Colon Surgery

Colon Surgery

What Is a Colostomy?

During a colostomy part of the colon (large intestine) is removed or disconnected. If the large intestine was diseased, it may be removed. If it was injured, it may be disconnected for a short time while it heals, then reconnected. During a colostomy, the colon is brought through the abdominal wall. This makes an opening, called a stoma, for stool and mucus to pass out of the body.

Types of Colostomies

The type of colostomy you have depends on what part of the colon is removed or disconnected. The most common types of colostomies are:

Sigmoid Colostomy

  • The last section of the colon is removed or disconnected. The rectum and anus may be removed, or they may be disconnected and left in the body.
  • The stoma is usually on the lower left side of the abdomen.
  • Stool is most often firm

Descending Colostomy

  • The sigmoid colon and part of the descending colon are removed or disconnected. The rectum and anus may be removed or just disconnected.
  • The stoma is usually on the left side of the abdomen.
  • Stool may be almost firm.

Transverse Colostomy

  • All of the sigmoid and descending colon and part of the transverse colon are removed or disconnected. The rectum and anus may be removed or just disconnected.
  • The stoma can be in the middle or on the right or left side of the upper abdomen
  • Stool varies from pastelike to almost liquid.

Types of Stomas

The stoma is created by bringing the colon through the abdominal wall and turning it back on itself, like a cuff. The stoma is pink and moist, like the inside of the mouth. It shrinks to its final size 6–8 weeks after surgery. The kind of stoma you have depends on your surgery. The most common types are:

End Stoma

  • An end stoma, most often done for a permanent colostomy. Stool and mucus pass from the same opening. If the anus is not removed, mucus passes from it as well.

Loop Stoma

  • loop stoma, most often done for a temporary colostomy. Stool passes from one side of the stoma. Mucus passes from the other. The anus is most often not removed, so mucus passes from it, too.

Two Stoma

  • Two stomas may be done for a temporary or permanent colostomy. Stool passes from one stoma. Mucus passes from the other. If the anus is not removed, mucus passes from it as well.

Colostomy: Caring for Your Stoma

You need to take care of your stoma and the skin around it (peristomal skin). That means keeping the stoma and the skin clean. It also means protecting the skin from moisture and contact with stool. This helps prevent skin problems and odor.

Check the Stoma

Check the stoma and the skin around it each time you change your pouch. Stand in front of a mirror, or use a hand mirror so that you can see all the way around the stoma. It should look shiny, moist, and dark pink or red. The skin around it should be smooth, with no red or broken spots.

Clean Around the Stoma

Clean around the stoma with warm water and a soft washcloth each time you change the pouch. Water does not harm the stoma. You can even take a bath or shower without your pouch if you choose.

  • There are no nerves in the stoma, so there is no feeling. Be sure to clean and dry the stoma gently. You could injure the stoma without knowing it.
  • The stoma may bleed a little when you clean it. That’s because there are tiny blood vessels in the tissue.

Protect the Skin Around the Stoma

For the pouch to stick well, the skin around the stoma needs to be dry and smooth. If the skin is moist or uneven, the pouch is more likely to leak. A leaky pouch will irritate the skin. It can also cause odor.

  • To help keep the skin healthy, pat it dry after you wash it.
  • If you like, apply an extra skin barrier, such as a wipe, before you put on a new pouch. This helps protect the skin if stool leaks around the pouch.

Common Causes of Skin Problems

  • A leaking pouch can make the skin red and weepy. Use a measuring guide to check that the opening on the pouch is the correct size.
  • Hair under the pouch can make the skin inflamed. To avoid this, shave off any hair around the stoma with an electric razor. Always shave away from the stoma
  • Allergies to skin barriers can make the skin itch, burn, or sting. You may need to try a new skin barrier or change to a new kind of pouch.
  • Yeast infections can make the skin red and itchy. Sweat under the pouch makes these infections more likely. A pouch cover can help keep the skin dry.

Call Your ET Nurse or Other Healthcare Provider If:

  • The skin around the stoma is red, weepy, bleeding, or broken.
  • The skin around the stoma itches, burns, stings, or has white spots.
  • The stoma swells, changes color, or bleeds without stopping.
  • The stoma becomes even with or sinks below the skin, or it sticks up more than normal.

Colostomy: Selecting Your Pouch

After a colostomy, stool is most often collected in a pouch that attaches to your body around the stoma. An adhesive skin barrier holds the pouch in place and keeps stool from leaking onto the skin. Most pouches are made of lightweight, odor-proof plastic. They lie flat against the body so they don’t show or make noise.

Types of Pouches

There are many styles of pouches. Your healthcare provider will help you select the one that’s best for you. The skin barrier has to fit around the stoma without touching it. And it must stick well so there is no leaking or odor from the pouch.

Two-Piece Drainable

  • The skin barrier and the pouch are separate pieces. The skin barrier is applied to the skin. The pouch snaps onto a flange on the skin barrier.
  • The bottom of the pouch has a tail with an opening. The tail is folded over and held closed with a clamp.
  • To empty the pouch, you remove the clamp.

One-Piece Drainable

  • The skin barrier and the pouch come as one piece. The skin barrier holds the pouch onto the skin.
  • The bottom of the pouch has a tail with an opening. The tail is folded over and held closed with a clamp.
  • To empty the pouch, you remove the clamp.

Discharge Instructions after Appendix Surgery

You just had your appendix removed laparoscopically. This is a procedure performed through several small incisions. After surgery, be sure to have an adult drive you home and follow the guidelines on this sheet. Make a follow-up appointment as directed by our staff.

Activity:

We encourage resuming walking and light activity immediately; as soon as you are sure you are not going to have issues with dizziness or lightheadedness. You may resume driving when it is comfortable to walk up and down stairs. Don’t plan on any strenuous activities, like sports or going to the gym, until your postop appointment. Your surgeon may have specific instructions to add to this; usually these are outlined to you before surgery. The bottom line: if it hurts, don’t do it!

Driving should not be attempted until you are off pain medications and able to go up and down stairs comfortably. You should be able to slam on the brakes to avoid an accident without causing any pain.

Eating:

The basic rule is take in what your body is telling you. Unless you have been given a specific diet plan, you may eat what you wish, even the day of surgery. Beware of nausea or queasiness the day of surgery, though. Some find it easier to digest bland foods, light foods, or predominantly liquids that evening. As you feel better, however, you can eat whatever seems good to you. We suggest a low fat diet until you return for your postop appointment. Make sure you stay hydrated, and avoid excessive caffeine. Also, no alcohol if you are taking prescription pain medications.

Elimination:

Constipation is very common after surgery. We recommend staying well hydrated, and using Miralax, prune juice, or Milk of Magnesia for a few days until things are back to normal. If you are at all prone to constipation, or if you need several days of pain medicine, it may help to add Benefiber, Metamucil or similar bulk fiber agents for a few days as well. Do not let more than 48 hours go by without a bowel movement without starting the above medications. If they fail to help within another 24 hours, call our office. Diarrhea is common if you are taking antibiotics. If you have this problem, we would suggest either probiotics while you are on the antibiotics, or eating yogurt with active cultures. If diarrhea occurs more than 4-6 times daily for more than 48 hours, call us. You should be able to urinate within 6-8 hours of leaving the facility. If you are unable to do so, call our office. Make sure your doctor is aware of any chronic difficulties with urination (like prostate trouble) before surgery.

Wound care:

Usually surgical wounds will have either glue or steri-strips (butterfly tapes) on them, often covered with gauze. Glue, steri-strips, or waterproof plastic dressings can all get wet the day after surgery (unless your surgeon advises differently). Wounds with visible staples or sutures can get wet in the shower after 48 hours. Do not submerge your wound (tub bathing or swimming) for one week. While soap will not harm the wound, do not scrub it. Do not apply peroxide or other chemicals unless you have been told to do so by your doctor. After 48 hours, change or remove gauze dressings or Band-aids. Do not leave soiled or wet dressings on the wound beyond 48 hours. Most wounds can then remain uncovered, unless you have been told otherwise. Light gauze covering to prevent chafing is acceptable if you wish. You may notice a slight drainage (usually pink or reddish in color) from the incision site. This is normal and not a cause for concern. Light pinkness immediately surrounding the incision, and not spreading over time, is normal. Bruising is common and may extend for up to an inch. Spreading redness, progressive swelling with bruising, and malodorous drainage are not normal and should prompt a call to our office.

Drains:

If you are sent home with surgical drains, you will likely be given instructions at the time of discharge for care of them, and a log sheet to record the output. It is important to note the daily output of the drain(s) so we will know when to remove them. Drains that empty into a suction bulb or attached bag can get wet in the shower. If there is gapping of the skin around the drain, Neosporin or similar ointment may be used to protect the area while you shower. Do not submerge the drain site underwater, such as tub bathing or swimming. Slight pinkish or yellowish drainage from around the tube is normal while it is in place, as is a small amount of redness at the site. Gauze over the site may help protect your clothing from staining. Foul smelling or copious drainage around the drain, or spreading redness around the drain, is not normal and should prompt a call to our office. If the drain reservoir fails to hold suction when you squeeze it, or if the drainage suddenly drops to near zero, call our office. Normal care of drains includes emptying the fluid in the reservoir every 8 hours and recording the amount per 24 hour period. Bring this record to your postoperative appointment. The fluid may need to be emptied more frequently if the drainage is heavy. Fluid will often be red at first, then pink, then yellow as the wound heals. Stringy material in the tubing or reservoir is normal.

Medications:

Use over-the-counter pain medications or a prescribed narcotic for your discomfort as needed. We recommend the following: Tylenol 1000 mg every 6 hrs around the clock for 2-3 days, in addition to Motrin/Advil/Ibuprofen 400-600 mg every 8 hrs and alternate these with Tylenol. Unless you are told differently by your surgeon or primary doctor, you can take 400 mg ibuprofen every 4-6 hours, or 800 mg every 8 hours, for the first 3-5 days after surgery, for a maximum dose of about 2400 mg/day (refer to the label for specific dosing based on age and weight). It is best if you can take some food with this medication. Tylenol is also acceptable to help with the baseline pain after surgery. It can be taken in conjunction with ibuprofen, and with your prescription (unless your prescription already contains acetaminophen–which is Tylenol). Be very careful not to exceed the dosage on the bottle. Taking more than 3 grams/day is not advisable. Most patients will be given a prescription for narcotics, if needed, but most will not need it. Prescription narcotic pain medications are there to help you recover comfortably, but stop them as soon as you are able. Side effects of nausea, vomiting, dizziness, fatigue, poor appetite, and above all constipation, are common. Do not use alcohol or drive if you are taking prescription pain medications. Blood thinners should only be restarted after surgery according to the plan discussed with you by your surgeon or prescribing doctor before surgery. If this was not made clear to you, call our office. All other medications should be resumed once you get home. Vitamins and supplements are not necessary to help you heal, unless you have a known deficiency. You may resume them after you get home if you wish. We would suggest sleep aids not be used while you are on narcotic pain medications.

If Difficulties Arise:

Please call us if any problems or questions arise.  We can be reached any time, including evenings and weekends, by calling our office number (703) 359-8640 and selecting to speak to the on call physician. 

Call your doctor if you have any of the following:

  • Fever over 101°F or chills
  • Increasing pain, redness, or drainage at an incision site
  • Vomiting or nausea that lasts more than 12 hours
  • Prolonged diarrhea
  • Chest pain or shortness of breath
  • Inability to urinate within 8 hours of discharge