Comparing Ileostomy vs. Colostomy Surgery (2024)

Ileostomy and colostomy are two types of ostomy surgery that treat diseases and conditions affecting the digestive system. Both include the creation of a stoma, by which a small piece of intestine is brought through the abdomen. An ostomy bag or a pouch is worn on the abdomen to collect stool as it leaves the body through the stoma.

However, there are some significant differences between an ileostomy and a colostomy. In a colostomy, the piece of intestine to form a stoma is from the large intestine (colon). In an ileostomy, the stoma is created from the small intestine.

This article will discuss ileostomy and colostomy, why you might need these surgeries, how they are performed, how they affect stool, recovery, and stoma and bag maintenance.

Understanding Colorectal Surgery Terms

Learning the terms surrounding colorectal surgeries is a key part of the process. Knowledge about the operation and how having a stoma will affect your body may help you adjust to the changes.

Asking questions when working with the colorectal surgeon, their staff, and an enterostomal therapy (ET) nurse is the best way to get good information.

Stoma Bag

A stoma is a part of the body that’s brought outside of the skin. A stoma bag is worn over the stoma to collect waste or fluid, which in the case of an ileostomy or colostomy, would be stool. A stoma bag may also be called an ostomy appliance, a pouch, or a bag.

Ostomy

Ostomy surgery is a term for any of the operations that allow bodily waste or fluids (most commonly stool or urine) to leave the body. Any of these types of surgeries and their outcome is called an ostomy. This includes ileostomy, colostomy, and urostomy (which involves the urinary tract).

Ileostomy vs. Colostomy

An ileostomy is when part of the small intestine is brought out through the abdomen. A colostomy is when part of the colon is used to create a stoma. They are similar in that they are both surgeries wherein stool leaves the body through a stoma.

The differences include:

• They involve different parts of the bowel (small intestine versus large intestine).
• An ileostomy bag may need to be emptied more frequently.
• Stool from a colostomy may be thicker than stool from an ileostomy.
• Stool from an ileostomy may contain more enzymes and irritate the surrounding skin (called the peristomal skin).

Why Someone Would Need These Surgeries

There are several different reasons why there would be a need for either an ileostomy or a colostomy.

Ileostomy

An ileostomy is placed either to bypass the colon or because the colon is removed (called a colectomy). This can be because of a problem with the colon.

Some of the diseases and conditions for which an ileostomy might be placed include:

• Accident/injury: damage to the colon that is severe enough that it needs time to heal
• Bowel cancer: a tumor or cancer in the small intestine, colon, rectum, or anus
• Bowel obstruction: when the bowel becomes blocked because of scar tissue (adhesions) or strictures (narrowed sections)
• Crohn's disease: a disease that primarily affects the digestive system, causing inflammation.
• Familial adenomatous polyposis (FAP): a hereditary condition that causes the growth of polyps (growths on the lining of the wall of the colon or rectum)
• Ulcerative colitis: a disease that primarily affects the large intestine, causing inflammation

An ileostomy may be permanent or temporary. When an ileostomy is temporary, another surgery might be done to restore the bowel, called a reversal. If the colon is intact and heals, the ileostomy might be reversed. This may occur in cases of some forms of cancer, obstructions, accidents, or injuries.

When the colon is removed entirely, the ileostomy may be permanent. This is usually true for Crohn's disease when treated with a colectomy and the placement of an ileostomy.

The ileostomy may be permanent or temporary in the case of FAP and ulcerative colitis. Sometimes this is the person's choice. Other times, it is due to the location and activity of the disease.

In FAP or ulcerative colitis, another procedure called a continent ostomy—ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA)—may be used. This is when the end of the small bowel is attached to the rectum or the anus.

An ileostomy might be temporary. After it is reversed, stool leaves the body through the anus (the bottom).

Colostomy

In a colostomy, part of the colon is removed or bypassed to allow it to heal.

Some of the diseases and conditions for which a colostomy might be placed include:

• Accident/injury: Trauma or damage to the colon
• Bowel cancer
• Crohn’s disease
• Diverticulitis: an inflammation of outpouchings (diverticula) in the lining of the colon
• Fistula: an abnormal connection between the colon and another organ or the skin
• Hirschsprung disease: a congenital (present at birth) condition in which the organs in the digestive tract are not fully formed
• Imperforate anus: a rare congenital condition in which there is no anal opening or the anal opening is narrowed
• Ulcerative colitis

In some cases, a colostomy might be reversed, such as with an accident or injury, a fistula, diverticulitis, congenital conditions, or some types of cancer. After treatment or healing, a reversal to restore the colon might be possible.

When a colostomy is set up for Crohn’s disease or ulcerative colitis, a reversal might also be possible, though in some situations, it may be permanent.

You should discuss for how long an ostomy may be needed and whether there’s a possibility of a reversal with your colorectal surgeon and other healthcare providers. They should be able to help you understand the options and if there is a need for more surgery.

General Overview of Each Surgery

Both ileostomy and colostomy surgery are major procedures. They will include many steps in the lead-up to surgery and a hospital stay followed by recovery at home. You will also need to understand how to care for a stoma and change the ostomy bag.

Ileostomy

During ileostomy surgery, a piece of the small intestine will be brought through the abdomen. The reason for the ileostomy will be an important factor in any additional parts of the surgery, such as removing the colon (colectomy) or a part of the small intestine.

Before ileostomy surgery, you will meet with your colorectal surgeon and ET nurse. This is to prepare for and understand what will take place during the surgery, decide on the placement of the stoma on the abdomen, and know the ins and outs oflearning to start life with a stoma. The stoma is usually located on the lower right of the abdomen.

The length of the surgery, what medications are taken, how much time will be spent in the hospital, and what aftercare looks like will vary. Some of these will depend on whether the surgery is performed with a traditional large incision or laparoscopically, with several small incisions.

However, you can probably expect to be in the hospital for three to seven days and recovering at home for four to six weeks.

After surgery, there will be instructions for how to approach diet, exercise, work, school, and sexual activity in the first days and weeks at home. Some changes might be needed (such as a modified diet and lower activity level) until the bowel and body have begun to heal.

Healthcare providers should give you instructions on how to get back to regular activity and an expanded diet.

Colostomy

In colostomy surgery, a portion of the colon is brought through the abdomen to create a stoma. During the operation, parts of the large intestine might also be removed.

Similar to ileostomy surgery, the pre-surgical preparation will include meeting with a colorectal surgeon, ET nurse, and any other healthcare providers who have a role. This will be an important part of understanding the surgery and learning how to care for the surgical site and stoma. The stoma is usually located at the top of the stomach or the lower left of the abdomen.

A colostomy may be created with an open incision or laparoscopically, which uses smaller incisions. Laparoscopic surgery usually means less time in the hospital and possibly a shorter recovery time overall.

The post-surgical period will be one of learning about any needed diet changes and how to care for a stoma. A healthcare provider will give guidance and instructions on when to add more foods to your diet and increase activity levels.

Effect on Stool

The removal of part of the intestinal tract and/or the placement of a stoma will have an effect on the consistency of stool.

Ileostomy

With an ileostomy, food waste is no longer passed through the colon. The colon absorbs water and a few nutrients. In bypassing that part of the intestinal tract, the stool will be more liquid. It will also be more acidic than stool that goes through a colon.

There is also no control over when stool leaves the body through the stoma. Peristalsis (the movement of the muscles in the small intestine) will push stool out of the stoma on its own.

There may be a high amount of stool leaving the body, especially in the first weeks after surgery. Drinking enough liquids during this time will be important as the body adjusts and learns to absorb more water without a colon. An ileostomy bag will need to be emptied several times a day.

Stool may change with the foods eaten. Your diet may affect smell, consistency, and color.

Colostomy

Stool through a stoma after a colostomy may be similar to what it was before the surgery. It will be more formed. However, it will depend on how high up the colostomy is placed. The more colon the stool passes through, the more formed it will be.

People with a colostomy will not have any control over when stool leaves the body through the stoma. However, the ostomy bag will generally need to be emptied fewer times a day than with an ileostomy.

Stool may change based on diet, but it may still be similar to having a colon. If not much of the colon is still intact, there may be more noticeable differences, and stool may be less formed and be more affected by diet in terms of color, consistency, and smell.

Recovery Period

The recovery period for ostomy surgery will vary based on the reason for the surgery and whether it’s an open surgery with a larger incision or laparoscopic. In most cases, there will be a hospital stay of at least a few days, followed by several weeks at home.

During the hospital stay, you are monitored for any adverse events from the surgery. At first, the diet may be only clear liquids. If the digestive system and the new stoma handle liquids well, the diet is advanced to full liquids, a modified low-fiber diet, then a standard diet.

In the hospital, you will also learn how to change your ostomy appliance in preparation for doing it at home. If there’s a care partner who will help with the changes at home, it will also be useful for them to learn.

Before leaving the hospital, there should be clear instructions given on:

• Activity level (including any restrictions on lifting objects, doing housework, starting exercise, and having sex)
• How to change the ostomy appliance
• Where to get more ostomy supplies
• Follow-up appointments with the surgeon and any other healthcare providers
• A plan for diet at home

Foods to Eat or Avoid

Diet after ostomy surgery is going to be individualized. However, in the beginning, the surgeon may recommend a diet of foods that are easier to digest. The diet should advance in stages, slowly adding foods and food groups to ensure the digestive system can handle them.

In the beginning, after surgery, some people may experience nausea or a lack of appetite. Advancing diet slowly may help in dealing with these symptoms.

Another part of life after ostomy surgery is the potential for bowel obstructions. You should speak to your healthcare provider about how to avoid blockages and what to do if one occurs.

Foods to avoid in the first days and weeks after ostomy surgery may include:

• Brown rice
• Corn
• Juice with pulp
• Fresh fruits
• Fried foods
• High-fat foods
• Meat with casings (such as sausage)
• Mushrooms
• Nuts
• Popcorn
• Raw vegetables
• Seeds
  

Some of the foods that may be allowed in the first days and weeks after surgery include:

• Bananas
• Canned fruits
• Nut butters
• Plain fruit and vegetable juices
• Protein drinks or shakes
• Well-cooked vegetables
• White bread
• White rice
• Yogurt

Stoma and Bag Maintenance

An ostomy appliance will need changing every so often, usually every few days. A key part of caring for a stoma is ensuring the skin around the stoma (peristomal skin) remains healthy.

There are a variety of types of stoma bags, flanges, adhesives, pastes, and powders that are available to suit individual stomas. An ET nurse can be helpful in getting access to different supplies in order to try them and determine which will work best.

Some stomas are challenging. The skin around it may have creases or wrinkles. The stoma may protrude farther or be flush with the skin. There are more specialized supplies available to help solve these issues, and working with healthcare providers and ostomy supply companies is important.

With every bag change, it’s a good idea to look at the stoma and the skin around it to ensure that everything looks healthy. In the beginning, the size of the stoma will change as the swelling from the surgery subsides. However, over time, the size should stabilize, and any changes should be discussed with a healthcare provider.

Depending on the reason for the surgery, there may be regular follow-up appointments needed with the surgeon, gastroenterologist, or another healthcare provider. It’s important to ask about how often there should be touchpoints and when it may be necessary to get extra help with the stoma.

Ostomy surgery can be life-saving. There will be an adjustment period to learning how to manage a new stoma, but getting help from healthcare providers and ostomy patient advocacy groups can help make the first days and months go smoother.

Summary

Ileostomy and colostomy are two types of surgery that treat conditions affecting the digestive system. For each, a stoma is created, in which a small piece of the intestine is brought through the abdomen. For an ileostomy, the small intestine forms the stoma, and for a colostomy, the large intestine does.

Stool is collected in a bag worn over the stoma. The stoma may be temporary and reversed, or permanent. The stool is more liquid and frequent with an ileostomy and more formed and less frequent with a colostomy.

Both are major surgeries that may be performed with a large incision or laparoscopy. A hospital stay of a few days and weeks of recovery at home is typical. After surgery, the diet slowly changes from a full liquid diet to include other foods.

You will be instructed on how to care for the stoma, change bags, and when to contact a healthcare provider for any concerns.