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What is a Colostomy?

A colostomy is created by surgically opening the large intestine (colon) to create a stoma. A portion of the large intestine (colon) or rectum is removed by the surgeon and the remaining portion of intestine is brought to the abdominal wall to create an opening called a stoma.

The visible part of the colostomy is the stoma. A typical stoma is placed around the abdomen and becomes the area where the stool now leaves the body. A colostomy has no controlling (sphincter) muscles so the body releases stool as it needs.

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Types of Colostomies

Sigmoid (Descending) Colostomy is the most typical ostomy surgery. This type of colostomy is created when the sigmoid colon is incised and brought to the surface of the abdomen. A sigmoid colostomy produces a regular bowel movement. Surgeons usually put the sigmoid stomas on the lower left side of the abdomen.

Transverse Colostomy is a surgical opening created in the transverse colon which results in one or two openings. This type of colostomy usually produces a stool that is more of a pasty consistency. The surgeon can choose to put the stoma on the upper, middle, or right side of the abdomen.

Loop Colostomy is created in the transverse colon, as well. This type of colostomy is actually one stoma, but with two openings. One of the stomas releases stool, the other, mucus.

An Ascending Colostomy is a rare type of colostomy. It is created in the ascending portion of the colon and the stoma is usually located on the right side of the abdomen.

A surgeon can make the colostomy temporary or permanent depending on the reason for the colostomy. A temporary colostomy allows the lower part of the colon to rest or heal. A temporary colostomy can have one or two openings. One of the openings releases stool; the other releases mucus. After the healing process, the doctor can reattach the large intestine and normal bowel function can resume.

A permanent colostomy involves the complete loss of a portion of the large intestine (colon), usually the rectum. The end of the remaining portion of the large intestine (colon) is brought to the abdominal wall to form the stoma.

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Reasons for a Colostomy

Colostomies are performed to alleviate or cure symptoms of a disease or an existing condition. Doctors will recommend a colostomy for several reasons, including:

  • Cancer
  • Diverticulitis
  • Imperforate Anus
  • Hirschsprung's Disease
  • Gastrointestinal Trauma
  • Colostomy Stomas

Stomas are typically round, are generally shades of red and pink, and are fleshy and moist. They also greatly vary in size (circumference). If you or your healthcare provider notes a stomal color of brown, purple, or black, your surgeon must be notified at once. A change in color may mean that the pouching appliance may be on too tight or an internal problem is present. Any color other than red or pink may indicate that the stoma is not perfused, which may result in death. No matter the reason for the change in stoma color, be sure to notify the surgeon immediately..

The frequency of the output of the stoma is affected by food and liquid intake. Medications and treatment prescribed by your doctor also have an effect. There may be slight bleeding when the stoma releases its output. If there is blood in the stool, or the bleeding is constant, you should contact your doctor.

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Colostomy Stomas

There are many different types of stomas as well, some of which include:

Normal Stomas

  • Protruding stomas protrude from the abdomen skin's surface. There is no difference if the abdomen is fleshy or flat. The protrusion varies in length and can slightly retract or extend throughout the life of the colostomy.
  • Flush stomas are flush with the skin's surface. The best way to deal with this type of stoma is to use a wafer system that has convexity. This will help the stoma stand out more against the skin so that a better seal will form.
  • Retracting stomas are pulled inward from the skin's surface. These types of stomas require a wafer system that has a high convexity. This helps the stoma stand out more against the skin and create a better seal and reduces irritation.
  • End stomas are made by dividing the intestine and bringing the closest end through the abdominal wall. An end stoma can be in either the large or small intestine.
  • Loop stomas can also be created in either the large or small intestine. A loop of intestine is brought to the abdominal wall. The portion above the skin's surface is made into two stomas. One opening releases the stool, the other releases mucus. Occasionally, a rod is put underneath the loop of the intestine to support the stoma on the skin's surface. The rod should only be removed under the physician's guidance.
  • Double-Barrel stomas can be made in either the large or small intestine. The intestine is separated and the two ends are brought through the abdominal wall and formed into two stomas. One opening releases the stool, the other opening releases mucus.

Challenging Stomas

  • Prolapsed stomas are usually found in overweight patients or patients with weak abdominal muscles. These types of stomas continually protrude 1 to 4 inches as time goes on. The treatment for a prolapsed stoma is to use a flat and flexible pouching system. This will prevent trauma to the stoma when pouching. Use of a support belt can prevent trauma and prevent the stoma from protruding further.
  • Parastomal stomas occur because of weak muscles in the abdominal wall that allow the intestine to come through the muscle, especially if the stoma is placed just outside of the rectus abdominus muscle. This can be prevented by wearing an abdominal support belt while lifting or exercising. A one-piece pouching system or a two-piece adhesive system helps adapt to any irregular contours of the skin and/or stoma.
  • Mucocutaneous Separation occurs when the sewn intersection between the stoma and the skin separates. This often occurs when you contract an infection or there is too much tension on the sewn stitch. If this occurs, call your physician. A wound care product can be used to absorb drainage and prevent excess soiling of separation from stool or urine.
  • Stomal Necrosis occurs when there is impaired or restricted blood flow to the stoma. Talk to your doctor if this happens. The stoma will slough off and a colostomy deodorizer will be used while the necrotic stoma is sloughing off.
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Colostomy System Products
Pouching systems
These types of systems include a one-piece or two-piece system. Both kinds include a skin barrier/wafer ("faceplate" in older terminology) and a collection pouch. The pouch (one-piece or two-piece) attaches to the abdomen by the skin barrier and is fitted over and around the stoma to collect the diverted output, which is stool, urine, or mucus. The barrier/wafer is designed to be as comfortable to the skin as possible and to protect the skin from the stoma output. Both two-piece and one-piece pouches can be either drainable or closed.

  • Two-Pouch Systems allow changing pouches while leaving the barrier/wafer attached to the skin. The wafer/barrier is part of a "flange" unit. The pouches include a closing ring that attaches mechanically to a mating piece on the flange. A common connection mechanism consists of a pressure fit snap ring, similar to that used in Tupperware™.
  • One Pouch Systems consist of a skin barrier/wafer and pouch joined together as a single unit. One-pouch systems are simpler than two-piece systems but require replacing the entire unit, including the skin barrier, every time the pouch is changed.
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Irrigation System
This is a special system that consists of an irrigation bag with a connecting tube (or catheter), a stoma cone, and an irrigation sleeve. Some colostomates can "irrigate" using a procedure similar to an enema. This cleans stool directly out of the colon through the stoma. A special lubricant is sometimes used on the stoma to make it easier to insert the catheter. Following irrigation, some colostomates use a stoma cap, a one- or two-piece system that simply covers and protects the stoma. This procedure is done for those who do not wish to wear a pouch.

These are the major types of colostomy systems. There are also a number of styles. Keep in mind, there is no right or wrong choice when it comes to colostomy systems. Each person must find the system that performs best for him or her. For instance, there are flat wafers and convex-shaped ones. There are fairly rigid and very flexible ones. There are barriers with and without adhesive backing and with and without a perimeter of tape. Some manufacturers have introduced drainable pouches with a built-in tail closure that doesn't require a separate clip.

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Life after a Colostomy

 

  • Work: With the possible exception of jobs that require heavy lifting, a colostomy should not interfere with work at all. People with colostomies are successful business people, teachers, doctors, clerks, writers, etc.
  • Sex and social life: Physically, the creation of a colostomy shouldn't affect sexual function. If there is an issue, it almost always relates to the removal of the rectum. In females, the position and structure of the vagina may feel slightly different. It is best to be open with your partner about how you are feeling. The colostomy itself should not interfere with normal sexual activity or pregnancy. It does not prevent one from dating, marrying, or having children.
  • Clothing: Usually, you are able to wear the same clothing as before surgery, including swimwear.
  • Sports and activities: With a securely attached and properly fitted pouch, you can swim, go camping, and participate in practically any type of sport. Caution should be taken in activities with heavy body contact. Special small pouches can be used if swimming or playing sports if desired. If you spend time in a sauna or hot tub, the heat may loosen the barrier. Be sure to always check for a proper seal.
  • Travel is not restricted in any way. Just remember to pack all of your ostomy supplies for the trip. Always keep your supplies where you can easily reach them.
  • Bathing and showering may be done with or without the pouch in place. If you shower/bathe with your pouch off, make sure that you choose a soap that is oil and residue free. These types of soaps will not affect the adhesive the colostomy system uses.
  • Diet: Unless your doctor has prescribed you a specific diet, there should be no diet restrictions and foods can be enjoyed as before.
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Learning How to Care for Your Colostomy

There are very important things to remember when caring for your colostomy.

  • Empty your pouch frequently. Never allow the output to reach a certain point (1/3 or ½ full) in the collection bag. A full pouch becomes heavy and may break loose from the skin. A full pouch is also more difficult to drain.
  • Replace your entire pouching system at least three times per week. For children and infants, the pouching system needs to be changed more frequently.
  • Plan on changing your pouch in the morning before your colostomy becomes too active.
  • Always care for your skin by using a clean washcloth or wipe, and soap with no oils, fragrances, or dyes.
  • Make sure your skin is completely dry. Constantly check for any color changes or visible signs of irritation.
  • Be sure that you have a Colostomy System in place that fits securely and comfortably.
  • For additional information contact your physician.


There are many options for colostomy systems and supplies, and we know that it can be overwhelming trying to find the system that performs best for your preferences and your lifestyle. It is not uncommon to try several types of colostomy supplies and systems until the best solution is found to fit your individual needs. Most importantly, there is no reason to stay with a poorly performing or uncomfortable pouching system.

Liberator Medical is here as both your colostomy supplies provider and a support system. Through Liberator Medical's Catheter Supply-Care Program*, our Supply-Care Specialists will work directly with your physician and/or insurance company to make sure you get the care you deserve. We're committed to ensuring your comfort, convenience, and privacy with discreet supply delivery and representatives always available to answer your questions.

Contact Liberator Medical at 1-866-643-0956 to learn more about our Catheter Supply-Care Program or simply to speak with a representative today.

*Co-payments, deductibles, and conditions apply.

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