Most people who have surgery to treat colorectal cancer will regain the full function of their bowels. A few, however, will need a colostomy, the surgical procedure that routes a small portion of the colon through an opening in the abdomen. After colostomy, stool passes through the stoma, or opening in the abdomen, and empties into a pouch worn over it (see Figure). Most people will need a colostomy bag or pouch only temporarily to allow the rectum to heal before it can be reattached to the colon. Fewer still need a permanent colostomy bag. Rectal cancer is the most common reason for performing a colostomy.
| Colostomy
Colostomy is a less common surgical procedure. It routes the colon to an opening in the abdomen for the elimination of stool. Surgeons opt for colostomy when a rectal cancer is so close to the anus that the anal sphincter must be removed — or when the remaining portion of the rectum needs time to heal before being reattached. In the latter case, the patient will only need a colostomy bag temporarily, until the rectum is reattached. |
For those who do need a colostomy, either permanent or temporary, the very idea can seem almost as overwhelming as having cancer. You might find it easier to imagine getting through cancer treatment than adjusting to life with "the bag."
There's no getting around the fact that a colostomy changes a person's life. But it doesn't have to put an end to the activities that have always made your life worth living. With time, people with colostomies are able to resume their normal routines of working, traveling, and even playing sports.
But adjusting does take time, and it requires support. If you know ahead of time that you'll need a colostomy, talk with your surgeon and with a nurse who specializes in the care of colostomy patients. Such nurses are called enterostomal therapy nurses or ostomy or continence specialists. During the consultation, which can take place in the hospital just before your surgery, the nurse will help find an area on your abdomen where the ostomy, or opening for the colon, will cause the least discomfort for you. The nurse might ask you to assume positions of activities that you enjoy — for instance, the stance of a golfer or the hunched position of a bicyclist — in order to find a location where the colostomy bag will be out of the way for such activities.
After surgery, a nurse in the hospital should be able to show you the mechanics of adjusting to colostomy. Important details include how to care for your stoma, how to fit a pouch over it, and how to change the pouch. Because you will no longer have voluntary control of your bowel movements, you'll need to become familiar with the consistency and frequency of the discharge. There are several different pouching systems and other colostomy products, and you might have to experiment with several of them before you find ones that work for you. Whichever type of pouch you use, you won't need to buy new clothing to conceal it — the pouches made today are inconspicuous because they are designed to lie flat against the abdomen.
Although it might take just a few weeks for you to become relatively comfortable with the mechanics of having a colostomy, your emotional recovery may take longer. It's not unusual for people to take six months to a year to begin to feel like themselves again. Even on days when you're feeling emotionally strong, you may have setbacks when you despair about your body image and related concerns.
Having a colostomy should not keep you from doing any activities; people with colostomies can swim, play tennis, go bicycling, and even have intimate relationships. Reading about this in a pamphlet or book is less convincing than actually getting to know people who are living proof that it's true.
It's very important that you tell all your doctors as well as your pharmacist that you've had a colostomy because it can affect the absorption of medications. Review all of the medications you're taking, both prescription and over the counter, to see if any adjustments need to be made in the dosages.
Though colostomy pouches are designed to seal in odor, these foods and beverages tend to cause odor or gas. Therefore, people who've had a colostomy will probably feel more comfortable if they avoid them:
- asparagus
- beans
- beer
- broccoli
- brussels sprouts
- cabbage
- carbonated drinks
- cauliflower
- cheese
- cucumbers
- dairy products
- eggs
- fish
- mushrooms
- onions
Colorectal Cancer
Colorectal cancer is the third most common form of cancer in men and women. Harvard Medical School's special report, Preventing and Treating Colorectal Cancer, details the latest research in both prevention and treatment of the disease, including screening tests, chemotherapies, and lifestyle recommendations like diet and physical activity. Learn who is at risk, what options are available for treatment, and what is on the horizon for colorectal cancer research.
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Comments: 4
The nurses did teach her how to us the bag, how to place it, and all of that but neither the nurses or the doctors told her what to expect from having a stoma. They didn't warn her that it could become prolapsed and become a hernia. My sister's stoma does not lay flat against her stomach but sticks out when she sits up. She was never told about the secretions that come out of the stoma, she was never told how delicate the stoma is and bleeds very easily while cleaning it. She was never told that one of the chemo medications she gets causes bleeding and thus when her stoma bleeds it can bleed very heavily for a short period of time. All of these things we had to learn as they happened to her. We were terrified when her stoma started sticking out because we didn't know what it was, we were terrified when we saw other secretions coming out of the stoma because we didn't know what it was, when her stoma first bled we were really frightened and I wanted to take her to the ER right away. Instead we spoke to her doctor who finally explained what a prolapsed stoma was and what the other secretions were. When her stoma started to bleed it was examined and we were told that it was healthy and that as long it stopped within a short amount of time and her blood levels showed no change that there was nothing to worry about and her usual chemo treatments were to stay the same even though one of the meds did cause bleeding. The blood was not coming from where the stool came out, just the skin on the bottom of the stoma.
There are many things that a patient has to learn. Not only care of the stoma but what to expect from it. Many patients don't know much about the stoma and they learn like my sister and myself learned; by seeing what happened, fear, and knowing what to ask a doctor.
Stoma knowledge has to be taught along with everything else.