Colorectal Cancer: Tips for Living with a Colostomy

The colon is the part of the large intestine that goes from the small intestine to the rectum. Food enters the colon from the small intestine. The nutrients and water are absorbed by the colon as the food passes through it. Then the waste is stored as stool in the rectum until it can be passed out of the body.

The colon has 3 main parts:

• Ascending colon. This part goes up the right side of your belly. It’s the part of the colon where the food enters from the small intestine.

• Transverse colon. This part runs across the upper part of your belly.

• Descending colon. This part runs down the left side of your belly and ends at the sigmoid colon. The sigmoid colon connects to your rectum. As waste moves through the large intestine, water is absorbed, and stool becomes more formed.

An ostomy is an opening through the skin that is created with surgery. A colostomy is when the opening is made with part of the colon. Stool that comes out is soft to firm. A colostomy may be needed when the colon isn't working correctly or when part of the colon needs to be removed.

An ostomy may be either temporary or permanent. When you have an ostomy, you need to wear a special pouch over the stoma to collect the waste.

A colostomy may be created at any point along the colon. The type of stool that comes out depends on where the ostomy is. For example:

• If the ostomy is toward the lower end of the colon, more liquid is absorbed, and the stool will be more solid.

• If the ostomy is very low along the descending colon, near the rectum, stools are well-formed. They are a lot like stools from a normal colon.

• If the ostomy is on the ascending or transverse colon, less water is absorbed. The stools are looser and more watery. They pass through the stoma more quickly and easily.

In some cases, surgery is done within a few days of diagnosis. It's done to remove as much of the colon cancer as possible. If a lot of the colon has to be removed or the colon needs time to heal, a colostomy might be needed. A colostomy can be temporary or permanent. Your healthcare provider will talk with you about surgery so you know what to expect and how your body will work afterwards.

Before the surgery, your bowels will need to be cleaned out. You will have to drink a special liquid to do this.

You will meet with an enterostomal therapy nurse or wound, ostomy and continence nurse before surgery. You will learn about the ostomy and look at your stomach to find the best place for the stoma. The nurse will teach you about the type of colostomy you'll have and how to care for it. They will answer your questions and address any concerns about ostomy care.

After surgery, you will be given pain medicine as you heal. You will stay in the hospital for a few days but will need to sit up and walk short distances shortly after surgery. Your stoma will be checked by the nurse every day. It may take a few days before you are ready to look at the stoma. This is normal. The nurse will be there to support you and answer any questions.

When you go home, you may need a home healthcare nurse to help you with your stoma care. They will also take care of your surgical wound to make sure you heal correctly. You will be told:

• How to clean and care for your skin

• How to prevent infection

• Changes that you should watch for and tell your healthcare provider about

• What medicines to take, what they're for, and how to take them

Most colostomy appliances are a 2-piece pouch system. There are different brands, sizes, and styles. You may need to try a few until you find the one that works best for you. The system consists of:

• A flange. This is a rubbery circle that sticks to your skin around the stoma. It can be cut to fit your stoma and protect the skin around it.

• A pouch. This is a small bag that attaches to the flange. It collects the stool. Some are closed and some can be drained through an opening at the bottom.

Your nurse will teach you:

• What supplies you will need and where to buy them 

• How to empty and clean the pouch

• How to change the pouch and flange

• How to get the best seal so the pouch doesn't leak 

• How to shower while wearing the pouch

Your skin must be clean and dry before placing the flange. This is so the flange sticks (adheres) well for a long time. You may dry your skin with a hair dryer on the lowest heat setting, or just wait until your skin air-dries fully. Your flange may need to be changed more often in high heat or humidity, or if you exercise or sweat a lot.

Right after your surgery, you may have problems getting a good seal between the pouch and the flange. This can cause the pouch to come loose. As the wound around the stoma heals, it will be easier to get a good seal.

Finding out that you need an ostomy can be stressful. The idea of living with a bag on your belly may be hard to accept. But for many people, a colostomy is life-saving surgery. Learning to care for and troubleshoot your colostomy will take some time. Your healthcare team will help you do this. You may also want to try an ostomy support group. This allows you to meet and talk with people who understand what you're going through.

It's common for an ostomy and pouch to go undetected. No one will know that you have an ostomy and pouch unless you tell them. You may choose not to tell many people. You can tell those who need to know. For instance, your workplace may need to know that you can’t lift heavy items.

Wearing loose fitting tops and bottoms can help conceal your pouch when needed. Be careful when letting your pets or young children to jump into your lap where the pouch is located. Also, be careful when putting on your seat belt. The lap belt may cross the area where the stoma is located.

The colostomy itself should not prevent you from having sex, traveling, or being physically active. Some people choose to wear a wrap over the colostomy to protect it during sex. When traveling, pack extra ostomy supplies. If you're flying, never pack all your supplies in the checked baggage. You may also want to limit and be aware of what you eat before you travel. For instance, some people find that certain foods cause gas. Talk to your healthcare team about any precautions to take when exercising.

Liquid and solid products are available to help control odor. Some are placed into the pouch, while others can be taken internally. It may help to empty your pouch often as well.

Always carry an emergency kit with extra supplies, such as:

• Pouches 

• Extra precut flange

• Roll of tape

• Wet wipes

You may want to make changes in your diet. A person with an ostomy should be aware of foods that cause gas. Of course, passing gas is a normal part of the digestive process. Most people pass gas more than 10 times a day to rid the colon of gas and pressure. Gas in the colon is a mix of hydrogen, methane, and carbon dioxide. It's caused by the breakdown of undigested sugars in the lower intestine. Some complex carbohydrates can't be fully broken down by normal digestive processes. Gas is the result. Changing your diet to limit these foods may help. Foods that can cause gas include:

• Asparagus

• Bananas

• Beans

• Broccoli

• Cabbage

• Carbonated drinks

• Carrots

• Cauliflower

• Dairy foods and drinks with lactose, including cow’s milk and some cheeses

• Onions

• Whole-grain foods

• Bran

• Some fruits and juices

Depending on the type of surgery you have, stools may pass at any time. Blockage (constipation) can be a problem for someone with a colostomy. Keep track of bowel movements. Note how hard or soft they are, and how often they occur. You'll need to drink plenty of water to keep the stools hydrated for as long as possible while they pass through the colon. An occasional dose of a laxative may help keep stool softer. But check with your healthcare provider first before taking them. Increasing vegetables, fruits, and juices may also help.

Connect with a local chapter of the United Ostomy Associations of America (UOAA) at ostomy.org. The UOAA provides education, information, support, and advocacy for people with ostomies.