An ostomy is a surgery that creates an opening through the abdominal wall so waste can leave the body through a new route. This opening, called a stoma, bypasses parts of the digestive or urinary system that are damaged, diseased, or have been removed. Between 800,000 and 1 million people in the United States currently live with an ostomy, and the procedure can be either temporary or permanent depending on the underlying condition.
Why an Ostomy Is Needed
An ostomy becomes necessary when disease or injury makes it impossible for waste to travel its normal path. The most common reasons include colorectal cancer, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), diverticulitis, bladder cancer, and intestinal blockages. Traumatic injuries to the colon, such as those from accidents or gunshot wounds, can also require emergency ostomy surgery.
In some cases, the surgery is planned well in advance as part of cancer treatment or disease management. In others, it happens urgently when a blockage, tear, or severe infection threatens a person’s life.
Three Main Types of Ostomies
Colostomy
A colostomy connects a section of the large intestine (colon) to the stoma, bypassing the rectum and anus. The stoma is typically on the left side of the lower abdomen, though its exact placement depends on which part of the colon is involved. Output consistency varies: a colostomy made from the upper portion of the colon produces loose or watery stool, while one made from the lower portion, closer to the rectum, produces soft to firm stool. Colostomies can be temporary or permanent.
Ileostomy
An ileostomy brings the lowest part of the small intestine (the ileum) to the surface, usually on the right side of the abdomen. Because the large intestine is completely bypassed, output is continuous and liquid to pasty. There is no voluntary control over when stool exits the stoma. Ileostomies can be temporary, often created to let a surgical site farther down the digestive tract heal, or permanent when the entire large intestine has been removed.
Urostomy
A urostomy reroutes urine. The surgeon uses a small piece of intestine to create a channel from the ureters (the tubes connecting the kidneys to the bladder) to the stoma. Urine then flows continuously into an external pouch. Unlike the other two types, urostomies are not reversible.
What a Stoma Looks and Feels Like
A stoma is a round, pinkish-red opening roughly one to two inches wide. It looks similar to the moist tissue on the inside of your cheek. Right after surgery, the stoma appears swollen, but it gradually shrinks over the following weeks. Some stomas sit flat against the skin, while others protrude slightly. The stoma itself has no nerve endings, so touching it causes no pain or sensation. It can bleed lightly when cleaned, which is normal because of its rich blood supply.
How the Pouching System Works
Because you can’t control when waste exits a stoma, an external pouching system collects output around the clock. The system has two main components: an adhesive skin barrier (sometimes called a wafer) that sticks to the skin surrounding the stoma and protects it from irritation, and an odor-proof pouch that attaches over the stoma to collect stool or urine.
Pouching systems come in one-piece and two-piece designs. A one-piece system has the bag and skin barrier fused together. A two-piece system uses a separate skin barrier with a flange that the pouch snaps or locks onto, allowing you to change the bag without removing the adhesive from your skin each time.
Drainable pouches have an opening at the bottom that you can unseal to empty throughout the day, then reseal. Closed-end pouches are discarded and replaced once they fill halfway. People with colostomies who have firmer, less frequent output often prefer closed-end pouches, while those with ileostomies or urostomies typically use drainable ones since output flows more continuously.
Recovery After Surgery
Hospital stays vary depending on the type of ostomy and whether it was performed as open or minimally invasive surgery, but most people spend several days recovering in the hospital. During that time, a specialized ostomy nurse teaches you how to care for the stoma, change the pouching system, and monitor for problems. The stoma begins functioning within a day or two after surgery, and the nursing team helps you get comfortable managing it before you go home.
Full recovery typically takes several weeks. During the first few weeks, physical activity is limited, especially lifting, to allow the abdominal incision to heal. Light exercise like walking is encouraged early on to support digestion and prevent constipation. Most people gradually return to their regular activities, including work and exercise, as healing progresses.
Dietary Adjustments
Diet matters more with an ileostomy than a colostomy, because bypassing the large intestine reduces the body’s ability to absorb water. Memorial Sloan Kettering Cancer Center recommends that people with ileostomies drink 8 to 10 glasses of liquid daily, including sports drinks or oral rehydration solutions to replace lost electrolytes. Sugary drinks, caffeine, and alcohol should be limited, especially in the first few weeks.
For the first three to four weeks after any ostomy surgery, a bland, low-fiber diet helps prevent blockages. That means avoiding raw fruits with skin (apples, grapes, berries), raw vegetables, whole grains, corn, and dried beans. Foods are reintroduced one at a time so you can identify anything that causes problems. Eating six small meals rather than three large ones, chewing thoroughly, and eating slowly all help output stay manageable. Over time, most people return to a varied diet, though some foods may always need to be eaten carefully or in smaller amounts.
Common Complications
Skin irritation around the stoma is the most frequent issue. Research shows that 36% to 73% of ostomy patients experience some form of peristomal skin complication, most commonly contact dermatitis from exposure to stool or adhesive. Symptoms include redness, soreness, itching, and in more severe cases, skin erosion or small ulcers. Proper fit of the skin barrier is the single most important factor in prevention. A barrier that’s too large leaves skin exposed to output, while one that’s too small can press against and damage the stoma.
Parastomal hernia, where tissue bulges through the abdominal wall next to the stoma, is the second most common complication. It occurs in roughly 5.5% of patients across all ostomy types, though rates vary widely depending on the study. Other possible complications include prolapse (the stoma extending outward more than normal), retraction (the stoma pulling inward below skin level), and narrowing of the stoma opening. Many of these can be managed without additional surgery, but some require revision.
When a Temporary Ostomy Can Be Reversed
If your ostomy was created to give a section of bowel time to heal, reversal surgery is typically planned six weeks to six months after the original procedure. Before scheduling a reversal, your surgical team confirms that the bowel has healed adequately and that you’re healthy enough for another abdominal operation.
Reversal may not be recommended if the bowel hasn’t healed well, if there isn’t enough healthy intestine to reconnect safely, if the anal sphincter muscles are too weak to maintain continence, or if the original condition has returned or worsened. When reversal is possible, the stoma is closed and the intestinal ends are rejoined, restoring the original path for waste. Bowel function after reversal can take weeks to fully normalize, with frequent or irregular bowel movements being common during that adjustment period.