Ileostomy vs colostomy: definition, purpose and procedure


Both an ileostomy and a colostomy are forms of ostomy surgery. Although they are similar, ileostomies and colostomies involve different parts of the intestine.

Ostomy surgery, or intestinal bypass, is a procedure that diverts the removal of intestinal contents from the intestine. Surgeons perform this procedure when disease or damage requires the removal of part of the intestine. Bowel is another term for the small intestine and large intestine of a person.

During ostomy surgery, a surgeon will pass part of the intestine through the walls of the abdomen. As a result, the waste exits through the abdominal walls rather than the anus.

The surgeon will also create an ostomy during the procedure by passing the end of the intestine through the opening in the abdomen and securing it to the skin. This creates an opening to which a person can attach an external collection bag, or an ostomy bag, to collect waste.

This article will cover the differences between ileostomies and colostomies and explain why a person might need one of these procedures.

Both ileostomies and colostomies are two types of ostomy surgery. Ostomy surgeries can be temporary or permanent.

Ileostomy

Ileostomies involve a surgeon hijacking part of a person’s ileum to come out of an opening in their abdomen. This new opening allows waste to exit through the new stoma rather than the anus.

The ileum is the last part of the small intestine and it helps digest food, as well as absorb nutrients and water.

Ileostomies can be temporary or permanent depending on the reason for their need. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), ileostomies are the most common type of temporary bowel bypass.

Learn more about ileostomies here.

Colostomy

A colostomy is similar to an ileostomy. However, a surgeon will redirect part of a person’s large intestine, also known as the colon.

The colon, which is the last part of the gastrointestinal tract, absorbs water and remaining nutrients from the food that passes through it. This final absorption helps form the stool.

During a colostomy, a surgeon attaches part of the colon to an opening in a person’s abdomen. This colon bypass allows waste to escape through a stoma on the abdomen.

As with ileostomies, colostomies can be temporary or permanent.

The type of ostomy surgery a person needs depends on their medical condition.

Ileostomy

Problems with the small intestine may require a person to have an ileostomy. Ileostomies divert waste from damaged or removed areas of a person’s ileum.

Depending on the cause of a person’s small intestine problems, an ileostomy can be temporary or permanent. A person may need an ileostomy for only 3 to 6 months to allow this part of the colon to rest and heal. In other cases, an ileostomy may be permanent.

People with a variety of health conditions may need an ileostomy.

Reasons for a temporary ileostomy

If a person has surgery on an area of ​​the bowel that is lower than the ileum, an ileostomy may be needed to allow the site to heal. Some surgeries that may require an ileostomy include:

In 3 to 6 months from surgery, the bowel should have recovered. After the bowel heals, surgeons can close the stoma and return the ileum to its original attachment point.

Reasons for a permanent ileostomy

A person may require a permanent ileostomy if a surgeon has removed or bypassed their colon, rectum, and anus.

Conditions that may require a person to have a permanent ileostomy include:

  • Crohn’s disease
  • some cancers
  • colonic dysmotility, where muscles or nerves in the colon do not work properly
  • ulcerative colitis, which is inflammation of the colon or rectum
  • familial polyposis, an inherited disease that causes abnormal growths in the colon and rectum

Colostomy

Certain illnesses or injuries can damage a person’s colon. Colostomies divert stool from the colon and through a stoma on a person’s abdomen.

Temporary reasons for a colostomy

A person may need a temporary colostomy if the colon needs time to heal. The reasons why a person has a temporary colostomy include:

Permanent reasons for a colostomy

If a surgeon needs to permanently remove or bypass part of the colon or rectum, a person may require a permanent colostomy. Conditions such as cancer can sometimes make a permanent colostomy necessary.

The procedures for ileostomies and colostomies are similar, but they involve different sections of the intestine. Surgeons can also use different techniques when performing these surgeries.

Ileostomy

Before performing an ileostomy, a surgeon will mark the future location of the stoma. Ileostomy stomas are usually found on the lower right side of a person’s abdomen. The surgeon will then remove a circle of skin between 2.5⁠ and 3 centimeters (0.98⁠-1.18 inch) in diameter of the abdomen.

After forming this hole, the surgeon will cut through the abdominal tissue to reach the ileum. There are then two main methods for forming the stoma: loop ileostomies or terminal ileostomies.

Temporary ileostomies are usually loop ileostomies. These involve the surgeon pulling a loop of intestine through a person’s abdomen and opening it, forming two stomata that they sew into the person’s belly.

Permanent ileostomies are usually terminal ileostomies. A terminal ileostomy occurs when the surgeon permanently detaches the ileum from the colon. They then attach the end of the ileum to an opening in the abdomen to form a stoma.

Colostomy

Surgeons perform colostomies in a manner very similar to ileostomies. Surgeons can form ostomies using loop or tip techniques during a colostomy.

Colostomies can have different names depending on the affected part of the colon. The type of colostomy will determine the location of a person’s stoma.

Types of colostomies include:

  • transverse colostomy
  • sigmoid colostomy
  • ascending colostomy
  • descending colostomy

After ostomy surgery, a person can get tired quickly after being discharged from the hospital. It is important that they rest until they have recovered from the surgery.

The bladder and bowel community notes that a person’s ileostomy stoma should be functional within days of surgery. A person may need to stay in the hospital for 1 to 2 weeks after an ileostomy operation.

After colostomy surgery, healthcare professionals will feed the person either through a vein or intravenously for a few days. A person may need to stay in the hospital for 3 to 10 days after having a colostomy.

A person may also feel like they want to have a bowel movement after surgery. Sometimes there may be a discharge from the anus, which will be a mixture of blood, mucus and leftover stools.

Additional side effects include excessive gas, constipation, and diarrhea. The amount of gas will decrease after the intestine has had time to heal and recover.

According to the NIDDK, a person should be able to return to work 6 to 8 weeks after surgery. They should avoid driving or lifting heavy objects for 2-3 weeks after the procedure.

People should also avoid physical exercise or extreme sports for 3 months. However, walking, swimming and cycling are suitable forms of exercise, as long as they are not strenuous.

It is also important to note that an ostomy should not affect a person’s ability to maintain a physical relationship. People can resume sexual activity as long as their health care team says it is safe to do so.

Once a person has had ostomy surgery, they may need to wear an ostomy bag, either temporarily or permanently. Ostomy bags attach to a person’s stoma and contain waste that is diverted from the intestines.

After ostomy surgery, a person will have no control over their stool. A person’s ostomy bag will fill with waste as the body digests food. A person will then have to manually empty it five to eight times a day.

The stool after an ileostomy may be watery or pasty because it contains more water.

Depending on where the colostomy occurred in the colon, a person may have watery or more solid stools.

For 6 to 8 weeks after surgery, a person’s healthcare team may recommend that they eat a low-fiber diet, as this will give the gut more time to heal.

Over time, a person should be able to resume their normal diet. However, the following foods can affect the gastrointestinal tract and cause more gas and odor:

  • cucumbers
  • broccoli
  • fish
  • eggs
  • onions
  • Beans

After surgery, a person may need to adjust their eating habits by:

  • avoiding large amounts of fluids next to meals
  • make sure they eat regularly
  • drinking plenty of fluids between meals
  • avoiding foods high in fiber
  • chew food well

The table below shows the main differences between the two types of procedures.

Both ileostomies and colostomies are forms of ostomy surgery. Each procedure involves different parts of a person’s gut.

Both ileostomies and colostomies can be life-saving surgical procedures. If a person has worrisome gut symptoms, they should talk to a doctor.


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