On rare occasions, depending on the size, location, and spread of the tumor, the surgeon might find that it is impossible to remove the cancerous tissue without damaging the muscles of the anal sphincter. When the anus is removed, the surgeon needs to create another pathway for the stools to exit the colon. This can be accomplished by bringing the cut end of the colon to the surface of the abdomen, through the skin, generally on the side of your abdomen.
The new opening that is created is called a stoma, from the Greek word mouth; since the stoma is made from the colon, it is known as a colostomy. The stoma will be pink and moist with a good blood supply. Since that portion of the intestinal wall has few nerve endings, you will not feel pain, light pressure, or any sensation of heat or cold within your stoma.
After surgery, a disposable, odor-proof, plastic colostomy pouch will be applied to the skin around your stoma to collect the exiting stool. Your nurse will show you how to change the pouch.
On first thought, a colostomy may sound like a major inconvenience. In fact, most patients find that having a colostomy does not prevent them from pursuing all of their previous activities. You should be able to return to work, engage in intimate or sexual contact, travel, and participate in most sports.
One of the best confidence-building suggestions I can make is that you ask your surgeon to put you in touch with other men and women who have been living with a colostomy, to hear about their experiences with this device.
Another suggestion is to be sure to get a second opinion from an expert rectal surgeon as to whether you do indeed need a colostomy.
Foods that affected your bowels before surgery will continue to do so after a colostomy. Eat smaller portions of gas-forming foods, and eat slowly, making sure that the food is broken down in to the smallest pieces possible before you swallow it. To decrease gas, avoid drinking through a straw, chewing gum, and talking while eating. If odor becomes a problem, take measures to control odor by emptying the pouch at regular intervals, using pouches with charcoal filters, good hygiene, oral deodorizing agents, pouch deodorants, room spray, and odor-proof pouches.
If you are having particular problems that you think are related to your diet, speak to a dietitian or to an enterostomal therapist. They will help you select or eliminate foods that may be causing your problems, and help you manage your stoma better.
Your nurse will be able to give you specific instructions on how to perform a colostomy irrigation. For this procedure you will put water into the colon for the purpose of emptying the bowel contents at the same time each day. The goal of irrigation is to help the colon to develop some degree of regularity. This should allow you to remain free of drainage for 24 to 48 hours.
Food Considerations with a Colostomy
Gas-forming foods: broccoli, cabbage, cauliflower, corn, cucumbers, dairy products, dried beans, mushrooms, onions, peas, radishes, spinach, string beans, sweet potatoes, yams, and yeast; beer and carbonated beverages are also gas-forming.
Odor-forming foods: asparagus, beans, broccoli, Brussels sprouts, cabbage, cauliflower, eggs, fish, garlic, onions, some spices, peas, and turnips.
Odor decreasing foods: tomato juice, yogurt, buttermilk, orange juice, parsley, and spearmint.
Stool-thickening foods: bananas, rice, bread, potatoes, creamy peanut butter, applesauce, cheese, tapioca, yogurt, pasta, pretzels, marshmallows.
Stool-loosening foods: string beans, chocolate, raw fruits, raw vegetables, leafy green vegetables (e.g., lettuce, broccoli, spinach), fried foods, greasy foods, prune or grape juice, highly spiced foods.