An ostomy is a surgery that creates a new opening in your abdomen, called a stoma, so that waste can leave your body through a different route. When part of your digestive or urinary tract isn’t working properly, is diseased, or has been removed, surgeons reroute the functional portion to this opening in your belly. Waste then passes into a small pouch you wear on the outside of your body. Up to one million Americans currently live with an ostomy.
How an Ostomy Works
During surgery, a surgeon separates the healthy part of your intestine or urinary tract from the damaged or missing section. They bring the end of the healthy portion through your abdominal wall and stitch it to the skin, creating a stoma. This stoma becomes your body’s new exit point for stool or urine, depending on the type of ostomy.
The stoma itself is a round, pinkish-red opening about one to two inches wide. It looks like moist tissue, similar to the inside of your mouth. It has no nerve endings, so you can’t feel it once it heals. A new stoma often looks swollen at first but shrinks over time. Some stomas lie flat against the skin, while others stick out slightly.
The Three Main Types
Ostomies are named for the part of the body they involve. The three most common types are colostomy, ileostomy, and urostomy.
A colostomy brings a section of your large intestine (colon) to the surface. The consistency of output depends on where along the colon the stoma is created. A stoma from the ascending colon (right side) produces loose or watery output because less water has been absorbed. A stoma from the descending or sigmoid colon (left side) produces softer or firmer stool, closer to what you’d normally pass.
An ileostomy uses the lowest part of the small intestine, called the ileum, and is typically placed on the right side of the abdomen. Because the large intestine has been bypassed or removed, the output is generally liquid or pasty. You have no voluntary control over when stool or gas exits an ileostomy, so the pouch collects everything continuously. People with ulcerative colitis or Crohn’s disease are among the most common candidates.
A urostomy reroutes urine when the bladder doesn’t function or has been removed. Surgeons use a small piece of intestine to create a channel that connects the tubes carrying urine from the kidneys to the stoma. Urine flows out continuously into a collection pouch.
Why People Need Ostomy Surgery
An ostomy becomes necessary when the normal path for waste is too damaged, diseased, or missing to function. The most common reasons include colorectal cancer, inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, diverticulitis, and serious traumatic injury to the bowel or bladder. In some cases, birth defects or other conditions affecting the urinary system require a urostomy.
Temporary vs. Permanent Ostomies
Not every ostomy is lifelong. A temporary ostomy gives a damaged section of bowel time to rest and heal, typically over several months. Once tests confirm that healing is complete, a second surgery reconnects the intestine and closes the stoma. Stool then passes through the anus again as it did before.
A permanent ostomy is used when the colon, rectum, anus, or bladder has been removed entirely or is too damaged to repair. This is common in advanced cancer or severe injury. With a permanent ostomy, waste continues to exit through the stoma for life. Some surgical configurations, like end colostomies, are usually permanent, while loop colostomies and double-barrel colostomies are more often temporary.
Pouching Systems and Equipment
The pouch (often called an ostomy bag) is how you manage output day to day. Every pouching system has two basic components: a skin barrier (also called a wafer) that adheres to the skin around your stoma and creates a seal, and the pouch itself that collects waste.
With a one-piece system, the barrier and pouch are fused together. It’s straightforward to apply, sits low-profile against your body, and has no extra parts. The tradeoff is that every pouch change means peeling off the barrier too, which can irritate your skin over time.
A two-piece system keeps the skin barrier separate from the pouch. The barrier stays on your skin, and the pouch snaps or clicks onto a flange ring. This lets you swap pouches without disturbing the barrier, which is easier on your skin and gives you flexibility to use different pouch sizes for different situations.
Some people also use convex barriers, which curve inward to press gently on the skin around the stoma. This helps the stoma protrude enough for output to flow cleanly into the pouch instead of leaking underneath the seal.
Eating After Ostomy Surgery
For the first few weeks after surgery, a bland, low-fiber diet helps your body adjust. That means cooked, easy-to-digest foods that aren’t spicy, heavy, or fried. Eating six smaller meals throughout the day rather than three large ones reduces the chances of diarrhea, bloating, gas, and tenderness around the stoma site. Keeping evening meals light also helps limit overnight output.
Hydration matters more with an ostomy, particularly an ileostomy, because your body absorbs less water when the large intestine is bypassed. Aim for eight to ten glasses of liquid per day (roughly two liters) to prevent dehydration. Over time, you can gradually reintroduce higher-fiber foods and figure out which ones your body tolerates well.
Exercise and Physical Activity
Living with an ostomy doesn’t mean giving up exercise. Walking, swimming, yoga, and many team sports are all possible once you’ve healed. Swimming is particularly well-suited because water supports your weight and reduces strain. Waterproof pouching products and sealants keep things secure in the pool.
The main precaution is protecting the muscles around your stoma. During the first six weeks, avoid lifting more than about eight pounds. After that initial healing period, you can gradually increase intensity. Ostomy support belts provide extra abdominal reinforcement during workouts. Empty your pouch before any activity, and if you play contact sports, a stoma guard adds a layer of physical protection.
Common Complications to Watch For
The most frequent long-term complication is a parastomal hernia, where tissue bulges through the abdominal wall near the stoma. Studies estimate the five-year incidence at roughly 38%, and some research places the overall rate between 30% and 50%. These hernias range from a minor cosmetic bulge to something that causes discomfort or interferes with pouching. Repair surgery is possible but recurrence rates are high, so many people manage smaller hernias with support garments instead.
Skin irritation around the stoma is the other common issue. Leaks from a poorly fitting barrier, allergic reactions to adhesive, or prolonged contact with digestive output can all cause redness, soreness, or breakdown of the surrounding skin. Getting a proper barrier fit, which sometimes means working with a specialized ostomy nurse, is the most effective way to prevent it.