Colostomies: Types & Care

Most nurses know that a colostomy is an opening of the abdomen in which the colon produces stool from via a stoma, rather than the rectum. If you have worked in the hospital, you probably have taken care of a patient with a colostomy. There are specific indications in which a patient would need a colostomy, and there are several types. Nursing care and education for these patients is important for their life going forward with a colostomy.

Colostomies: Types & Care

Indications for a Colostomy

 There are several reasons that a patient would need to have a colon resection and receive a colostomy. The one that comes to mind first is cancer. If the patient has a colonoscopy and cancer is found, then they are referred to a surgeon as well as an oncologist. Patients who have chronic inflammatory diseases such as Crohn's or ulcerative colitis that do not heal could be referred to have surgery. Sometimes there is an obstruction or the blood supply to a certain part of the colon is cut off, and the bowel essentially dies, then that section of the colon would be resected. Some children are born with birth defects, and a colon resection with colostomy is needed. Chronic diverticulitis can cause strictures from scar tissue and abscesses, and sometimes it can rupture. These patients would need a colostomy to allow the bowel to heal.

Types of Colostomies

Depending on the location of the issue in the colon determines what kind of colostomy the patient will receive and where on the abdomen it is located.

Loop Transverse Colostomy

This type of colostomy leaves the ascending colon and hepatic flexure, and the rest is removed1. It has two stomas (on the right upper abdomen) that look like one large one; one only produces mucus, and the other stool1. 

Double-barrel Transverse Colostomy

The same area is resected as in the Loop Transverse (also on the right upper abdomen), except the bowel is separated. There are sometimes two stomas, and when there aren't, the bowel is sewn closed, and mucus will then come out of the orifice.

Ascending Colostomy

This type of colostomy takes out the ascending part of the colon, which doesn’t leave much active bowel. This one is on the right lower abdomen.

Descending Colostomy

A large part of the descending colon is resected along with the sigmoid and rectum. This stoma is located on the lower left of the abdomen and can have a single or double barrel stoma.

Sigmoid Colostomy

The sigmoid and rectal areas are removed; the stoma is also on the left lower abdomen and can have a single or double barrel stoma. 

Sometimes a colostomy is temporary and will be reversed after a certain amount of time. The colostomy is performed in order to allow the bowel to heal and rest from infection or surgery. For these patients, their bowels should return to normal function after a colostomy reversal. The most common type of colostomy used for temporary measures is the transverse colostomy1.

What to Expect

For each type of colostomy, the stool will differ. The stool from ascending colostomies will contain digestive enzymes that can irritate the skin. Which is why a well-fitted barrier is important. Transverse colostomies produce pasty or loose stool and descending, and sigmoid colostomies have more solid stool. 

Most hospitals have nurses that educate patients who undergo colostomies. There is also an organization called the United Ostomy Associations of America. They can provide education and support; they even have conferences where a person and their family can network with other people with the same condition. Educators give sessions on different topics, and companies bring their products for people to see.

There are two main types of pouches that the patient can choose from. The first one has the pouch and barrier together in one piece. The other is a two-piece system where the pouch can be removed from the barrier. Either one can empty from the bottom or the pouch needs to be removed to empty it. There are cases in which the patient can use a stoma cap. This is for the person who is having regular stools on a schedule.

Skin Care

Taking care of the skin around the stoma is very important. Cutting the opening for the stoma cannot be too tight or too big; it should be about ⅛ larger than the stoma. This will protect from leakage and skin irritation1. The pouch should be secure, so it won’t leak and be easy to remove and put back on. Patients can shower with the pouch on if they want to. If not, they must totally dry the skin before reattaching the barrier. Men can shave the hair around the stoma so that it will adhere better. The pouching system should be changed regularly, according to the manufacturer's instructions.

Problems Patients Face with Colostomy

Gas can be a problem, and if it is, there are certain foods to avoid. Vegetables like broccoli and onions can cause gas. Other foods to stay away from are eggs, beans, milk, cheese, or carbonated drinks1. Digestion is very individual, so the patient can eliminate foods to see what causes the most gas for them. Smaller meals and regular eating may help to prevent gas as well.

What most people think of when talking about a colostomy is odor. The same foods that cause gas often cause more odor in the stool. Emptying the pouch often can help decrease the odor, and there are pouches that are odor resistant. There are also medicines that can help with an odor problem, such as chlorophyll tablets1. 

If a patient develops ulcers around the stoma, they should see their doctor. People with colostomies can develop constipation or diarrhea. This can be caused by the same things that it caused people without a colostomy. The remedies would be very similar such as eating high-fiber diets and drinking plenty of water. 

Some patients that don’t have their rectum will still feel pressure or the urge to have a bowel movement. This is normal, and it is reported that sitting on the toilet may help. There are those that have a short bowel and nutrients aren’t absorbed as they were before surgery. These patients need to be closely watched by their doctor to make sure they are staying healthy.

Conclusion

Having a colostomy is a life-changing event. It is a lot more care to have normal bowel movements and requires a lot of education before and after surgery. Taking care of colostomy patients can be challenging for the nurse. There are a lot of emotions to work through for the patient to be able to learn how to adjust to their new lifestyle.

What has been your experience with colostomies?

Or, do you have one and can share from personal experience?

References/Resources

1American Cancer Society: Colostomy Guide

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Brenda F. Johnson

About Brenda F. Johnson, MSN

Gastrointestinal Columnist

Brenda F. Johnson, BSN, RN Specialty: 25 years of experience in Gastrointestinal Nursing

60 Articles   326 Posts

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Thanks for your article. It was very informative.

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Specializes in MICU/CCU, SD, home health, neo, travel.

I had a temporary colostomy for 4 months after a partial colectomy where the reanastamosis failed. I hated it. Then when they did the reanastamosis I got a temporary ileostomy for another 4 months to allow it to heal properly. I hated that even more because it was impossible to get a good seal no matter how hard I tried and it leaked and was super messy. 

When I was in the hospital after the surgery that resulted in a colostomy, I asked a nurse on the second day after my surgery to please change my bag for me. It was not during the time when I knew she would be most busy but I felt she was unnecessarily nasty about it anyway in the way she asked me who was going to change it when I got home. I told her I was, but  I still needed some help as it was new to me. She said, "You are a nurse, aren't you?" and I said, "Yes, and it's different when it's your own." I was tempted to speak to her manager about her attitude but I didn't.

Please remember that even if your patient is "in the same business", so to speak, they are looking at things from a different angle and it is all new to them. Even if they have experience with something, it's different when it's them that's experiencing it.

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Specializes in Gastrointestinal Nursing.
22 hours ago, CeciBean said:

I had a temporary colostomy for 4 months after a partial colectomy where the reanastamosis failed. I hated it. Then when they did the reanastamosis I got a temporary ileostomy for another 4 months to allow it to heal properly. I hated that even more because it was impossible to get a good seal no matter how hard I tried and it leaked and was super messy. 

When I was in the hospital after the surgery that resulted in a colostomy, I asked a nurse on the second day after my surgery to please change my bag for me. It was not during the time when I knew she would be most busy but I felt she was unnecessarily nasty about it anyway in the way she asked me who was going to change it when I got home. I told her I was, but  I still needed some help as it was new to me. She said, "You are a nurse, aren't you?" and I said, "Yes, and it's different when it's your own." I was tempted to speak to her manager about her attitude but I didn't.

Please remember that even if your patient is "in the same business", so to speak, they are looking at things from a different angle and it is all new to them. Even if they have experience with something, it's different when it's them that's experiencing it.

Ceci, first off, I'm sorry that you had to go through the surgeries. I hope that all is better with your health. I understand what you are saying about nurses treating nurses. I too had a nurse treat me that way post surgery. It's a reflection of their lack of skill, confidence, whatever. But nurses should treat their patients with the same respect as anyone, and not assume that we are equipped to deal with things post op as if we hadn't just gone through a traumatic surgery, anesthesia, etc. I did complain, and you have every right to do the same. How are things for you now?

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