I’ve always heard the word “colostomy” followed by the word “bag”. That is, if you had a colostomy, you’d defecate in a bag for the rest of your life. A while back I was watching Trauma in the E.R. on The Learning Channel. A 10-year-old boy was severely injured in a car wreck. In the end, he needed a colostomy. I thought how aweful it must be to have a bag attached to you until you die.
Then I thought, “Why does ‘colostomy’ automatically mean ‘bag’?” If you have a piece of colon removed, it doesn’t seem that it would necessarily follow that you couldn’t evacuate in the normal way.
So what exactly is a colostomy procedure? Aside from accidents, why would people have to have them?
Weird, the things that pop into my head from time to time…
“A colostomy is an incision (cut) into the colon (large intestine) to create an artificial opening or “stoma” to the exterior of the abdomen. This opening serves as a substitute anus through which the intestines can eliminate waste products until the colon can heal or other corrective surgery can be done. The bowel movements fall into a collection pouch”
According to that same site:
“Surgery of colon and rectum is done for various reasons including cancer, diverticulitis, inflammatory bowel disease, and fistulae.”
So one procedure is defined as the creation of a substitute anus by rerouting the intestine to the outside of the body, and the other is the removal of part of the intestine.
Stoma means a ‘mouth-like’ opening and comes from the Greek for mouth. Hence a ‘mouth-like’ opening from the colon is a colstomy (from the ileum it is an ileostomy etc.)
For cancer of the colon treatment they are frequently permanant, but for trauma or other causes, they may be temporary, and the connection may be remade at a later date.
I believe in most cases they are temporary. The bag is used only until the anastomosis has healed. In some cases, for reasons I know not why, they have to be permanent. Perhaps a kindly doctor will edify us shortly.
Whether a colostomy is permanent or not is mainly a matter of mechanics. It depends on how much of the colon had to be removed and the location. Most colostomies done today are temporary.
If the colostomy is fairly low on the colon, a bag may not be necessary. It depends how much of the colon remains in front of the the colostomy to absorb water. Some people just wear a small dressing over the stoma and irrigate it 3-4 times a week.
Colostomies are in my experience, always covered by a bag. This is because the stoma lacks a sphincter and therefore there is no method for controlling evacuation of either feces or gases. The bag serves to collect the feces and to filter the gases.
If no bag was worn there would be an irregular excretion of solids and gases- uncontrolled incontinence and flatulence- which is not appreciated by society. ;).
I am not a doctor, but a nurse; and with more experience of colostomy care than might be desired.
Colostomies are temporary when after all the surgery is done, enough non-diseased colon remains to hook things up again. The standard interval between colostomy and re-anastomosis is (straining brain hard to remember) 6 weeks.
Why 6 weeks? Why not lop out a piece of colon and sew the ends back together right away? It has to do with the no so robust nature of the colon. The colon wall is delicate compared to the small intestine. It is discontinuously lined with smooth muscle tissue. When this delicate tissue bears some insult (trauma, infection, obstruction) it weakens to the point where stitches pull right through it. It’s impossible to sew inflamed large bowel. It’s easier to anchor the delicate tissue in the body wall and place a bag over the opening.
You invariably get a colostomy if the colon contents (pre-poop) have somehow spilled into the abdomen. Thats because poop elicits a huge inflammatory response and commonly couses infection of the abdominal contents. You also need a colostomy if you’ve had large bowel obstruction. The colon proximal to the obstruction inflates like a balloon, thinning out its delicate walls.
The only time removal of a piece of colon will not necessitiate a temporary colostomy is if the patient is bowel-prepped prior to surgery and if no obstruction exists.
What’s bowel-prepping? First you drink about 4 liters of laxative (ironically sold under the brand name “go-litely”)and shit your brains out. Afterwards, you take antibiotics to kill of as much of the gut flora as possible. Now your ready to be resected and re-anastomosed all at one time
Interestingly, the situation is quite different with the small bowel. It has thicker, more muscular walls and the contents are sterile. You can re-anastomose small bowel to small bowel without a waiting period.