A stoma is a surgically created opening on the surface of your abdomen that allows waste to leave your body through a new route. Surgeons create one by bringing a section of intestine (or, less commonly, a ureter) through the abdominal wall and stitching it in place. The waste passes into a small pouch worn on the outside of the body. Stomas are created when disease, injury, or a birth condition makes it unsafe or impossible for waste to follow its normal path.
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. It’s typically round or oval, roughly the size of a quarter to a half-dollar, though the exact size varies from person to person. Because a stoma has no nerve endings, it doesn’t feel pain when touched. You can’t feel output passing through it either. It does have a blood supply, so it may bleed slightly if rubbed or bumped, which is normal in small amounts.
Three Main Types
The type of stoma you have depends on which part of the body needs to be rerouted. Each type sits in a slightly different spot on the abdomen and produces a different kind of output.
Colostomy
A colostomy brings a section of the large intestine (colon) to the surface. It’s most often placed on the left side of the lower abdomen, though it can appear on the right side if the surgery involves the upper portion of the colon. Because the large intestine absorbs water, output from a colostomy is usually soft to firm, depending on how much colon remains in use. A colostomy placed higher up the colon produces looser, more watery output, while one placed lower produces stool that’s closer to what you’d normally expect.
Ileostomy
An ileostomy brings the lowest part of the small intestine to the surface, typically on the right side of the abdomen. Because food hasn’t yet passed through the large intestine, the output is more liquid and continuous. You have no voluntary control over when waste exits, so the pouch collects it around the clock. People with an ileostomy need to pay close attention to hydration, since the large intestine, which normally absorbs a significant amount of water, is no longer in the loop.
Urostomy
A urostomy reroutes urine rather than stool. The surgeon uses a small piece of intestine to create a channel from the ureters (the tubes connecting your kidneys to your bladder) to an opening on your abdomen. Urine flows steadily into an external pouch. This type is needed when the bladder has been removed or can no longer function.
Why Someone Might Need a Stoma
Several conditions can lead to stoma surgery. The most common include:
- Colorectal cancer: when a tumor requires removal of part of the colon or rectum
- Inflammatory bowel disease: Crohn’s disease or ulcerative colitis that has severely damaged the colon
- Bowel obstruction: a blockage caused by cancer, scar tissue, or other conditions
- Surgical recovery: a temporary stoma can protect healing tissue after colon or rectal surgery
- Congenital conditions: some babies are born with conditions like Hirschsprung disease or an improperly formed anus that require a stoma early in life
- Nerve damage or trauma: injuries or nerve problems affecting the rectum or anus
Temporary vs. Permanent
Not all stomas are lifelong. A temporary stoma is created to divert waste while a surgical site heals, and it’s reversed once recovery is complete. Reversal typically happens three to 12 months after the original surgery. Before scheduling the procedure, your surgeon will confirm that the bowel has healed fully with no leaks, that any underlying disease has cleared, and that your anal muscles and nerves still work well enough to control bowel movements.
A permanent stoma is necessary when the rectum, anus, or bladder has been removed entirely, or when the underlying condition makes reconnection unsafe. Many people live with a permanent stoma for decades with few limitations.
How the Pouching System Works
A stoma pouch is an odor-proof bag that attaches to the skin around the stoma using an adhesive ring called a skin barrier. The barrier serves double duty: it holds the pouch in place and protects the surrounding skin from contact with waste, which can cause irritation.
There are two basic designs. A one-piece system has the bag and skin barrier fused together as a single unit. You remove and replace the whole thing at once. A two-piece system separates the skin barrier from the bag. The barrier stays on your skin with a flange (a plastic ring), and you snap the bag on and off as needed. This lets you change the bag without peeling the adhesive off your skin every time.
Skin barriers come in several styles. Cut-to-fit barriers can be trimmed to match an irregular or still-healing stoma. Pre-sized barriers come already cut to standard round dimensions. Convex barriers have a slight outward curve that helps press the skin flat around a stoma that sits flush with or below the skin surface, while flat barriers work best when the stoma protrudes naturally.
Taking Care of the Skin Around It
The skin surrounding a stoma, called peristomal skin, is vulnerable to irritation from moisture, adhesive, and contact with output. Keeping it healthy is one of the most important parts of daily stoma care. The skin barrier opening should be sized to fit closely around the base of the stoma so waste doesn’t leak onto exposed skin.
Clean the area with plain water and a soft material like a washcloth or paper towel each time you change the pouch. Soap isn’t necessary and can leave a residue that prevents the adhesive from sticking. When removing the old barrier, peel it gently in the direction of hair growth while pressing the skin down and away with your other hand. If hair around the stoma causes problems, clip it with scissors or shave carefully with a disposable razor. Avoid chemical hair removers.
Change the pouching system on a regular schedule that gives you reliable wear time, and change it immediately if you feel itching or burning underneath or notice a leak. If the skin does become red, raw, or weepy, a light dusting of skin barrier powder sealed with an alcohol-free sealant can help protect the area while it heals. A rash with small raised bumps may signal a fungal infection, which is common in warm, moist skin under the barrier and responds to antifungal powder.
Eating and Drinking With a Stoma
Most people with a stoma can eat a wide variety of foods, but some adjustments help prevent problems. High-fiber foods are the main concern in the early months because they can be harder to pass through a narrowed opening. Raw vegetables (other than lettuce), raw fruits with skin like apples and grapes, whole grains, and dried beans are best introduced slowly and in small amounts until you know how your body handles them. Chewing thoroughly makes a noticeable difference.
Hydration matters more with a stoma than it did before surgery, especially with an ileostomy. Aim for about eight to ten glasses of water a day. If you’re dealing with loose or watery output, sports drinks or oral rehydration solutions help replace lost electrolytes. Over time, most people develop a clear sense of which foods affect their output and adjust accordingly.
Possible Complications
Most stomas function well, but complications can develop. The most commonly reported issues involve the stoma itself or the skin around it. A parastomal hernia happens when tissue pushes through the abdominal wall next to the stoma, creating a visible bulge. It’s one of the more frequent long-term complications and can sometimes be managed with a support belt, though larger hernias may need surgical repair.
Retraction occurs when the stoma pulls below the skin surface, making it harder for the pouch to seal properly. The opposite problem, prolapse, is when the stoma extends outward more than it should. Prolapse is relatively uncommon, occurring in up to 3% of people with a stoma. A prolapsed stoma should be checked at each pouch change for signs of damage like bleeding or bruising on the tissue surface. Skin erosion around the stoma is another common issue, usually caused by leakage or a poorly fitting barrier, and it responds well to better pouch fit and skin care.