Colostomy procedures can help with managing several conditions, including diverticulitis and colon cancer. There are four main types, each suited to different scenarios.
A colostomy is a type of surgery that redirects the end of your large intestine (colon) to a surgical opening in your skin (stoma) to help your body get rid of stool. A surgeon makes the stoma in your abdominal wall and cuts off or redirects the remaining part of the colon below it.
While most colostomies are permanent, some colostomies are temporary. Whether a colostomy is permanent depends on whether it’s being used to treat a short-term problem, such as an intestinal obstruction, or a chronic disease, such as colon or rectal cancer.
A colostomy may be recommended in a variety of cases, including:
- birth defects that affect the large intestine
- colon cancer
- diverticulitis
- inflammatory bowel disease (IBD)
- injuries
- intestinal obstruction
The four main types of colostomy to discuss with a doctor include transverse, ascending, descending, and sigmoid. Each is named for the part of the colon in which a surgeon makes the stoma.
Learn more about the other key differences between each of the four types.
Transverse colostomy
A transverse colostomy is a common form of this surgery. It involves creating a stoma in the middle or right upper abdominal wall so that stool may exit the body before it reaches further down the colon.
This type of colostomy may be needed if a large amount of your colon is inflamed, diseased, or compromised. Transverse colostomies involve cutting off or redirecting the largest amount of your colon compared with other types of colostomies.
There are two types of transverse colostomies:
- Loop transverse colostomy: This type involves two stomas, which may look like one large stoma. One releases stool, and the other releases mucus.
- Double-barrel transverse colostomy: This type involves two separate stomas created after your bowel is completely divided. As with a loop transverse colostomy, one stoma releases stool, while a second, smaller stoma (called a mucus fistula) releases mucus.
A transverse colostomy may be either temporary or permanent, depending on the underlying problem affecting your colon. Temporary transverse colostomies may be used for a few weeks or several months in cases of acute infection or inflammation.
After a transverse colostomy, you can pass stool and gas through a bagging system or pouch, though you won’t be able to control the output.
Also, since this surgery is made higher up in your abdominal wall, only a small portion of your colon remains active. Because of this, you’ll notice a difference in the consistency of your stools. They may be soft and oatmeal-like or a bit firmer like a paste.
Ascending colostomy
An ascending colostomy involves the next-highest portion of your large intestine. This procedure involves making a stoma along the right side of your abdominal wall and cutting off a larger part of your colon.
As a result, the colon may emit digestive enzyme -containing liquid and looser stools.
Overall, an ascending colostomy is considered rare and is only used in cases where you may not be a candidate for an ostomy of the lower part of your small intestine ( ileostomy ) or if intestinal obstruction or colon disease makes a colostomy impossible to perform.
Descending colostomy
Descending colostomies involve the descending, or lower-left, portion of your colon. Stool output is not as loose, but you may go 2 to 3 days without having a bowel movement.
A descending colostomy may involve either single- or double-barrel stomas. A single-barrel version, also called an end colostomy, is more common. This involves sewing the stoma flush with the skin. End colostomies are also usually permanent.
Sigmoid colostomy
A sigmoid colostomy is the most common form of this surgery. It also preserves the largest amount of your colon.
This type of colostomy involves the sigmoid colon, which is just below the descending portion. It’s also placed on the left side of your abdominal wall. It can be either permanent or temporary.
Having a sigmoid colostomy also ensures that stool output is more solid and more regular. Also, like a descending colostomy, a sigmoid version most often involves an end colostomy, though some cases involve a double-barrel version.
Colostomy types and their risks
All types of colostomies pose similar risks. These include potential side effects and complications , such as:
Taking care of your stoma and the surrounding skin can help reduce some of these risks, along with changing your bagging system regularly.
However, you should consider seeking immediate medical attention if you experience any of the following:
- bleeding in or around the stoma
- abdominal cramps, nausea, or vomiting that doesn’t stop
- watery stools
- lack of stool for several hours
The bottom line
The four types of colostomy include transverse, ascending, descending, and sigmoid. Each involves cutting off or redirecting the colon at different points.
The higher the stoma in your abdominal wall, the less of a working colon you have, and you can expect more stool changes.
Ultimately, the type of colostomy a doctor recommends depends on the underlying health condition being treated, as well as the extent of the damage to your colon. You’ll need to wear a pouch to collect stools via the stoma in all cases.
Consider talking with a doctor before your surgery about the types of pouches that are available for your stoma, as well as ways to reduce your risk of side effects after your colostomy.
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