Anal stitching: the ultimate body mod...?

November 8, 2006 7:18 PM

When one is forced to get a colostomy bag, er, installed...

...do they sew up the anus, since it's no longer functional?

posted by limeonaire to health & fitness (15 comments total)

considering that one has to give attention to maintaining and cleaning the site--the bag itself is not permanent and must be changed regularly--such location would be extremely awkward...
posted by troybob at 7:34 PM on November 8, 2006

Well, see, that's why I'm asking this—it's my understanding that generally, colostomy attachments are located around the hip or side, not at the anus. This is often because the destruction or removal of the lower part of the intestines necessitates the attachment of a colostomy bag, which usually fills with somewhat more liquidified waste than one would expect to issue from the anus after complete digestion.

So given that...what happens to the anus, which is no longer in use? Do they leave it open and vestigial, or do they sew it up?
posted by limeonaire at 7:45 PM on November 8, 2006

There are different types of colostomies. In the most common, called a "Hartmann's Colostomy," the anus is sealed (I don't know if it is stiched or how). The ostomy outlet is not the anus, it is located in the abdomen. (I have had two friends with Crohn's disease).
posted by nanojath at 7:51 PM on November 8, 2006

doh! i totally read the question wrong...sorry about that...i've cared for colostomy patients before but never got around to asking about that...
posted by troybob at 8:00 PM on November 8, 2006

What purpose does sealing serve?
posted by phrontist at 8:08 PM on November 8, 2006

My speculation was that it'd keep out infection?
posted by limeonaire at 8:16 PM on November 8, 2006

Depends. Many colostomies are short term (short as in months to a few years) because of cancers or something else that renders the lower part of the large intestine unusable pending healing and then the colon is reconnected to itself at a subsequent surgery. If the lower part of the colon is fully resected than the anus is sealed.
posted by shagoth at 8:35 PM on November 8, 2006

I know someone who had a colostomy bag. His anus remained unsealed. In his case, his intestinal track was eventually reconnected to the rectum, and he was able to stop using the colostomy bag.

I was surprised at the idea of sealing the anus so I googled around. It looks like that in a "Hartmann's colostomy", the severed end of the large intestine is sealed ---not the anus.

Sealing the anus strikes me as something that would psychologically bother the patient, and medically somewhere between pointless and dangerous. Dangerous because the area around your anus gets put under more stress than you'd think (during walking, running, sitting), so I'd worry a bit about any seals tearing open and creating wounds.
posted by Humanzee at 8:39 PM on November 8, 2006

It depends on where in the colon or rectum the problem was that caused the person to have the colostomy. Since the colon normally secretes waste of it's own, the anus is generally left open. If the person had, say a tumor in the rectum, the anus would be closed since that part of the person's colon would be gone.

By the way, colostomy appliances are not the horrifying thing that they were for generations past. The person who has one has a self- adhesive pad placed over the stoma, with a small opening in it. There is a plastic ring on the adhesive pad, and the colostomy bag snaps on like Tupperware.

Oops- on preview, what shagoth said.
posted by puddinghead at 8:40 PM on November 8, 2006

I have to admit that I've wondered the same thing myself, from the perspective of a gay man.

(Just throwin' the thought out there.)
posted by CrayDrygu at 9:07 PM on November 8, 2006

In permanent single-barrel colostomies where they remove the tract that comes after the stoma, the anal tissue is also removed with the rectum. So it's technically not the "anus" that's being closed--it's the opening/sinus where the anus used to be that is closed up.

If the anus & segment of colon that comes below the stoma are not removed (one example is with the aforementioned Hartmann's pouch) then the anus isn't stitched shut. Waste exits out the stoma, and the anus isn't a fuctional part of the GI tract--but that doesn't make the anus completely nonfunctional. Though the GI tract ends at the stoma, the rectal stump is still living tissue that produces mucous. This mucous exits via the anus occasionally.

re: infection & closure
In general terms, think of the inside of your GI tract as a separate enviroment that the inside of your body in terms of thinking about infection. Think of yourself topology-wise as a donut, and the GI tract lumen is the donut hole. The tract is essentially continuous with the external enviroment (this is why bacteria that's not a problem hanging out in your gut can make you very sick if your gut gets perforated). As far as infection goes, if the lower colon/anus are removed, then the opening would give access to your body's internal environment if it weren't shut, which would lead to infection. If there's a Hartmann's pouch, however, with the upper end of the pouch shut, then there's no access to the internal enviroment. If there's a double-barrel or loop colostomy, the only openings are to the mouth, anus, and stoma openings--no access to the internal environment (in that case, topology-wise you're a donut with two donut holes).


short answer: if the anus isn't removed, then it usually isn't stitched shut. if the anus is removed, then the former "business end" is shut.
posted by neda at 10:36 PM on November 8, 2006

This is from my brother:

"My 45 year old wife is a two year survivor of rectal cancer. Here is the scoop on colostomies.

First off, there are not nearly as bad as everyone thinks. Modern bags have great seals and there is a wide variety of shapes and sizes available. The only real downside is an inability to hold gas in. That can be managed by monitoring what and when you eat.

For my wife the tumor was about 2 inches from the anal opening. Even with this location, the surgeon had to remove the last foot and a half of her colon because allows for the best re-attachment of the colon to a new opening on left side of her body. The removal of such a large piece also has something to do with the vascular structure of colon and where best to cut it off. The new opening is roughly parallel to her navel on the left side. This also allows the bag to be hidden below her waistline. Unless you knew she had a colostomy you wouldn't even suspect it.

Regarding the anus- it's gone. This part of the surgery caused the most difficult recovery. Like with most cuts the wound needs to drain but it also need to close up. This area is difficult to heal because the movement of the legs essentially opens the wound due to normal activities. It took months to heal, which I've been told is normal. The good news is it never got infected and healed nicely. The scar is between the cheeks and isn't visible.

All her other body parts are intact and work as advertised. Best of all, she is still with us. "
posted by bondcliff at 6:25 AM on November 9, 2006

A relative of mine has a colostomy bag, installed after a botched surgery. He sometimes uses the toilet and sometimes uses the bag. The hope is that he'll use the bag less and less, and eventually be able to have it removed.
posted by The corpse in the library at 8:59 AM on November 9, 2006

I was surprised at the idea of sealing the anus so I googled around.

You are a brave, brave person.
posted by The corpse in the library at 9:01 AM on November 9, 2006

Anyone else hoping If I Had an Anus turns up in here?
posted by hermitosis at 9:53 AM on November 9, 2006