What is the Difference Between Colostomy and Ileostomy?

A colostomy and ileostomy both involve bringing a section of the intestine to the surface of the abdomen to create a drainage point for feces when the patient's intestinal tract is not functioning normally. In the case of a colostomy, the section of intestine involved is part of the large intestine, also known as the colon. By contrast, an ileostomy uses the ileum, the end of the small intestine, bypassing the colon altogether. Both procedures are used in a number of different settings and some alternatives to the colostomy and ileostomy have been developed to give patients more options.

In either procedure, the patient is placed under general anesthesia to allow the surgeon to perform abdominal surgery. Some indications for an ostomy procedure can include bowel cancer, injuries to the bowl that need time to heal, perforations of the bowel, and severe damage to the bowel caused by inflammation. The surgeon takes a section of intestine above the area of concern and creates an outlet through the abdomen. The outlet attaches to a pouch to collect feces.

Both procedures are potentially reversible and the surgeries may be used as a temporary measure while a patient's intestines are recovering from a medical issue, such as injuries that require time to heal. The section of injured bowl can be bypassed with the ostomy procedure to allow it to heal, and then surgeon can return to reverse the surgery once the bowel is healthy again. Success rates with colostomy and ileostomy reversal vary, depending on factors like the patient's general level of health and the surgeon's skills and experience.

These procedures are associated in the popular imagination with the dreaded ostomy bag, an external pouch used for collecting feces. Management of an ostomy pouch does require some training and practice, but once patients get used to it, they can engage in a wide variety of activities including sports and heavy physical activity after a colostomy or ileostomy. Some surgeons have also developed alternatives such as procedures with an internal collection pouch, or procedures where the opening is capped and the bowel is periodically flushed to drain it as needed. Patients may want to discuss all the available options before consenting to a procedure.

When colostomy and ileostomy are recommended, it is usually because a surgeon believes these are the best treatment options. The procedures are invasive and require lifestyle adjustments for the patient, and they are not suggested lightly. Patients should ask their surgeons about aftercare and other issues when they prepare for surgery so they know what to expect.