Colostomy: why it is done, how it is created and life afterwards

In a colostomy, part of the large bowel is brought out through an opening made in the tummy. The opening is called a stoma. The NHS explains that you will no longer poo from your bottom: it comes out of the stoma into a pouch or bag that you stick on the tummy. It is usually done because part of the large bowel needs to be removed, or rested after surgery.

A stoma may lie flat against the skin or stick out a couple of centimetres. The NHS says it should be soft, slippery and pink, like the inside of your mouth. It should not hurt, but it can bleed easily when scratched or wiped. Some sticky white or yellow mucus may sometimes come out of the bottom, which is normal.

A colostomy may be done when part of the large bowel, rectum or anus needs to be removed or rested after surgery. The NHS lists the reasons as a growth in the large bowel such as bowel cancer or polyps; a bowel condition such as inflammatory bowel disease; infection such as diverticulitis or an abscess; a bowel obstruction; not enough blood getting to the bowel; the large bowel becoming very swollen; and injury to the bowel, or to the spinal cord or nerves, that stops you controlling when you poo.

Depending on the reason, the colostomy may be permanent, or temporary and reversed later when the bowel is joined back together. The surgical team should explain what is expected in your case and what the long-term plan is.

During colostomy surgery, part of the colon is separated from the rest of the bowel and brought outside the body through an opening in the tummy. Sometimes part of the large bowel also needs to be removed. The NHS says there are two main ways of doing the operation: laparoscopic (keyhole) surgery, with a few small cuts, or open surgery, with a single larger cut. Both are done under a general anaesthetic.

A colostomy is a big change physically and mentally, and the NHS says that asking questions and talking about worries beforehand can help you adjust. Before a planned operation you will usually see a stoma nurse, who will look at and feel your tummy to find the best position for the stoma, marking it with long-lasting ink so the surgeon can see it. They will give you information about the operation, let you try different stoma bags and give you contact details for the stoma nurses at the hospital.

It may help to practise wearing and changing a bag at home before surgery, to build confidence and check whether it causes skin problems such as itching or a rash. You will receive information about getting your bowel ready, which usually means a special diet and possibly laxatives in the days before so that the bowel is empty. If a colostomy is done as an emergency, you may not be able to prepare, but a stoma nurse can support you afterwards.

After the operation you will have a bag attached to your tummy, which may feel bloated and sore. The NHS says to ask for painkillers if you need them. You will usually stay for around 2 to 7 days. Recovery takes around 8 weeks, during which you will usually eat a low fibre diet while the bowel heals, avoid heavy lifting and strenuous activity, and wait until recovered before driving.

Many people find daily life improves after a colostomy because they no longer have pain or uncomfortable symptoms, and it should not stop you living a full and active life. Practical points from the NHS include the following.

• Bags: one-piece bags stick directly around the stoma, while two-piece systems have a ring that stays in place and a bag that clips on. Some bags can be drained, others are closed and changed when full.

• Diet: when things settle you can reintroduce usual foods and aim for a healthy, balanced diet. Some foods may cause wind or smell, regular meals and thorough chewing help prevent blockage, and plenty of fluids prevent dehydration.

• Medicines: many medicines dissolve slowly in the digestive system and may not work as well with a colostomy, so speak to your doctor about liquid or powder forms. Do not stop prescribed medicines without advice.

• Work, relationships and pregnancy: you should be able to return to work when you feel well and comfortable managing the stoma, you can resume your sex life when you feel ready, and a colostomy does not affect fertility, though you should check with your doctor that you are fully recovered before trying to get pregnant.

As with any operation, complications can happen. The NHS lists infection around the stoma, dehydration and bowel blockage (obstruction). A blockage is serious because the bowel could burst and you may need further surgery. Problems with the stoma itself can include a hernia next to the stoma, the stoma retracting into the tummy, the stoma coming out too far above the skin (prolapse) and skin damage around the stoma.

The NHS advises asking for an urgent GP appointment or NHS 111 help if you have a very high temperature or feel hot, cold or shivery; lots of blood from the stoma or in the bag; signs of dehydration; no poo from the stoma for much longer than is normal for you, or you feel uncomfortable; severe tummy pain; or you are feeling or being sick, with vomit that may be green. Contact your stoma nurse or GP if you think you have a stoma problem or it is causing skin problems.

If you have a temporary colostomy, it may be possible to reverse it with further surgery that reconnects the large bowel and closes the opening in the tummy, after which you poo from your bottom and no longer need a bag. The NHS says reversals usually happen for loop colostomies that were done in an emergency, and that it is not always possible to reverse a colostomy. Your surgeon can tell you whether it is an option and when.

In the UK, colostomies are mostly created by NHS colorectal surgical teams, with stoma nurses providing education and ongoing support. Private colorectal surgeons offer planned operations too. Whichever route you use, make sure you know who your stoma nurse is, how to order supplies and where to turn for help with bags and skin problems outside working hours.