A colostomy can be short-term (temporary) or life-long (permanent) and can be made in any part of the colon.
A transverse colostomy is made from the transverse or the horizontal part of the colon. The transverse colostomy is in the upper abdomen, either in the middle or toward the right side of the body. Colon problems like diverticulitis, inflammatory bowel disease, cancer, obstruction (blockage), injury, or birth defects can lead to a transverse colostomy. This type of colostomy allows the stool to leave the colon before it reaches the further portion of colon called the descending colon.
When the problems are 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 reversed (closed) and you will go back to having normal bowel function.
The type of discharge from a transverse colostomy varies from time to time and from person to person. A few transverse colostomies discharge 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 that are very irritating, so the nearby skin must be protected. 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.
Your colostomy does not have a sphincter muscle or control mechanism like your anus does. For this reason, 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. The pouch does not usually bulge, and it’s not easy to see under your clothes.
A sigmoid colostomy is made from the lower portion of the intestine called Sigmoid colon. Because there is more working colon, it may produce more solid stool more regularly. The sigmoid colostomy is the most common type of colostomy.
The stoma or the opening 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 that 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 anus to hold the stool back. Many people use a lightweight, disposable pouch to prevent accidents. A reflex to empty the bowel will set up quite naturally in some people. Others may need mild stimulation, such as juice, coffee, a meal, a mild laxative, or 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.
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. Figure out what is normal for you.
Initially it is necessary to have colostomy bags for output from a descending or sigmoid colostomy but with proper irrigation care you may be able to avoid a colostomy bag altogether (see irrigation in colostomy care).