b. A temporary colostomy is normally made for diversion of fecal material. Fecal diversion is utilized in order to rest a portion of the colon following intestinal surgery, in preparation for further surgery, or in cases of severe inflammatory disease (such as diverticulitis).
c. A permanent colostomy serves as an artificial anus for the remainder of the patient's life. This procedure is done in conjunction with the removal of the lower bowel and rectum. Although there is no sphincter muscle control at the stoma, bowel movements may be controlled by a daily routine that encompasses diet, physical activity, and colostomy irrigation’s. Consistency of the bowel movements generally depends upon the location of the colostomy (see figure 1-5), but can be manipulated by the patient's choice of diet.
d. Whether temporary or permanent, a colostomy can be very distressing to the patient. Patients with colostomies require encouragement, understanding, and assistance in overcoming the negative emotions associated with a colostomy, and in learning independence and self-sufficiency in living with a colostomy.
e. Colostomy "training" should begin as soon as possible, with the permission of the physician, after surgery. The ease and skill with which the nursing personnel care for the patient with a colostomy are important in helping the patient physically and emotionally. The patient and his family will learn that a colostomy can be effectively managed to allow a full and active life.
f. There are several different surgical procedures that create different types of colostomies. The procedure used will depend upon the nature of the disease, the desired end result (temporary or permanent), and the physician's preference, among other things. For example:
Figure 1-5. Colostomy sites.
(1) Two stoma openings can be created at the abdominal surface (double barrel). One serves as a temporary artificial anus for the functioning part of the gastrointestinal tract, discharging feces, and flatus. The second opening leads to the nonfunctioning part of the colon and rectum. Mucous or serous secretions are normally discharged from this opening. This opening may also be utilized for irrigation of the resting colon. This procedure would be utilized when the colostomy is temporary. Later surgery would involve closing the stomas with re-anastomosis of the bowel.
(2) A single colostomy may be done at one of the sites illustrated in figure 1-5. The site chosen normally depends upon the portion of the bowel that must be removed. The colostomy site is created at a section of healthy bowel. The bowel distal to the colostomy is removed and the rectum surgically closed.
