A stoma is a surgically created opening on the abdomen that allows waste to leave the body when the normal route is no longer safe or functional. Surgeons bring a section of the intestine (or, less commonly, the urinary tract) through the abdominal wall so that stool or urine can exit into a small pouch worn on the outside of the body. Roughly 1 million people in the United States live with a stoma, and the procedure is one of the most common in gastrointestinal surgery.
Why Someone Might Need a Stoma
A stoma is created when part of the digestive or urinary system needs to be bypassed. That can happen for a wide range of reasons, from chronic disease to emergency trauma. The most common conditions include:
- Colorectal cancer: Removing a tumor sometimes means removing the section of bowel it sits in, and waste needs a new exit path.
- Inflammatory bowel disease: Crohn’s disease or ulcerative colitis can damage the colon severely enough that diverting stool away from it is the safest option.
- Bowel obstruction: Blockages caused by cancer, scar tissue, or other conditions may require a stoma to relieve the obstruction.
- Bowel perforation: A hole in the intestinal wall is a surgical emergency, and a stoma lets the damaged area heal without contact with stool.
- Congenital conditions: Some babies are born with structural problems, such as Hirschsprung disease or an absent anal opening, that require a stoma shortly after birth.
In some cases, the stoma is created during surgery when nearby organs are accidentally injured and the bowel needs time to recover.
The Three Main Types
The type of stoma depends on which part of the body it diverts from. Each is named for the organ involved and placed in a specific area of the abdomen.
A colostomy brings part of the large intestine (colon) to the surface, typically on the left side of the abdomen. Because stool has already passed through most of the digestive tract by this point, the output tends to be semi-formed and similar to a normal bowel movement.
An ileostomy brings the end of the small intestine (ileum) to the surface, usually on the right side. Since less water has been absorbed at this stage of digestion, the output is more liquid and the pouch generally needs to be emptied more frequently.
A urostomy reroutes urine when the bladder has been removed or can no longer function. Surgeons use a small segment of intestine to create a channel from the kidneys to an opening on the right side of the abdomen. Urine drains continuously into an external pouch.
Temporary vs. Permanent
Not every stoma is lifelong. Many are created as a temporary measure, giving a diseased or surgically repaired section of bowel time to heal. Once healing is complete, a second surgery reconnects the intestine and closes the stoma.
However, reversal isn’t guaranteed. About 19% of stomas initially planned as temporary end up becoming permanent. The odds of successful reversal depend on several factors. Stomas created during planned (elective) surgery are reversed far more often than those created in emergencies: 86% versus 49%. Age over 65, serious underlying health problems, surgical complications, and advanced cancer all reduce the likelihood of reversal. Loop ileostomies, where the intestine is brought to the surface in a loop rather than cut completely, have the highest closure rates.
What a Stoma Looks and Feels Like
A stoma looks like a small, round piece of moist, pink-red tissue on the abdomen, similar in color and texture to the inside of your cheek. It typically protrudes slightly from the skin’s surface. Its size and shape can shift a little throughout the day as the intestine naturally contracts and relaxes.
One detail that surprises many people: a stoma has no nerve endings for pain. You won’t feel it being touched, and a small amount of painless bleeding from the surface is normal because of the dense blood vessels there. You can’t consciously control when waste exits, which is why an external pouching system is essential.
How the Pouching System Works
The collection system worn over a stoma has two main components. A skin barrier (sometimes called a wafer or flange) is an adhesive piece that sticks to the skin surrounding the stoma, forming a seal to prevent leaks and protect the skin. The pouch itself attaches to this barrier and collects waste. Some systems are one piece, where the barrier and pouch are fused together. Others are two-piece, letting you snap off the pouch to empty or replace it without removing the adhesive barrier from your skin each time.
Pouches are discreet, sitting flat under clothing, and most people around you would never know one is there. They’re emptied several times a day for ileostomies and urostomies, or once or twice a day for colostomies, depending on output.
Common Complications
Skin irritation around the stoma is the single most frequent complication after ostomy surgery. Exposure to digestive output, adhesive reactions, or a poorly fitting barrier can cause redness, small bumps, skin erosion, or even ulcers on the surrounding skin. Keeping the barrier well-fitted and the skin clean goes a long way toward preventing these problems.
Early after surgery, the stoma itself can sometimes lose blood flow (ischemia), pull back below the skin surface (retraction), or separate from the surrounding skin at the stitched edges. Later complications include parastomal hernia, where tissue bulges through the abdominal wall next to the stoma (occurring in roughly 5.5% of patients, though some studies report much higher rates), and prolapse, where the intestine pushes further out than it should. Most of these complications are manageable with adjustments to the pouching system or, in more serious cases, additional surgery.
Living With a Stoma
A stoma changes daily routines, but it doesn’t have to limit them dramatically. People with stomas run marathons, swim, lift weights, dance, and return to physically demanding jobs. One widely cited case involved a 44-year-old firefighter with a permanent colostomy who completed a nine-month training program of running, swimming, rowing, and weight training to pass the physical tests required for his job. Another involved five men with ileostomies who ran the London Marathon. A 28-year-old woman with an ileostomy returned to dance and gym classes after building her strength back gradually.
Diet typically requires some attention, especially in the first weeks after surgery. Many people find that certain foods increase gas or change the consistency of output, and it takes some experimentation to learn what works best. There’s no single “stoma diet,” and most people eventually eat a wide variety of foods. Some follow specific patterns like high-protein or low-carbohydrate eating, while others make no special changes at all.
Swimming and bathing are safe with a stoma. The pouching system is waterproof, and many people use additional accessories like barrier strips or stoma caps for extra security during water activities. Exercise, including resistance training, is encouraged, though building up gradually and paying attention to how the pouch sits during movement helps avoid issues.