Colostomia alternates between the following attacks:
- Hops in place and then slides toward Isaac in the closest cardinal direction, firing projectiles in both perpendicular directions as she moves and leaving trails of explosive gas.
- The slide can be at a slight angle if Isaac isn't perfectly aligned with it.
- Colostomia continuously performs this attack until ~40% of the room is covered in explosive gas.
- Launches a Butt Bombs Bomb towards Isaac that ignites any gas clouds its explosion hits, causing a chain of explosions.
- This is always her first attack upon spawning.
- Unlike Isaac's Butt Bombs, these do not fog the room.
After dropping to half health, the bag containing Colostomia explodes, creating explosive clouds and leaving her adhering to the floor.
- Jumps to another nearby location, firing 8 projectiles in a radial burst and creating a puddle of harmful Brown Creep where she lands.
- Only 2 puddles of Brown Creep can persist at once.
- Spits two Butt Bombs Bombs at Isaac. The range of these bombs is dependent on how close Isaac is to her.
- Farts, creating a ring of explosive gas around her location.
- Colostomia is based on a Colostomy bag, a removable, disposable bag that attaches to the exterior opening of a colostomy to permit sanitary collection and disposal of bodily wastes.
- Colostomia's 1st phase charge attack is similar to an attack from The Witness in Antibirth.
- Colostomia is confirmed female according to messages from Not Your Sagittarius in the official Binding of Isaac Discord.
- Upon death, Colostomia diffuses into the water of the arena, turning it from green to a murky brown.
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