Types of colostomies

A colostomy can be short-term (temporary) or life-long (permanent) and can be made in any part of the colon. The different types of colostomies are based on where they are located on 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’s 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.

two views showing a loop transverse colostomy from inside the body and from outside detailing the active and inactive portions of the colon


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’s only one stoma. The mucus from the resting portion of the bowel comes out through the anus.

illustration showing a double barrel transverse colostomy from inside the body and from outside including the active and inactive portions of the colon


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’ll 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’ll soon notice that, although you can usually tell when your colostomy is going to pass stool or gas, you can’t control it. Your colostomy does not have a valve-like sphincter muscle like your anus does. Because of this, you’ll 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’s right for you. This is also discussed in more detail later in Choosing a Colostomy Pouching System.

Managing a transverse colostomy

When a colostomy is made in the right half of the colon (near the ascending 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 soft or loose stool. It’s 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 Caring for a Colostomy for more on this.)

Trying to control a transverse colostomy with special diets, medicines, enemas, or irrigations usually doesn’t 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 doesn’t usually bulge, and it’s not easy to see under your clothes.

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 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 often a better choice if the discharge is liquid. (For more on this, please see Ileostomy: A Guide.)

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

Descending and sigmoid colostomies

Located 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 the most common type of colostomy. It’s made in the sigmoid colon, and located just a few inches lower than a descending colostomy. Because there’s more working colon, it may put out solid stool on a more regular schedule.

illustration showing the portion of the colon removed for a descending colostomy and a sigmoid 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’s 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 doesn’t 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’s 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 Colostomy Irrigation.

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 after surgery to figure out what’s normal for you.

In its original form this document was written by the United Ostomy Association, Inc. (1962-2005) and reviewed by Jan Clark, RNET, CWOCN and Peg Grover, RNET. It has since been modified and updated by:

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: December 2, 2014 Last Revised: December 2, 2014

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