Choosing between a colostomy and an ileostomy is a significant decision that can impact your health and quality of life. If you're facing this choice, here are some insights and advice that might help you navigate the process:

- Seek multiple opinions: It's important to consult with at least two or three surgeons from different facilities. This is because some surgeons might only recommend procedures they are familiar with or perform themselves.

- Consider the risks and benefits of removing the lower colon and rectal stump: If the lower third of your colon is damaged, removing it can help eliminate the risk of future cancer in the rectal stump or anus.

- Explore continence-restoring alternatives: Look into options like the BCIR (Barnett Continent Internal Reservoir), which is made from the last two feet of the small intestine. This method allows waste to be drained a few times a day with a catheter, avoiding the need for an external pouch. It's particularly suitable for those already considering an ileostomy. This procedure is available at specific hospitals in the U.S., and there are online resources to learn more about it. Other related procedures include the Koch pouch, J-pouch, and IAAP, though damage to the last third of the bowel might rule out a standard J-pouch.

- Understand output consistency and adaptation: A colostomy typically results in firmer output because the large intestine absorbs water, while an ileostomy starts with liquid output that thickens over time as the small intestine adapts. Diet plays a crucial role in managing output for both types.

- Consider the irrigation option with a colostomy: Many colostomy patients can irrigate, which might help reduce the daily impact of the stoma.

- Learn from long-term lifestyle experiences with an ileostomy: Many people with an ileostomy lead normal lives for decades, engaging in activities like schooling, dating, marriage, raising a family, pursuing careers, and enjoying hobbies such as motorcycling, flying, traveling, and swimming.

- Make an informed decision: Before making a decision, gather comprehensive information about all surgical options and their long-term implications to ensure you are making a fully informed choice.