Colostomies typically take place in a hospital setting. Patients should follow their physician’s recommendations in preparing for the procedure. This may include making dietary changes or adjusting medication dosages or undergoing preparatory diagnostic procedures. Just prior to surgery, patients are placed under general anesthesia, meaning they are not awake during the procedure.

During the surgery, part of the colon is examined. The diseased part of the colon may be removed or disconnected. This is usually accomplished through an abdominal-perineal (A-P) resection in which the surgeon makes an incision in the abdomen and perineal area around the anus. If cancer or other disease is present, it is removed. A separate incision is made in the abdomen and the remaining section of colon is brought to the surface of the skin at this place. The section of colon is then folded back and stitched into place to form the stoma. The location of the stoma depends on how much of the colon is removed. For example, the commonly performed sigmoid colectomy produces a stoma on the lower left abdomen, near the location of the sigmoid colon. In some cases, the anus and rectum are also removed and the anal area is permanently closed.

Once the stoma has been created, a small disposable bag is securely fastened over the opening. This bag will collect the patient’s waste products and will need to be emptied and replaced by the patient periodically. When the colon has been connected to the stoma, the body usually adjusts well. If the ostomy is created near the end of the colon – as is often the case – the patient only loses a storage area and a sphincter that helps release the feces.

The portion of the colon that is connected to the stoma will determine which type of colostomy is performed. For example, a sigmoid colostomy involves the sigmoid colon, the last section of the colon. This type of colostomy is more likely to result in stool that is more fully formed, because a lot of liquid has already been absorbed by the time the stool reaches the sigmoid colon.

However, if the ostomy is created from a part of the colon that is higher up in the digestive tract – such as in an ascending or transverse colostomy – the patient may lose some ability to absorb water. This means that body wastes are likely to be less formed and more liquid.

Patients typically experience abdominal pain following a colostomy procedure. This discomfort usually subsides after several days and can be controlled with pain medication.

A patient may be hospitalized for a week to 10 days following the procedure. Prior to from the hospital, nurses review important information regarding colostomy care, including care of the site, ways to handle the colostomy bag and signs of possible medical complications. For example, bulges in the skin around the stoma may indicate the presence of a hernia.

Other complications that may require medical attention include:

• Severe cramps for more than two or three hours
• Unusual odor that lasts more than a week
• Significant change in stoma size and appearance
• Obstruction at the stoma
• Excessive bleeding from the stoma
• Watery discharge that lasts more than five hours
• Narrowing (stenosis) of the stoma
• Chronic skin irritation or ulcers

Immediately after surgery patients are given intravenous fluids and eventually clear liquids. Colostomies start to discharge body waste within a few days of the procedure. Often, there is a lot of gas and watery stool until the bowel settles down following surgery. Patients usually begin eating solid foods within a few days of the procedure.

Although normal activities can usually be resumed within one to three weeks, complete healing may take a couple of months. Until healing is complete, patients may be asked to refrain from certain activities, such as contact sports. Some patients report side effects related to sexual intimacy, but these usually are temporary.