Ostomy surgery is an operation that reroutes how waste leaves your body. When part of the bowel or urinary tract is too diseased, injured, or damaged to function normally, a surgeon brings a section of intestine through the abdominal wall and connects it to the skin, creating a new exit point called a stoma. Waste then passes through this opening into an external pouch you wear on your abdomen. Around 100,000 ostomy surgeries are performed each year in the United States, and an estimated 725,000 to 1 million Americans are currently living with one.
Why Ostomy Surgery Is Needed
The most common reason for ostomy surgery today is bowel cancer. When a tumor blocks or damages part of the intestine, removing that section may require rerouting the digestive tract. Colorectal cancer accounts for a large share of these procedures, but several other conditions lead to ostomy surgery as well.
Chronic inflammatory bowel diseases, particularly Crohn’s disease and ulcerative colitis, can destroy enough intestinal tissue that diverting waste becomes the safest option. Severe diverticulitis, especially when it causes a perforation and abdominal infection, is another frequent trigger. Some people need an ostomy because of fecal incontinence that hasn’t responded to other treatments, while others require one after traumatic injury to the abdomen or because of a genetic condition called familial adenomatous polyposis, which causes hundreds of precancerous growths in the colon.
Radiation therapy to the pelvis can also damage the rectum badly enough to require surgical diversion. In some of these situations the ostomy is permanent. In others, it’s temporary, giving damaged tissue time to heal before the surgeon reconnects the bowel.
The Three Main Types
Colostomy
A colostomy brings a section of the colon (large intestine) through the abdominal wall, typically on the lower left side. Because digested food has already passed through most of the intestine by this point, the output tends to be semi-formed, similar to a normal bowel movement. Colostomies are the most common type created for rectal cancer and severe diverticular disease.
Ileostomy
An ileostomy uses the ileum, the lowest section of the small intestine, and the stoma usually sits on the right side of the abdomen. Output from an ileostomy is looser and more liquid than from a colostomy because less water has been absorbed. People with ulcerative colitis or familial adenomatous polyposis often receive this type after their entire colon is removed.
Urostomy
A urostomy diverts urine rather than stool. The surgeon uses a small piece of intestine to create a channel that carries urine from the kidneys to a stoma on the abdomen, bypassing the bladder entirely. This is typically done when the bladder must be removed or can no longer function, often because of bladder cancer.
What a Stoma Looks and Feels Like
A stoma is a round, pinkish-red opening about one to two inches across. It looks like moist tissue, similar to the inside of your cheek. Right after surgery it appears swollen, but it gradually shrinks over the following weeks. Some stomas sit flat against the skin, while others protrude slightly. Both are normal.
One thing that surprises many people: a stoma has no nerve endings that sense pain, so touching it doesn’t hurt. It also has no muscle, which means you can’t control when waste comes out. That’s why an external pouching system is necessary.
How Pouching Systems Work
Every ostomy pouch has two basic components: a skin barrier (sometimes called a wafer) that sticks to the skin around the stoma and creates a seal, and a pouch that collects the output. These come in two designs.
A one-piece system combines the barrier and pouch into a single unit. It’s simple to apply and sits lower profile against the body, but when you change the pouch, you remove the entire assembly, barrier included. A two-piece system keeps the barrier and pouch separate, connected by a snap-style ring. This lets you swap out the pouch without peeling the barrier off your skin each time, which can be gentler on the surrounding skin and more flexible if you want to alternate between pouch sizes or styles.
Which system works best is largely personal preference. Many people try both before settling on one.
Hospital Stay and Recovery
How long you stay in the hospital depends on whether the surgery was done through a large incision (open surgery) or smaller incisions using a camera (laparoscopic surgery). Most people stay a few days to a week. During that time, a specialized nurse teaches you how to empty and change your pouch, clean around the stoma, and recognize signs of problems.
Full recovery from the surgery itself generally takes a few weeks. During that initial period, your medical team will likely recommend eating a lower-fiber diet, avoiding raw fruits and vegetables, seeds, nuts, and corn. Spicy and high-fat foods can also cause discomfort early on. Staying well hydrated is especially important with an ileostomy, since the body absorbs less water when the colon is bypassed.
If your ostomy was created as a temporary measure, reversal surgery typically happens a few months later, once imaging confirms that the original surgical site has fully healed.
Common Complications
The most frequent long-term complication is a parastomal hernia, where tissue bulges through the abdominal wall around the stoma. This happens more often than most people expect. Studies show that up to 48% of people with a permanent colostomy and about 28% of those with an end ileostomy develop one over time. CT scans detect even higher rates, catching small hernias that don’t yet cause symptoms.
Most parastomal hernias are manageable without another operation. A support belt or changes to your pouching system can keep them under control. Only about 30% of people who develop a hernia eventually need surgical repair. When surgery is required, techniques that reinforce the area with mesh have lower infection rates (2 to 3%) than simple stitched repairs.
Other complications to watch for include skin irritation around the stoma from pouch adhesive or leaking output, narrowing of the stoma opening, and prolapse, where the intestine pushes further out than it should. Many of these are correctable with adjustments to your pouching routine or a follow-up procedure.
Living With an Ostomy Long Term
After the initial recovery, most people return to their regular activities, including work, exercise, swimming, and travel. The pouch sits flat enough under clothing that it’s rarely visible. Modern pouching systems include odor-filtering vents, and the seal against the skin prevents leaks during normal activity.
Diet expands significantly after those first few weeks. Most people can eat whatever they enjoyed before surgery, though some learn through experience that certain foods produce more gas or odor. Keeping a simple food diary during the first couple of months helps identify any personal triggers without unnecessarily restricting your diet.
Dehydration is an ongoing concern for people with ileostomies, since the colon normally absorbs a large amount of water. Drinking extra fluids and paying attention to electrolyte intake becomes a daily habit rather than a temporary recovery step. For those with colostomies, hydration matters less acutely, but staying consistent with fluids still helps keep output manageable.