Colostomy
WHAT IS IT?
A colostomy is one of the 3 most common types of surgical procedure that results in a stoma being formed.
(The others being an ileostomy and a urostomy.) The procedure involves one end of the large intestine being diverted though an opening in the abdomen, usually on the left side. A pouch is then fitted over the stoma to collect waste products that now avoid the rectum and anus. Depending on the patient’s individual needs and medical conditions, all or just part of the colon can be removed. Approximately 6,400 permanent colostomies are performed in the UK every year and about 1 in every 500 people in the UK are living with a stoma.
WHY IS THE PROCEDURE REQUIRED?
There are many different reasons and medical conditions that require a colostomy, some only needing it to be temporary (to allow the bowel to heal) and some require a permanent colostomy (when the bowel is too diseased or damaged to function properly again).
The inflammatory bowel diseases Crohn’s and Ulcerative Colitis often require a colostomy, as well as certain cancers such as anal, vaginal and cervical cancer.4
LIVING WITH A STOMA
Although patients can live a full life after colostomy surgery and it is often a procedure that dramatically improves a person’s quality of life, there are some complications and issues that need to be considered.
The way certain drugs are absorbed can be affected due to the absence of the colon and the altered transit time through the small intestine, so the type of medication prescribed to a stoma patient must be carefully considered and monitored. Modified release and enteric coated drugs should usually be avoided as they may not be absorbed. Distribution of water soluble drugs, drug metabolism, and drug excretion can also be changed after a colostomy.
Patients may require a diet change after surgery, such as a temporary low-fibre diet while the bowels are swollen, but generally after time a normal diet can be resumed. Multi-vitamin supplements may be required if the patient is not absorbing enough nutrients.
There are significant psycho-social issues that a patient may face after stoma surgery, and the reaction will vary from person to person. It can be a challenge to adapt to life with a stoma, and the patient’s family may also struggle. Body image and self-esteem are often affected, and there may also be relationship and self-care concerns.
Usually a patient will see a specialist stoma nurse around the time of having a colostomy, but a pharmacist could also help with some of the issues discussed above.