A stoma is a surgically created opening in the abdomen that allows waste to exit the body when the normal route is no longer safe or functional. It looks like a small, round piece of moist pink or red tissue, similar to the inside of your mouth, and typically measures one to two inches across. Between 725,000 and one million people in the United States live with one. Some stomas are temporary, created to let the bowel heal after surgery, while others are permanent.
What a Stoma Looks and Feels Like
A healthy stoma is pink or red, wet, and slightly shiny. Some sit flat against the skin, while others protrude slightly. Because the tissue has no nerve endings, touching the stoma itself doesn’t cause pain. You can’t feel output passing through it. The skin surrounding the stoma does have normal sensation, which is why irritation or leaks around the base can be uncomfortable.
The Three Main Types
The type of stoma you have depends on which part of the digestive or urinary system is rerouted.
Colostomy
A colostomy brings a section of the large intestine through the abdominal wall. It’s usually placed on the left side of the lower abdomen. The consistency of output depends on where along the colon the stoma is formed. A stoma made from the ascending colon (the first section) produces loose, watery output because less water has been absorbed. One made from the descending or sigmoid colon, closer to the end of the digestive tract, produces soft to firm output that more closely resembles a normal bowel movement.
Ileostomy
An ileostomy uses the lowest part of the small intestine and is typically placed on the right side of the abdomen. Because digested food hasn’t yet passed through the large intestine, where most water absorption happens, ileostomy output is more liquid. Normal daily output ranges from 600 to 1,200 milliliters. That high fluid loss makes dehydration a real concern: roughly 20 to 40 percent of ileostomy patients experience dehydration after surgery. If output exceeds 1,500 milliliters per day for two consecutive days, it’s considered a high-output stoma and usually requires medical management to prevent dangerous fluid and electrolyte losses.
Urostomy
A urostomy diverts urine rather than stool. The surgeon uses a small piece of the small intestine to create a channel, rerouting the tubes that carry urine from the kidneys so that urine flows through the stoma into an external pouch. The stoma itself works the same way visually but collects liquid continuously.
Why Someone Might Need a Stoma
The most common reason for creating an intestinal stoma is bowel cancer. Surgeons may need to remove a section of the colon or rectum, and a stoma gives the remaining bowel a way to function or time to heal. Other conditions that frequently lead to stoma surgery include Crohn’s disease, ulcerative colitis, diverticulitis (particularly when the colon perforates), and familial adenomatous polyposis, a genetic condition that causes precancerous growths throughout the colon.
Severe abdominal trauma, loss of blood supply to the intestine, and fecal incontinence that doesn’t respond to other treatments can also require a stoma. In some cases, a stoma is created as a palliative measure when a tumor is blocking the rectum and can’t be surgically removed.
Temporary vs. Permanent Stomas
A temporary stoma is created to protect a healing surgical connection further down the bowel. Once that connection is strong enough, the stoma can be reversed. Most reversals are planned six weeks to six months after the original surgery, though the exact timing depends on recovery and overall health. Common scenarios for temporary stomas include recovery after colorectal cancer surgery, treatment for diverticulitis, and inflammatory bowel disease operations.
A permanent stoma is necessary when the rectum or anus has been completely removed, or when the bowel can’t safely be reconnected. This is most common after certain rectal cancer surgeries or when repeated operations have failed.
How the Pouching System Works
Since a stoma has no muscles to control output, waste collects in an external pouch worn over the opening. The system has a few key parts.
- Skin barrier (wafer): A flat or curved adhesive piece that sticks to the skin around the stoma, creating a seal. Convex barriers press gently inward and are used when a stoma sits flush with or below the skin surface, helping output flow into the pouch instead of leaking underneath.
- Pouch: The bag that collects output. Drainable pouches open at the bottom so you can empty them while they’re still attached. Closed-end pouches are sealed and discarded after a single use.
- Flange or coupling: In a two-piece system, a snap-style ring connects the pouch to the skin barrier, so you can change the pouch without removing the adhesive from your skin each time.
Most people empty a drainable pouch several times a day and change the entire skin barrier every few days, though this varies with output volume and skin sensitivity.
Diet Adjustments, Especially With an Ileostomy
For the first three to four weeks after surgery, a bland, low-fiber diet is standard. Raw fruits with skin (apples, grapes, strawberries, blueberries) should be avoided during this window because fibrous material can clump together and block the stoma opening. Even bananas are limited to one small ripe one per day in those early weeks.
Some foods carry a higher blockage risk long-term for people with ileostomies. These include corn, popcorn, nuts and seeds, raw cabbage, celery, mushrooms, dried fruits, whole grains, and most vegetable skins. The common thread is tough, indigestible fiber that doesn’t break down easily before reaching the stoma.
After the initial recovery period, high-fiber foods can be added back one at a time. Drinking at least eight to ten glasses of fluid per day (about two liters) helps keep output at a manageable consistency and protects against dehydration. People with slightly elevated output (1,000 to 1,500 milliliters daily) can often manage by limiting fluid intake to 1.5 liters per day and adding extra salt to meals. Those with higher output may need specialized glucose-electrolyte drinks while limiting plain water, tea, coffee, and juice to under one liter daily, since hypotonic fluids can actually worsen fluid loss.
Common Complications
The most frequent long-term complication is a parastomal hernia, where tissue pushes through the abdominal wall next to the stoma, creating a visible bulge. One study following ostomy patients over five years found a cumulative hernia rate of nearly 38 percent. These hernias range from cosmetically bothersome to painful enough to require surgical repair. Wearing a support belt and avoiding heavy lifting can reduce the risk.
Skin irritation around the stoma is another persistent challenge. Digestive enzymes in the output, especially from an ileostomy, can break down surrounding skin quickly if the pouching system leaks. Getting the right fit on the skin barrier is the single most important factor in preventing this. Other complications include prolapse (where the stoma extends outward more than it should), narrowing of the opening, and retraction (where the stoma sinks below skin level, making a secure seal harder to achieve).