Expert view - colostomy

Here, Professor RJ (Bill) Heald considers a question frequently asked by patients*.

Q: Do I really need a permanent colostomy?

‘If you have rectal cancer, the height of your tumour above the bottom of your anal canal influences whether you will need a permanent colostomy or not. Your surgeon will always write down the height of your tumour – so it is reasonable to ask him or her what this height is, as it makes a major difference to your future.


  1. Around 2 – 3 centimetres. Cancers with their lower edge this low down will almost always require abdomino-perineal excision and permanent colostomy, with the exception of some rather uncommon tumours that can sometimes be completely controlled with chemoradiotherapy.

  2. 4 – 6 centimetres. Some specialists will be prepared to perform an operation that preserves the anal canal and restores colorectal continuity or even joins a colon “pouch” on to the anal canal itself, thus restoring relatively normal anal function. In these cases where a permanent colostomy is being suggested, a second opinion is a really sensible course of action, which should give no offence to the surgeon concerned.

  3. 7 – 12 centimetres. Tumours this far into the rectum will almost always be suitable for a restorative procedure (which allows the bowel to be joined together) which requires at the most a temporary protective colostomy or ileostomy. This should ultimately lead to relatively normal bowel function after the primary treatment has been concluded and the stoma closed. Again, if a permanent colostomy is recommended a second opinion is appropriate.

  4. 12 – 15 centimetres and above. These cancers are in general more simple to understand and manage: removal and re-joining is generally possible.

If you do need a permanent colostomy, you may wish to consider the possibility of irrigation. Irrigation is a way of regulating your bowel movements by emptying the colon at a scheduled time. Many patients find that irrigation brings a welcome sense of freedom and normality to life with a colostomy.’

To read more about irrigation, click here.

* Please note that this is a general answer applying to Basingstoke practice. If you have questions or concerns about your specific diagnosis and treatment, you should talk to your specialist nurse.