A stoma is a surgically created opening in the abdomen that allows waste to leave the body through a different route than usual. Surgeons create a stoma when part of the bowel or urinary system is diseased, damaged, or needs time to heal. The opening is formed by bringing a section of intestine (or a urinary channel) through the abdominal wall to the skin’s surface. Roughly 100,000 people in the United States have bowel-related stoma surgery each year.
What a Stoma Looks and Feels Like
A stoma is pink or red and looks like moist tissue, similar to the inside of your mouth. Right after surgery it appears swollen, but it gradually shrinks over the following weeks. Some stomas lie flat against the skin, while others protrude slightly. No two look exactly alike.
One detail that surprises many people: a stoma has no nerve endings. You won’t feel pain or sensation in the stoma itself, though the skin surrounding it can be sensitive. Because it’s living tissue with a good blood supply, it may bleed a small amount if bumped or rubbed during cleaning, which is normal.
The Three Main Types
Colostomy
A colostomy connects the large intestine (colon) to the abdominal surface. Stool bypasses a diseased or damaged section of the colon and exits through the opening. Output ranges from liquid to fully formed stool depending on where along the colon the stoma is placed. The closer to the rectum, the more formed the stool tends to be.
Ileostomy
An ileostomy brings the end of the small intestine through the abdomen, usually on the lower right side. It’s used when the entire colon has been removed or needs to be bypassed. Output starts as a steady liquid after surgery and gradually thickens to a paste-like consistency. Because the small intestine’s digestive enzymes are still active in this output, the skin around an ileostomy is especially vulnerable to irritation and needs careful protection.
Urostomy
A urostomy reroutes urine when the bladder has been removed or can no longer function. The most common method uses a short segment of the small intestine as a pipeline: the ureters (tubes from the kidneys) are connected to this segment, and the other end is brought to the skin surface. Output is urine, sometimes mixed with a small amount of mucus from the intestinal tissue.
Why Someone Might Need a Stoma
Colorectal cancer is the single most common reason for stoma surgery in adults. Beyond cancer, the list of conditions is broad: inflammatory bowel disease (Crohn’s disease and ulcerative colitis), diverticulitis with complications, bowel injuries from trauma, fecal incontinence, and radiation damage to the bowel. In some cases, surgeons create a stoma to protect a fresh surgical connection further down the intestine, giving it time to heal without stool passing through.
Over 130,000 intestinal stomas are created in the U.S. each year when accounting for all of these conditions. Urostomies add to that number, typically performed after bladder cancer or severe bladder dysfunction.
Temporary vs. Permanent Stomas
Not every stoma is lifelong. Surgeons often create a temporary stoma to let the bowel heal after conditions like diverticulitis, trauma, or cancer treatment. Once healing is complete and you’re healthy enough for another surgery, the stoma can be reversed: the intestine is reconnected so stool passes through the rectum again. Most reversals happen six weeks to six months after the original operation, though the timing depends on how well recovery is going.
Reversal isn’t always possible. Your surgical team may advise against it if the bowel hasn’t healed well, if there isn’t enough intestine left to reconnect safely, if the anal sphincter muscles are too weak (which would mean incontinence after reversal), or if overall health has declined too much for another abdominal operation. When the underlying condition is permanent, such as removal of the entire rectum, the stoma is permanent from the start.
How the Pouching System Works
Because a stoma has no muscle to control when waste exits, output collects in a pouching system worn over the opening. The system has two core parts: an adhesive skin barrier that sticks to the skin around the stoma and an odor-proof pouch that collects waste.
Pouching systems come in one-piece and two-piece designs. A one-piece system has the barrier and pouch built together. A two-piece system uses a separate skin barrier with a plastic ring (called a flange) that the pouch snaps or adheres onto, letting you change the pouch without removing the barrier from your skin each time. Most drainable pouches have an opening at the bottom that you can unclip to empty into a toilet when the pouch is about one-third full. Closed-end pouches, more common with colostomies that produce formed stool, are simply removed and discarded when full.
Eating and Staying Hydrated
Diet matters more after stoma surgery than many people expect, particularly with an ileostomy. The small intestine is where your body absorbs most of its water and electrolytes, so when output exits earlier in the digestive tract, you lose more fluid, sodium, and potassium than usual. Sipping fluids slowly and frequently helps with absorption. Drinks that contain sodium, potassium, and a small amount of sugar are better choices than plain water, and adding extra salt to meals helps your body hold onto fluid.
For the first six weeks after surgery, the bowel is still swollen and high-fiber foods are harder to digest. During that window, keeping fiber under about 8 to 13 grams per day is typical. That means avoiding whole grains, seeds, raw vegetables and fruits with skins, nuts, and dried beans. Choosing well-cooked vegetables and canned or peeled fruits keeps things gentler. After the six-week mark, you can gradually reintroduce fiber. The long-term goal is a normal high-fiber diet: 20 to 25 grams daily for women and 25 to 35 grams for men.
High-potassium foods like bananas, potatoes, and cooked spinach become especially important if you’re experiencing frequent loose output, since diarrhea accelerates potassium loss.
Common Complications to Watch For
Skin irritation around the stoma is one of the most frequent day-to-day problems. It’s especially common with ileostomies because the digestive enzymes in the output can break down skin quickly if the pouching system doesn’t fit well or leaks. Keeping the skin barrier properly sized and sealed is the main defense.
The most common long-term complication is a parastomal hernia, where tissue pushes through the abdominal wall next to the stoma. Some researchers consider it nearly unavoidable over time. In many cases, the only visible sign is a bulge around the stoma. Most parastomal hernias are manageable with a support belt and careful pouch placement, but in rare situations the hernia can trap a loop of bowel, which requires emergency surgery.
Other complications include stoma prolapse (where the intestine telescopes outward through the opening more than expected), stenosis (narrowing of the stoma opening that restricts output), and retraction (where the stoma sinks below skin level, making it harder to get a good seal with the pouch). Preoperative planning, including having a specialist mark the ideal stoma site on your abdomen before surgery, reduces the risk of many of these issues.