Patient education: Colostomy or ileostomy surgery (The Basics)

What is a colostomy or ileostomy? — Colostomy and ileostomy are types of surgery where the doctor cuts the intestine (bowel) and attaches it to the skin. This creates an opening for bowel movements to leave the body. The opening is called an "ostomy."

The type of ostomy depends on which part of the intestine is connected to the skin (figure 1):

●Colostomy – This is when the opening connects to the large intestine (colon).

●Ileostomy – This is when the opening connects to the small intestine.

The hole in the skin is sometimes called a "stoma." This is the medical term for "opening." When you have an ostomy, your bowel movements will empty directly into a small plastic bag or pouch that is worn outside of your body. The bag protects you from odor and wetness.

Some people have an ostomy for a short time while their body heals. Other people have an ostomy for the rest of their life.

This surgery can be done in 2 ways:

●Open surgery – During an open surgery, the doctor makes a cut, or "incision," in the skin. This allows them to see directly inside the body when they do the surgery.

●Minimally invasive surgery – "Minimally invasive" surgery lets the doctor make smaller cuts in the skin. They insert long, thin tools through the cuts. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery).

You might be able to return to normal activities sooner if you had minimally invasive surgery than if you had an open surgery.

How do I prepare for an ostomy surgery? — The doctor or nurse will tell you if you need to do anything special to prepare. If possible, the doctor will have you meet with a nurse who specializes in ostomy care. They will help answer your questions and explain how you will care for the ostomy after surgery.

Before your procedure, your doctor will do an exam. Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Cleaning out your intestines – You might need to take medicines to empty your intestines before surgery. This is called "bowel prep."

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during an ostomy surgery? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will cut your intestine. Then, they will stitch 1 end of the intestine to the skin to make a stoma. If the other end of the intestine is sewn to the skin to make another stoma, it is called a "loop ostomy." If the other end of the intestine is stitched closed, it is called an "end ostomy."

●The doctor will close your incisions and cover them with clean bandages. They will place a small plastic bag or pouch over the stoma or stomas.

●The surgery takes about 2 to 4 hours to complete.

What happens after an ostomy surgery? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might be in the hospital for 3 to 7 days after surgery.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of an ostomy? — Your doctor will talk to you about all of the possible risks and answer your questions. Possible risks include:

●Bleeding

●Infection

●Problems with the stoma such as bleeding, narrowing, separating from the skin, collapsing below the skin, or sticking out too far

●Blockage in the intestine

●Hernia where the surgery was done

●Problems with the skin around the stoma

What else should I know? — Before you go home from the hospital, make sure that you know how to care for your ostomy. You also need to know how and when to empty or change your ostomy bag.

Ask what problems to look for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

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Patient education: Living with a colostomy (The Basics)
Patient education: Living with an ileostomy (The Basics)
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