Transitioning from Temporary Ileostomy to Permanent Colostomy

Hi, I would like to know if anyone went from a temporary ileostomy to a permanent colostomy. What are the pros and cons of a permanent colostomy? I have been having a lot of issues with my ileostomy, and now I am having a very bad leakage, and my skin is all red and inflamed. The doctor wants to avoid reversal and go straight to a permanent colostomy. I would love to hear all of your input. Thanks so much for all the support that I have gotten from this site.

I've had both a colostomy (to start) and now an ileostomy. I can tell you that your skin problems will probably be a thing of the past with a colostomy. The output from an ileostomy is much more caustic and can easily damage the skin. Otherwise, functioning with either is much the same. You will have to empty less often with a colostomy and probably won't have to worry about what you eat, if you do now. If you trust your doctor, I'd say go ahead. Just make sure he is going to form a stoma that sits well above your skin. I don't know why you are having leakage issues now, but it can sometimes be due to a stoma being flush with the skin or even below the skin surface. Good luck.

Terry

Terry is correct, and you will probably like a colostomy better.

Regards, IGGIE

Hi Micky, you didn't say why you got the ilieo. So it might not be better, such as if you had motility issues or constipation, then a colostomy might not be better. Also, a second opinion might help you decide what's better.

I'm 8 months into managing my ileostomy and have no colon, so any sort of reversal isn't an option - needless to say, I'm jealous! From what I've heard/read/seen, colostomies are much easier than what we have and require far less management. Colostomates have few diet restrictions, don't have the worries about hydration, protein, low fiber, or nutrient absorption, rarely deal with caustic high flow, and empty pouches less often. And in some cases, they can use irrigation and bowel training to go with just a stoma cap for a day - even 2!

Think of it - corn on the cob, pistachios, worry-free berries, unpeeled fruits and veggies! Not eating 5 times a day, timing loperamide and meals to reduce flow, fewer leaks, going more than 2-3 hours without emptying your pouch, less burping and managing the pouch… heck, even being able to sleep all night without worrying about waking up at 4 a.m. covered in output and having to change sheets…again!

Sounds like an amazing option to me. But is there no way to have a j-pouch and connect whatever is left of your colon to the rectum and avoid any ostomy? If not (I can't - my rectal stump is too short and scarred from necrosis to ever be used), I'd absolutely trade an ileostomy for a colostomy any day! Go for it!

Good luck!

Tips on Hernia Prevention with Collin | Hollister

I had an ileostomy due to fecal incontinence, a prolapse, and a half-dead colon that was infected. I have already gone to a second option; this is what he is recommending. I have a dead nerve in my rectum, so if he does the reversal, it won't even work.

So definitely a reversal is off the table. Therefore, your options are to stay with the ileostomy or get a colostomy. I definitely think a colostomy is easier to manage. Since you asked for pros and cons, I'll provide the pros and cons of a colostomy as I see them.

Pros for Colostomy:
1. More Formed and Predictable Output
    ■ This is the most significant advantage.
    ■ The colon's primary job is to absorb water. Therefore, the output from a colostomy, especially one lower in the descending or sigmoid colon, is more formed, similar to regular effluent. It is expelled in intermittent "boluses" rather than a constant flow.

2. Less Frequent Pouch Emptying
    ■ Because the output is more solid and less frequent, many ostomates with a colostomy only need to empty their pouch 2-4 times a day.

3. Reduced Skin Irritation Risk
    ■ The output does not contain active digestive enzymes.

4. Lower Risk of Dehydration and Electrolyte Imbalance
    ■ The colon is still involved in absorbing water and some electrolytes. This makes it much easier to stay hydrated.

5. Potential for Irrigation (Sigmoid Colostomies Only)

6. Fewer Dietary Restrictions
   ■ Once healed, ostomates with a colostomy can often return to a fairly normal diet. While some foods (like cabbage, beans, or onions) may cause gas, and others can cause blockage if not chewed well (like corn, nuts), the restrictions are generally less severe.           

7. Smaller Appliance Options
    ■ Because the output is solid and less frequent, a smaller, more discreet closed pouch can often be used. These are discarded after each use, which some ostomates find more convenient than emptying a drainable pouch.

Cons for Colostomy:
1. More Pronounced Odor
    ■ The colon contains a much larger and different population of bacteria than the small intestine. These bacteria are essential for breaking down waste, but they produce very odorous gases and effluent.

2. Constipation and Impaction Risk
    ■ The output of a colostomy is more solid and can become too solid. Colostomates can be prone to constipation, and in severe cases, the hard effluent can cause a blockage (impaction).

3. The Passing of Effluent Can Be Painful
    ■ The "life investment" (stoma) itself has no nerve endings, but the effluent from a sigmoid colostomy can be large and fully formed. Passing formed effluent through the abdominal wall muscle and skin can cause a sensation of cramping or pressure that is sometimes described as painful/uncomfortable.

4. Higher Risk of Parastomal Hernia
    ■ Colostomies, especially those in the left lower abdomen (sigmoid colostomies), are created in an area that is naturally a weaker point in the abdominal wall. The larger diameter of the colon and the increased intra-abdominal pressure from straining to pass formed effluent contribute to a higher lifetime risk of developing a parastomal hernia.
    ■ Straining to pass formed effluent in the context of a colostomy requires a nuanced explanation because you have no voluntary sphincter control over the "life investment".
        • "Straining" refers to the physical, often involuntary, increase in pressure inside your abdominal cavity that occurs when you are constipated or trying to pass hard, formed effluent.
        • Due to the colon's water-absorbing function, if the effluent sits in the colon for too long or you are slightly dehydrated, it can become firm and dense.
        • The ostomy site is, by definition, a hole in your strong abdominal wall muscles. It is the weakest point in that structural layer.
        • When you repeatedly strain (increase intra-abdominal pressure), that pressure pushes outward in all directions.
        • The internal organs and loops of intestine, pushed by this high pressure, will seek the path of least resistance. Over time, they can begin to bulge out through the weak point — the muscle defect around your "life investment" — creating a parastomal hernia.
       • Think of it like inflating a balloon with a weak spot. The air pressure will always cause the weak spot to bulge out first and most prominently.
        • So, in the context of a colostomy, "straining to pass formed effluent" means:
          ○ The involuntary, physical act of increasing pressure within the abdomen to overcome the resistance of passing firm effluent. This repeated high pressure is a primary mechanical cause of parastomal hernias.
          ○ While you cannot control when output happens, the consistency of that output (influenced by diet and fluid intake) directly affects the physical forces your ostomy site endures. This is why preventing constipation is a critical part of long-term colostomy management.

5. Potential for Larger, Less Protruding "Life Investment"
    ■ The colon has a larger diameter than the ileum. A colostomy "life investment" may be larger and may not protrude as much as an ideal ileostomy "life investment," which can make achieving a secure seal with the appliance slightly more challenging.

6. Psychological Impact of "Normal" Effluent
    ■ For some ostomates, seeing and disposing of fully formed effluent in a pouch attached to their abdomen can be more psychologically difficult to cope with than liquid effluent, which feels less like a traditional bowel movement.

Of course, the location of your "life investment" matters. The effluent is more solid/semi-solid for descending and sigmoid colon colostomies. Transverse colostomies have more liquid/semi-liquid output. An ascending colon colostomy is more liquid and provides no significant advantage over an ileostomy.

Update as of now, the doctor decided not to do anything since I got a very bad rash and bad leakage. So I am stuck in the hospital again. He will not reverse at the moment.