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The colon is about 1.7m (5ft) long and is roughly twice the width of the small intestine. It connects the small intestine to the rectum (the section before the anus).
The main function of the colon is to conserve water in the body by extracting it from the bowel contents.
The large intestine is the colon and the rectum.
A colostomy is a surgical procedure in which your colon is cut and brought through the abdominal wall to create an artificial opening (called a stoma). Your faeces can then be collected in a bag called a colostomy bag, which is attached to the opening, until the colon can heal or other corrective surgery can be done.
In most cases, a colostomy is a temporary measure. However, in certain situations a colostomy can be permanent because joining up the cut ends of the bowel is not possible. Many diseases of the bowel require a colostomy.
Why it is necessary
Why a colostomy is necessary
A colostomy may be performed for many reasons. A colostomy may be needed to divert the contents of your intestine if you have an inflammatory disease of the bowel.
If the muscles that control your bowel movements (sphincter muscles) are removed during surgery, you will be unable to control your bowels. You will need to have a colostomy so that your bowel contents can pass into a colostomy bag.
If you have colon cancer, it may be necessary to remove a length of your bowel containing the tumour. If you have a tumour in the lower part of your rectum, you will need to have the whole of your rectum and anus removed. In this instance, you will need a permanent colostomy.
Sometimes, a colostomy may be necessary to relieve a bowel obstruction, or there may be inherited bowel problems, such as a bowel defect that is present at birth. Colostomies may also be performed following an injury to the abdomen.
How it is performed
How a colostomy is performed
If a length of your bowel has to be surgically removed, you will usually need to have a colostomy at the same time.
A colostomy is performed by making a small cut through the wall of the abdomen to one side of the main incision (from where the section of bowel has been removed).The upper cut end of the bowel is brought out through this opening, known as a stoma, and the edges are stitched to the margins of the opening. The lower cut end may be closed internally or may also be brought out.
The bowel contents pass out through the colostomy and are collected in a waterproof bag, which is worn over the stoma. The bag is made of a special waterproof material, known as hydrocolloid, which is adhesive and sticks to the area without the need for adhesive tape.
Recent advances in surgical instrumentation have made a colostomy easier to rejoin in places that are difficult to reach. Until recently, it was technically impossible to rejoin the bowel if a length that involved the upper rectum had been removed. Linear and circular staplers are now routinely used in colostomy surgery. In many cases colostomies are temporary, and when the cut in the abdomen is closed it leaves only a minor scar. If it is a temporary colostomy, the final stage of restoring continuity of the bowel (joining it up together again) will often be done eight to 12 weeks later.
Some colostomies have to be permanent because joining up the cut ends of the bowel is impracticable. If the cancer is advanced, the whole of the rectum and anus may need to be removed and a permanent colostomy will be required.
Recovering from a colostomy
Following a colostomy operation, you may experience abdominal pain. If you do have pain in your abdomen, you will be given medication to relieve it. For two or three days after your operation you will be fed intravenously until normal bowel function is resumed.
You will probably have to stay in hospital for three to 10 days, and normal activity can usually be resumed within one to three weeks. However, heavy lifting must be avoided for four to six weeks.
A stoma nurse is specially trained to assist people who have had a colostomy operation. The nurse will give you dietary advice to minimise bowel problems and will ensure that the colostomy opening (stoma) on the abdominal wall and the surrounding skin remains healthy. The nurse will also take care of all the materials that you will need.
Caring for your colostomy
If you have a colostomy, it's very important that you take good care of it to avoid any problems occurring. Following the tips below will ensure that you and your colostomy remain healthy:
- Always wash your hands before emptying or changing your colostomy bag.
- Whenever you change your colostomy bag, clean the skin around the stoma using a mild soap (unless your GP advises otherwise).
- Empty the bag when it's a third full and before you go to bed.
- On removing the bag, cover the stoma with a piece of tissue to prevent leakage.
- Keep all your supplies within easy reach when you go to the toilet.
- If your stoma bleeds heavily, turns black, becomes swollen or smells strongly, you should contact your nurse or GP.
- If you have problems with wind, avoid eating food such as broccoli, cheese, beans and beer.
- Take plenty of exercise to help to reduce wind.
- To prevent your bag smelling, eat foods that have a natural deodorant, such as apple sauce, cranberry juice and yoghurt.
Joining your local colostomy support group can be a great way to get useful tips and advice from other people who have a colostomy. As well as providing you with practical information, colostomy support groups can also be a good source of moral support. To find out where your nearest group is, you can contact the Colostomy Association (see 'Useful links').