and water run through the wound, pat the area dry and reapply the dressing afterwards.
If you notice drainage from your incisions, particularly if it is thick and foul-smelling or associated with a fever, you should contact your surgeon.
If you notice redness around your incisions, especially if it is getting worse or associated with drainage or a fever, you should contact your surgeon.
Medications - Pain Management
Pain after a large open colostomy operation can be significant. You will probably be placed on a device that provides pain medication to you whenever you press a demand button (called a PCA, or Patient Controlled Analgesia). Once you are able to start taking an oral diet, the PCA will be weaned off and you will be started on oral pain medications. It is very important to us that your pain be well controlled. Your pain should be controlled well enough for you to begin getting out of bed the morning after surgery and for you to perform deep breathing exercises. If you have pain that is not well enough controlled to allow you to walk or breathe deeply, talk to your surgery team. You may need to have your pain medications changed or increased.
If your colostomy operation is performed laparoscopically, pain is typically just around the site of incisions. However, you may have more general abdominal pain or even shoulder pain due to the air used to inflate your abdomen during the surgery. Pain from air inflation will go away in 24 to 48 hours.
You will be discharged with pain medication, typically a mild to moderate strength narcotic. Take as needed and as prescribed. You may also take over-the-counter medications such as advil for pain. Most narcotic medications prescribed are combined with Tylenol (acetaminophen) and you should not take additional Tylenol if you are taking a narcotic medication that already contains Tylenol.
You will likely be prescribed a stool softener when you go home. Pain medications can cause constipation and a stool softener may help. You may also be given nausea medication if you have experience nausea or vomiting from taking your pain medication.
Unless otherwise instructed, you should be able to resume your usual home medications the night of or the morning following your surgery.
Click here for more detailed information on commonly prescribed medications
Diet & Bowel Care
You may resume your usual diet as you feel able unless otherwise instructed. You may have some abdominal bloating or mild nausea after your operation, so eat slowly and only what you can tolerate. Your appetite may be less than usual but typically returns to normal within a week or two. Be sure to drink plenty of liquids (6-8 glasses of water or juice each day) if your appetite is not very good.
If your surgery required creation of an ileostomy you may have too much liquid stool output. If your ileostomy puts out more than a liter (about a quart) a day, you may need medications to help control this in order to prevent dehydration.
It is common to have some constipation after surgery, especially when taking narcotic
pain medications. You will probably be prescribed a stool softener when you are discharged.
If you are having trouble moving your bowels after surgery (if your stool is hard
or you have to strain excessively) you may need a laxative. If you do feel like you
need a laxative after having colon surgery, you should call your doctor before taking
any over the counter medications. If your doctor says it is OK to take a laxative,
over the counter medications can treat this well. Senna, Miralax, or dulcolax are
some of the most common and are available at most drug stores or grocery stores. Take
If you are having trouble having a bowel movement AND have abdominal bloating, nausea or vomiting, and not passing gas, you should call your doctor.
You may notice blood in your stool during the first few bowel movements following colostomy surgery. This usually is caused by small amount of bleeding at any site where your intestine had to be divided and put back together (called an anastomosis). It usually looks like thick clots or mixed in with the stool. This will often look like bright red blood once in the toilet bowl. If there is a large amount of blood, if the bleeding persists, or if you have any light-headedness or dizziness, you should call your doctor.
You will be given a date and time to see your surgeon following surgery, usually 3 weeks if done laparoscopically and 10-14 days if done open. If you are discharged late in the day or over the weekend, you will be given a number to call the following business day for an appointment. If you are having trouble making an appointment, you should call your doctors' office directly for assistance.
If your ostomy operation was for cancer, you will likely need to see other doctors for continued care. Oncologists are medical doctors who specialize in the non-surgical treatment of cancer. If you need chemotherapy or radiation therapy before or after surgery, they will be the team that coordinates and administers that care. Ask your surgeon or Oncologists about clinical trials that you may qualify for in the treatment of your cancer.
If your ostomy operation was to divert stool away from a groin or perineal wound, you will need continued therapy to that area and possibly other surgeries, depending on the problem you have. This additional treatment may be with specialized wound therapists, Plastic surgeons or other surgeons.
Call Your Doctor If: