A stoma is created through surgery. A surgeon makes an opening in your abdomen and brings a section of your intestine (or ureter) to the surface of your skin, where it’s stitched in place. This redirects waste out of your body through that opening instead of through its normal path. People get stomas because of cancer, inflammatory bowel disease, traumatic injuries, and several other conditions that damage or block the digestive or urinary tract.
Conditions That Lead to a Stoma
The most common reason for stoma surgery is colorectal cancer. When a tumor needs to be removed along with a section of the colon or rectum, surgeons sometimes can’t reconnect the remaining bowel safely. A stoma gives the body an alternative exit route for waste.
Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, is another frequent cause. These conditions can damage the colon so severely that removing part or all of it becomes the best option for relieving symptoms and preventing life-threatening complications. Diverticulitis, where small pouches in the colon wall become infected or rupture, can also require removal of a section of bowel and creation of a stoma.
Some stomas are created in emergencies. A perforated bowel, where a hole develops in the intestinal wall and leaks contents into the abdomen, requires immediate surgery. Traumatic injuries from accidents or gunshot wounds can damage the colon badly enough to need a stoma. Bowel obstructions caused by cancer, scar tissue, or other conditions may also require one when the blockage can’t be cleared any other way. In rare cases, babies are born with conditions that require stoma surgery shortly after birth.
Three Main Types of Stomas
The type of stoma you get depends on which part of your body needs to be bypassed.
- Colostomy: A piece of the large intestine is brought through your abdominal wall, usually on the left side of your lower abdomen. Waste output is digested food, and its consistency ranges from loose and watery to soft or firm depending on where along the colon the stoma is placed. A stoma higher up in the colon produces looser output, while one near the end of the colon produces firmer stool.
- Ileostomy: The lowest part of the small intestine is brought to the surface, typically on the right side of the abdomen. Because food hasn’t passed through the large intestine yet (where water is absorbed), the output tends to be more liquid than with a colostomy.
- Urostomy: This type redirects urine rather than stool. A small piece of intestine is used to create a channel that carries urine from the kidneys out through the abdominal wall, bypassing the bladder entirely. It’s used when the bladder has been removed or can no longer function, often due to bladder cancer.
What Happens During Surgery
The surgery to create a stoma is performed under general anesthesia, meaning you’re fully asleep. Your surgeon first addresses the underlying problem, whether that’s removing a tumor, repairing damaged bowel, or clearing an obstruction. Then they create a small opening in the abdominal wall, pull a loop or end of intestine through it, and stitch the intestine directly to the skin surface. The exposed tissue, which is the stoma itself, is pink and moist, similar to the inside of your cheek.
The procedure can be done as open surgery through a larger incision or laparoscopically through several small incisions using a camera and specialized instruments. Laparoscopic surgery tends to result in shorter hospital stays and fewer complications. When a prior colorectal surgery was done laparoscopically, later stoma-related procedures also go more smoothly, with shorter operating times (about 61 minutes versus 83 minutes for open surgery) and hospital stays roughly a day shorter.
Not every stoma surgery is planned. Emergency situations like a perforated bowel or severe trauma may mean you go into surgery without the kind of preparation that scheduled procedures allow. In those cases, surgeons focus on stabilizing you first, and stoma education and adjustment happen during recovery.
Temporary vs. Permanent Stomas
Not all stomas are forever. Many are created as a temporary measure to let a section of bowel heal after surgery, particularly after cancer removal. The idea is that once the surgical site has recovered, a second operation reconnects the intestine and closes the stoma.
The commonly quoted timeline for reversal is about three months, but real-world data shows it often takes longer. In a study of rectal cancer patients who received temporary ileostomies, 79% eventually had their stomas reversed, with the median time to reversal being 5.5 months. Nearly all reversals happened within two years. The delay beyond the three-month target is usually driven by ongoing cancer treatment, the need for additional healing, or patient-specific risk factors that make it safer to wait.
A stoma becomes permanent when the underlying condition requires removal of the rectum or anus entirely, or when the remaining bowel can’t be safely reconnected. This is more common with advanced rectal cancer or severe, widespread Crohn’s disease. Your surgical team will typically tell you before the operation whether the stoma is expected to be temporary or permanent, though sometimes that determination can only be made during surgery itself.
Recovery After Stoma Surgery
Hospital stays after stoma surgery generally range from a few days to about a week, depending on whether the procedure was laparoscopic or open and how complex the underlying surgery was. Before you’re discharged, the surgical team will make sure your stoma is functioning, meaning output is passing through it normally.
A stoma care nurse will teach you how to manage your ostomy pouch: how to empty it, how to change the adhesive barrier that attaches it to your skin, and how to keep the skin around the stoma healthy. Most people find the learning curve steep at first but manageable within a few weeks. The pouch sits flat against your body and is not visible under most clothing.
Full recovery from the surgery itself takes several weeks. During that time, you’ll gradually return to normal activities, starting with light walking and progressing from there. Lifting heavy objects is typically restricted for six to eight weeks to let the abdominal incision heal and reduce the risk of a hernia forming around the stoma site.
Living With a Stoma Long Term
People with stomas work, exercise, travel, swim, and maintain intimate relationships. The adjustment is real, but it’s largely a practical one rather than a physical limitation. You’ll need to keep supplies on hand (pouches, adhesive wafers, skin barrier products) and develop a routine for emptying and changing your pouch that fits your schedule.
Diet often requires some attention, especially with an ileostomy. Because the large intestine is bypassed, staying hydrated takes more effort since less water is absorbed from food. Some foods can cause blockages at the stoma site, so eating slowly and chewing thoroughly matters more than it used to. With a colostomy, dietary adjustments are usually milder, and many people return to eating most of the foods they enjoyed before surgery.
Skin irritation around the stoma is the most common ongoing issue. It’s usually caused by output leaking under the adhesive barrier and is managed by ensuring a proper fit and using protective skin products. Regular follow-up with a stoma care nurse, especially in the first year, helps catch and correct these problems early.