Colostomy: A Guide

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Types of colostomies

A colostomy can be short-term (temporary) or life-long (permanent) and can be made in any part of the colon.

Transverse colostomies

The transverse colostomy is in the upper abdomen, either in the middle or toward the right side of the body. This type of colostomy allows the stool to leave the body before it reaches the descending colon. Some of the colon problems that can lead to a transverse colostomy include:

  • Diverticulitis. This is inflammation of diverticula (little sacs along the colon). It can cause abscesses, scarring with stricture (abnormal narrowing), or rupture of the colon and infection in severe cases.
  • Inflammatory bowel disease
  • Cancer
  • Obstruction (blockage)
  • Injury
  • Birth defects

If there are problems in the lower bowel, the affected part of the bowel might need time to rest and heal. A transverse colostomy may be used to keep stool out of the area of the colon that is inflamed, infected, diseased, or newly operated on – this allows healing to take place. This type of colostomy is usually temporary. Depending on the healing process, the colostomy may be needed for a few weeks, months, or even years. If you heal over time, the colostomy is likely to be surgically reversed (closed) and you will go back to having normal bowel function.

A permanent transverse colostomy is made when the lower portion of the colon must be removed or permanently rested, or if other health problems make the patient unable to have more surgery. The colostomy is then the permanent exit for stool and will not be closed in the future.

Types of transverse colostomies

There are 2 types of transverse colostomies: the loop transverse colostomy and the double-barrel transverse colostomy.

Loop transverse colostomy (Figures 2 and 3): The loop colostomy may look like one very large stoma, but it has 2 openings. One opening puts out stool, the other only puts out mucus. The colon normally makes small amounts of mucus to protect itself from the bowel contents. This mucus passes with the bowel movements and is usually not noticed. Despite the colostomy, the resting part of the colon keeps making mucus that will come out either through the stoma or through the rectum and anus. This is normal and expected.

Double-barrel transverse colostomy (Figures 4 and 5): When creating a double-barrel colostomy, the surgeon divides the bowel completely. Each opening is brought to the surface as a separate stoma. The 2 stomas may or may not be separated by skin. Here, too, one opening puts out stool and the other puts out only mucus (this smaller stoma is called a mucus fistula). Sometimes the end of the inactive part of the bowel is sewn closed and left inside the belly. Then there is only one stoma. The mucus from the resting portion of the bowel comes out through the rectum.

The newly formed transverse colostomy

Right after surgery, your colostomy may be covered with bandages or it may have a clear pouch over it. The type of pouch used right after surgery is usually different from those you will use at home. Before you look at your colostomy for the first time, keep in mind that it may be quite swollen after surgery; there may also be bruises and stitches. While a stoma normally is moist and pink or red in color, it may be darker at first. Your stoma will change a lot as it heals. It will get smaller and any discoloration will go away, leaving a moist red or pink stoma. This may take several weeks.

You will soon notice that, although you can usually tell when your colostomy is going to pass stool or gas, you cannot control it. Your colostomy does not have a valve-like sphincter muscle like your anus does. Because of this, you will need to wear a pouch over your colostomy to collect the output. Your ostomy nurse or doctor will help you find a pouching system that is right for you. This is also discussed in more detail later in the section "Choosing a pouching system."

Characteristics of a transverse colostomy

When a colostomy is made in the right half of the colon, only a short portion of colon leading to it is active. The stool that comes out of a transverse colostomy varies from person to person and even from time to time. A few transverse colostomies put out firm stool at infrequent intervals, but most of them move fairly often and put out a soft or loose stool. It is important to know that the stool contains digestive enzymes (chemicals made by the body to break down food). These enzymes are very irritating, so the nearby skin must be protected. (See "Protecting the skin around the stoma" under "Helpful hints" for more information on this.)

Trying to control a transverse colostomy with special diets, medicines, enemas, or irrigations usually does not work and is seldom advised. In most cases, a pouching system is worn over a transverse colostomy at all times. A lightweight, drainable pouch holds the output and protects the skin from contact with the stool. The pouch does not usually bulge, and it's not easy to see under your clothes.

Closing a transverse colostomy

If you are to have your colostomy closed the surgeon may say that he plans to "take it down" or "reverse it" in a few weeks or months, but sometimes no plans are mentioned. Many things must be taken into account when thinking about closing a colostomy. Some of them are:

  • The reason you needed the colostomy
  • Whether you can handle more surgery
  • Your health since the operation
  • Other problems that may have come up during or after surgery

It is best to talk to your surgeon about these things before you leave the hospital so that you know what the plans are and when to see the surgeon again. If you are at home now and did not get instructions, call the doctor's office or clinic and find out what the doctor wants you to do. It is your job to stay in touch with the doctor.

Ascending colostomy

The ascending colostomy is placed on the right side of the belly. Only a short portion of colon remains active. This means that the output is liquid and it contains many digestive enzymes. A drainable pouch must be worn at all times, and the skin must be protected from the output. This type of colostomy is rare because an ileostomy is better if the discharge is liquid. (For more information, please contact us for a copy of Ileostomy: A Guide.)

Caring for an ascending colostomy is much like caring for a transverse colostomy (as discussed above).

Descending and sigmoid colostomies

Located at in the descending colon, the descending colostomy (Figure 6) is placed on the lower left side of the belly. Most often, the output is firm and can be controlled.

A sigmoid colostomy (Figure 7) is made in the sigmoid colon, and located just a few inches lower than a descending colostomy. Because there is more working colon, it may put out solid stool on a more regular schedule. The sigmoid colostomy is the most common type of colostomy.

Both the descending and the sigmoid colostomies can have a double-barrel or single-barrel opening. The single-barrel, or end colostomy, is more common. The stoma of the end colostomy is either sewn flush with the skin or it is turned back on itself (like the turned-down top of a sock).

The stool of a descending or sigmoid colostomy is firmer than the stool of the transverse colostomy. It does not have as much of the irritating digestive enzymes in it. Output from these types of colostomies may happen as a reflex at regular, expected times. The bowel movement will take place after a certain amount of stool has collected in the bowel above the colostomy. Two or 3 days may go between movements. Spilling may happen between movements because there is no muscle to hold the stool back. Many people use a lightweight, disposable pouch to prevent accidents. A reflex to empty the bowel will happen quite naturally in some people. Others may need mild stimulation, such as juice, coffee, a meal, a mild laxative, or irrigation. This is discussed later in the section called "Irrigation for descending and sigmoid colostomies only.”

While many descending and sigmoid colostomies can be trained to move regularly, some cannot. Training, with or without stimulation, is likely to happen only in those people who had regular bowel movements before they became ill. If bowel movements were irregular in earlier years, it may be hard, or impossible, to have regular, predictable colostomy function. Spastic colon, irritable bowel, and some types of indigestion are some conditions that cause people with colostomies to continue to have bouts of constipation or loose stool.

Many people think that a person must have a bowel movement every day. In truth, this varies from person to person. Some people have 2 or 3 movements a day, while others have a bowel movement every 2 or 3 days or even less often. It may take some time to figure out what is normal for you.


Last Medical Review: 03/17/2011
Last Revised: 03/17/2011