Having a colostomy for anal cancer
A colostomy is an operation to bring the end of your large bowel (colon) out onto the surface of your tummy (abdomen).
A colostomy is a type of 
. You might have a colostomy if you have surgery for anal cancer.
Having a colostomy means your poo no longer passes out of your body through your anus. Instead, it passes out through the stoma. You wear a bag that sticks to your skin over the stoma to collect the poo.
When you might have a colostomy
is normally the first treatment your doctor recommends for anal cancer. You usually have surgery and a permanent colostomy for anal cancer if:
- the cancer hasn’t completely gone after chemoradiotherapy
- the cancer comes back after treatment
- you can’t have or do not want chemoradiotherapy
If there are still cancer cells after chemoradiotherapy or the cancer comes back
You have surgery to remove:
- your anus including the ring of muscle around your anus (anal sphincter)
- back passage (rectum)
- the last part of your colon
Doctors call this operation an abdominoperineal resection (APR).
If you can’t have or do not want chemoradiotherapy
Some people may have an APR and colostomy as their first treatment instead of chemoradiotherapy. This is not very common but may be if they:
- have had previous radiotherapy to the lower tummy (pelvis), and they can’t have more to cure the cancer
- have a type of anal cancer called
adenocarcinoma or adenosquamous carcinoma - these are less sensitive to radiotherapy - are having drugs to suppress their
immune system as part of an organ transplant - this is because they may not be well enough to complete chemoradiotherapy without taking breaks - decide against having chemoradiotherapy
What does a colostomy look like?
A colostomy for anal cancer is generally on the lower left side of your abdomen. It is normally red and wet like the inside of your mouth. This is because the inside of the bowel is lined with the same moist tissues (mucous membrane) as the mouth.
The size and shape of a colostomy can vary. Some may sit flat on your abdomen and others may stick out a bit. After your operation, the stoma will be swollen to start with. A lot of the swelling will go down over the first few days. But it can take up to 6 weeks to settle to the size it will remain.
The colostomy has no nerve supply, so it doesn't hurt. But you have to take care not to injure it. This is because you won't feel any pain there if you do.
You put a special bag over the colostomy. This is called a colostomy bag or stoma bag. Your poo passes out of the colostomy and into the bag. Some of the that your bowel makes also passes out through the colostomy. This is normal, and it collects in the bag with the poo
Looking after your colostomy
Learning to look after a colostomy takes time. You usually see a specialist nurse called a stoma nurse in the run up to your operation. They specialise in looking after people with stomas. They will talk with you about having a stoma and make sure you are prepared.
Before your operation your stoma nurse marks on your abdomen where your colostomy is going to be. This is so you can find a place for it that suits your normal lifestyle.
Your stoma nurse can answer your questions and show you the type of colostomy bag you will use at first. They will show you how the bag works and how to fit and empty it. The stoma nurse or ward nurse look after your colostomy and change your bag for the first few days. They then gradually encourage you to do it yourself.
Your stoma nurse also gives you information about your diet. And they can answer any questions you have about practical things, such as:
- travelling
- doing sports
- what to wear
You might have questions on how the colostomy will affect your sex life. People often feel embarrassed to talk about this. But it is an important part of the conversation when talking about your surgery. Your stoma nurse has experience in this. And they understand that surgery and a colostomy might affect your life in many ways.
Going home with a colostomy
Adjusting to living with a stoma is not always easy and might take time.
Talk to your stoma nurse or the ward nurses about any support you feel you need at home. You can ask the stoma nurse to show a friend or relative how to look after the colostomy. This means they can help out when you get home.
Your stoma nurse will give you their contact details before you leave the hospital. You can ring them for advice and support. They may arrange to visit you at home.
Stoma supplies and prescription charges
Make sure you always have plenty of extra supplies so you don't run out. It is helpful to keep everything you need to change your colostomy together in a bag or one place. This can make changing it a smooth and easy process.
Your stoma nurse will give you colostomy bags to take home. Once you have found the type of bag that works for you, you can get more from the chemist or direct from a local stockist. Your stoma nurse will give you the order code for the supplies you need. They can also help you set up a delivery or supplier.
People with a permanent stoma do not have to pay for their prescriptions. This includes stoma supplies. Your GP still needs to give you a signed prescription though.
Prescriptions are free in Scotland, Wales and Northern Ireland. If you live in England you will need to apply for a Medical Exemption Certificate to get your prescriptions for free. You get the form to apply from the hospital or your GP.
