Many colostomies are reversible. Whether yours can be reversed depends on why it was created, how much healthy bowel remains, and whether your body has healed enough to handle reconnection surgery. Temporary colostomies are designed from the start with reversal in mind, while permanent ones are placed when the rectum or anal muscles can no longer function. Understanding which category yours falls into is the first step.
Temporary vs. Permanent Colostomies
Surgeons create temporary colostomies to give a damaged or inflamed section of bowel time to heal. Common reasons include diverticulitis, inflammatory bowel disease, traumatic injuries, bowel obstructions, and some birth defects. In these cases, the colon is brought to the surface of the abdomen through a loop opening, which is specifically designed to be easier to reverse later. Once the downstream bowel has recovered, the two ends are reconnected and normal digestion resumes.
Permanent colostomies are a different situation. They’re typically placed when the rectum itself must be removed, most often because of rectal cancer. They’re also used when the muscles that control bowel movements have permanently failed. In both scenarios, there’s no functional endpoint to reconnect to, so reversal isn’t an option. Most permanent colostomies are “end colostomies,” where the remaining colon is brought directly to the abdominal wall rather than looped through it.
What Makes You Eligible for Reversal
Even if your colostomy was intended to be temporary, reversal isn’t automatic. Your surgical team will evaluate several things before scheduling the procedure. According to Cleveland Clinic criteria, you’ll need to show that:
- The original surgery site has fully healed, with no leak where the bowel was previously joined.
- The underlying disease has cleared, with no active infection or inflammation in the bowel.
- Your anal nerves and muscles still work well enough to control bowel movements after reconnection.
- Your overall health is strong enough to tolerate another surgery.
Leaks that don’t heal at the original surgical site are the main reason a planned reversal might not happen. If the connection point never fully sealed, trying to restore the flow of stool through that area could cause serious infection.
How Many People Actually Get Reversed
The reality is that not everyone who could theoretically be reversed ends up going through with it. For people who had a Hartmann’s procedure (a common emergency surgery that creates an end colostomy), only 26% to 40% ultimately have their colostomy reversed. That low number reflects a mix of factors: some patients develop new health problems that make another surgery too risky, some have disease progression, and some simply adapt to life with the bag and decide against additional surgery.
Certain health conditions raise the risk of complications enough that surgeons may advise against reversal. A large national database analysis found that independent predictors of major complications included age over 70, a BMI of 40 or higher, smoking, chronic lung disease, dependence on dialysis, bleeding disorders, and long-term steroid use. Each of these roughly doubled or increased the odds of a serious problem after reversal.
Timing of the Reversal
Reversal surgery doesn’t happen right away. Your body needs months to heal from the initial procedure. A retrospective study broke patients into three timing groups: early reversal at 45 to 120 days (median 90 days), intermediate reversal at 121 to 180 days (median 150 days), and late reversal beyond 180 days (median 210 days). Most surgeons aim for somewhere in the three-to-six-month window, though the exact timing depends on how quickly your body recovers and whether any additional treatment, like chemotherapy, needs to finish first.
What Happens During Reversal Surgery
The basic idea is straightforward: the surgeon detaches the stoma from the abdominal wall, reconnects the two ends of the bowel, and closes the opening in your abdomen. The specifics vary depending on the type of colostomy you have.
For loop colostomies, the reconnection is simpler because the bowel was never fully divided. The surgeon removes the stoma, aligns the two sides, and stitches or staples them back together. For end colostomies, the procedure is more involved. The surgeon needs to locate the sealed-off downstream end of the bowel inside the abdomen and rejoin it to the functioning upstream end using either a circular stapling device or hand-sewn stitches.
When possible, surgeons perform the reversal laparoscopically (through small incisions with a camera). The open approach, which requires a larger abdominal incision, carries significantly higher risk. One large database analysis found that open reversal was associated with 1.67 times the odds of a major complication and 3.42 times the odds of death compared to the laparoscopic approach.
Risks and Complications
Colostomy reversal is real surgery with real risks. Complication rates range from 6% to 40% depending on the study and patient population, with overall morbidity reported as high as 50% in some analyses. Mortality, while low, can reach up to 7% even in planned (non-emergency) settings. Infection is the most common complication.
The most serious specific risk is an anastomotic leak, where the new connection between the two bowel ends doesn’t seal properly. Stool can escape into the abdominal cavity, causing a dangerous infection that sometimes requires yet another surgery. In some cases, a failed reversal means a new colostomy has to be created.
Life After Reversal
Getting your colostomy reversed doesn’t mean your bowel immediately works the way it did before. The section of colon that was resting for months has essentially been offline, and it takes time to regain normal function. Most people experience a period of adjustment that includes more frequent bowel movements, looser stools, and some urgency. For many, this gradually improves over weeks to months as the bowel readapts.
Some people find that their bowel habits never fully return to their pre-colostomy baseline. The degree of change depends on how much colon was removed, how long the colostomy was in place, and individual healing. Dietary adjustments during recovery, typically starting with easy-to-digest foods and gradually reintroducing fiber, help the bowel ease back into its normal workload. Most people find their new normal manageable, even if it’s slightly different from before.