An ostomy is a surgically created opening in the abdomen that allows waste to leave your body through a new route. Surgeons bring a section of the intestine (or, in some cases, the urinary tract) through the abdominal wall and attach it to the skin, creating a small, visible opening called a stoma. Waste then exits through this stoma into a wearable pouch, bypassing the usual path to the anus or bladder.
How an Ostomy Changes Waste Elimination
Normally, digested food travels through the small intestine and large intestine before exiting the body as stool. When part or all of the bowel is diseased, injured, or missing, that pathway no longer works properly. Ostomy surgery reroutes the system: a surgeon brings a healthy section of intestine through the abdominal wall and stitches it to the skin surface. From that point on, waste passes through this opening instead.
Because a stoma has no muscle, it cannot control when waste comes out. There’s no “holding it” the way you would with a functioning rectum. Instead, a pouching system worn on the outside of the body collects the output continuously. This is the core reality of living with an ostomy, and everything else, from diet to daily routines, revolves around managing that flow.
The Three Main Types
Ostomies are named for the part of the body they divert.
- Colostomy: A section of the colon (large intestine) is brought to the skin surface, usually on the lower left side of the abdomen. Stool consistency depends on which part of the colon is used. An opening from the descending or sigmoid colon produces soft to firm stool, while one from the ascending colon produces loose or watery output.
- Ileostomy: The ileum, the lowest part of the small intestine, is brought through the abdominal wall, typically on the right side. Because waste hasn’t yet traveled through the colon where water is absorbed, ileostomy output is consistently loose and watery. There is no control over gas or stool from this type.
- Urostomy: This type diverts urine rather than stool. A small piece of intestine is used to create a channel that connects the ureters (the tubes carrying urine from the kidneys) to a stoma on the abdomen. Urine flows continuously into an external pouch.
What a Stoma Looks and Feels Like
A stoma is a roundish opening, roughly one to two inches wide. It’s 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; others protrude slightly. Appearance varies from person to person.
One detail that surprises many people: a stoma has no nerve endings. You won’t feel pain or sensation at the stoma itself, though the surrounding skin can certainly become irritated.
Conditions That Lead to Ostomy Surgery
Cancer is the single most common reason someone needs an ostomy, particularly colorectal cancer that requires removal of part of the bowel. Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, is the next most frequent cause, followed by diverticular disease, a condition where small pouches in the colon wall become infected or inflamed.
Less common reasons include severe fecal incontinence, certain genetic conditions like familial adenomatous polyposis (which causes precancerous growths throughout the colon), and congenital conditions present at birth such as Hirschsprung’s disease and spina bifida. In some cases, traumatic injury to the bowel or bladder also requires ostomy surgery.
Temporary vs. Permanent Ostomies
Not every ostomy is lifelong. Surgeons often create a temporary ostomy to give a section of the bowel time to heal after surgery or to let inflammation resolve. Temporary ostomies are typically constructed as “loop” ostomies, where the intestine is looped through the abdominal wall rather than completely divided. This makes reversal simpler.
Reversal surgery is usually considered three to twelve months after the original procedure, once the bowel has fully healed. Before scheduling a reversal, your surgeon will confirm that there’s no leak at the internal surgical connection, that disease or infection has cleared, and that the anal nerves and muscles still function well enough to control bowel movements. If those criteria aren’t met, or if the condition that required the ostomy is permanent (such as removal of the entire rectum), the ostomy stays in place for life.
The Pouching System
Every person with an ostomy wears an external pouching system to collect waste. These systems have two essential components: a skin barrier (also called a wafer) that adheres to the skin around the stoma and creates a seal, and a pouch that collects output.
There are two main designs. A one-piece system combines the barrier and pouch into a single unit. It’s simpler to apply since there’s no coupling step, but changing the pouch means removing and replacing the entire system, barrier included. A two-piece system keeps the skin barrier in place on your body while letting you snap or clip a fresh pouch onto it. This means less frequent removal of the adhesive from your skin, which can reduce irritation.
Most people empty or change their pouch several times a day depending on the type of ostomy and the volume of output. Ileostomies tend to require more frequent attention because of higher liquid output.
Skin Care Around the Stoma
Skin problems around the stoma are the most common complication ostomates face, and the most frequent reason they visit a specialist nurse. The skin in that area is constantly exposed to adhesive, moisture, and potentially corrosive digestive output, especially with ileostomies where the waste contains active digestive enzymes.
The most typical issue is irritant contact dermatitis, essentially a chemical burn from stool or urine that leaks under the skin barrier. This shows up as redness, rawness, or a burning sensation on the skin surrounding the stoma. Proper fit of the skin barrier is the most important preventive measure: if the opening is too large, skin is exposed to waste; if too small, it can press on the stoma and cause swelling.
Other potential complications include fungal infections (particularly yeast, which thrives in warm, moist environments under the barrier), mechanical injury from repeatedly pulling adhesive off the skin, and allergic reactions to pouching materials. Keeping the peristomal skin clean, dry, and properly sealed under a well-fitted barrier prevents the majority of these problems.
Diet and Daily Life
For the first few weeks after surgery, a bland, low-fiber diet helps the body adjust. This means cooked, easy-to-digest foods that aren’t spicy, heavy, or fried. The goal is to avoid diarrhea, excessive gas, and bloating while the surgical site heals. New foods get introduced one at a time so you can identify anything that causes problems.
Hydration matters more than usual, particularly with an ileostomy. Because the colon is bypassed and can no longer absorb water from waste, the body loses more fluid. Drinking eight to ten glasses of liquid daily helps prevent dehydration. Over time, most people discover which foods increase gas, cause odor, or thicken output, and they adjust accordingly. There’s no single “ostomy diet” that works for everyone.
Beyond eating, most activities remain open. People with ostomies swim, exercise, travel, work, and have intimate relationships. Clothing choices sometimes shift toward higher-waisted pants or looser tops to accommodate the pouch, but many ostomates find the pouch is invisible under regular clothing. The adjustment is real, but the restrictions are far fewer than most people expect going in.