Elective colostomy placement.

[MC87]

Hello everyone,. I am a full time wheelchair user with MS. I have no movement from mid chest down. I have been dealing with a neurogenic bladder and bowel for 30 years. I am to a point that the strength in my fingers is affecting many aspects of my bowel regimen. I am set up for an elective colostomy. The two options are a transverse or descending colostomy. The surgeon and ostomy nurse suggest the transverse because they feel it will be easier for me to take care of as a wheelchair user. I want this to make my life easier so I want to make the right decision. I also work, so I need to consider clothing. If any wheelchair users, or anyone with one of these can give me some insite, I would really appreciate it.

[ot dave]

Hi MC87,
I don't have MS, but I do have a permanent colostomy...and I'm an occupational therapist. So, I might have some insight that might be beneficial for you. I don't know what your current bowel regimen consists of, but you'll still need some control of your hands/fingers in order to continue to independently perform bowel care with a colostomy. The colon is used to absorb water that makes it through from the small intestine, in addition to a bunch of other digestive duties. Essentially, the more colon you have, the more water that will be absorbed, making your colon its most efficient, and the more formed your stool will be with a descending colon. That said, your body will adjust with a transverse colostomy, just not as quickly as a descending colostomy would.
From a functional standpoint, the transverse colostomy would be positioned higher on the abdomen, usually above the navel. A descending colostomy would likely be positioned on the left hand side, usually lower than the navel. I agree that accessing a transverse colostomy while in a wheelchair will definitely be easier to care for... and, if when the time comes, it will make it easier for any care givers as well.
Clothing shouldn't be an issue, as long as you're not wearing a lot of tight fitting clothing. I have a substantial hernia that requires the use of an abdominal binder. I am able to wear any clothes I want, but I avoid things like jeans or non-elastic waist pants. The tail of my pouch falls below my waist line, so tight waisted pants are a no go for me and my lifestyle. For you, I suspect you will be able to find pouches that don't go into the waist band, therefore allowing you to dress as you always have. Of all of the post ostomy issues we can help with here, that will likely be one of the easier ones to deal with!
Questions to ask your surgeon: Options for a resection if it becomes problematic? Will the remainder of the colon be removed? Will the rectum/anus be removed? Folks with residual colons/rectums have to deal with mucous discharges from the residual anatomy. Not usually a big deal for folks with fully functioning hands, but it might be something to address as it might be similar to your current bowel regimen to deal with...not on a daily basis, but enough that it needs to be addressed. You might want to discuss the possibility/pros and cons of a total APR (abdominoperineal resection, basically removing everything past the colostomy) as you are doing this electively to make life easier. Not having to deal with residual anatomy would make this a more effective approach...in my opinion anyway. An APR however removes any chance of reconnection should that become an issue.
I hope that helps some. Let us know if we can answer anything else.

David

[MC87]

Thanks David, I appreciate your insight. It gives me some things to think about.

[lms1]

Hi,
I’m in a wheelchair or scooter for all my ostomy needs. I have an incomplete spinal cord injury. I had an elective colostomy in 2009 due to a neurogenic bowel. I have completely normal hand function. I have a descending colostomy so my appliance is on my left side below my waist. I wheel right up to a toilet and empty directly into the toilet. Because my ostomy is below my waist it does not interfere with my clothing. I retired in 2018 but worked without issue with the ostomy. In fact, it was much better because I didn’t have the fear/risk of accidents. I think the key for you will be how much hand function you have. A transverse colostomy will have looser output and therefore be easier to empty the bag. Regarding the remaining intestine, David is correct that it can be problematic. I was fine for 6 years, but now have diversion/disuse proctitis. I do get minor discharge from my rectum and may consider removal at some later date. Some folks never have trouble. In closing, I was injured when I was 18 and my only regret about my ostomy is that I waited until I was 56 to get one.

Send me a PM if you want to discuss more.

Good Luck,

Linda