Ostomy surgery creates an opening in the abdomen, called a stoma, that gives waste a new path out of the body. Surgeons reroute part of the intestine or urinary tract through this opening, bypassing organs that are diseased, damaged, or removed. Roughly 1 million people in the United States currently live with an ostomy, and the surgery is performed to treat a range of conditions from cancer to inflammatory bowel disease.
How a Stoma Works
A stoma is the visible part of an ostomy: a small, round piece of intestinal tissue that sits flush with or slightly above the skin surface, usually on the lower abdomen. It has no nerve endings, so it doesn’t hurt. Because the stoma has no sphincter muscle, there’s no voluntary control over when waste exits the body. Instead, a pouching system adheres to the skin around the stoma and collects output throughout the day.
Three Main Types of Ostomy
The type of ostomy depends on which part of the body needs to be bypassed.
- Colostomy. A section of the colon (large intestine) is brought through the abdominal wall, typically on the left side. Output consistency depends on where along the colon the stoma is placed. A sigmoid colostomy, made from the lowest section, produces soft to firm stool. An ascending colostomy, made higher up, produces loose or watery output because less water has been absorbed.
- Ileostomy. The ileum, the lowest part of the small intestine, is brought through the abdominal wall, usually on the right side. Because the colon is completely bypassed, output is consistently liquid to pasty, and there is no control over gas or stool. An ileostomy stoma is designed to protrude about 2 to 2.5 centimeters above the skin to help output drain cleanly into the pouch.
- Urostomy. The tubes that carry urine from the kidneys are rerouted through a small piece of intestine and out through a stoma, bypassing the bladder entirely. Urine flows continuously into an external pouch.
Why Ostomy Surgery Is Needed
Ostomy surgery is recommended when part of the digestive or urinary tract can no longer function safely. The most common reasons include colorectal cancer, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), diverticular disease, intestinal blockages, and traumatic injuries to the bowel. Some people are born with conditions affecting the anus or large intestine that require an ostomy in infancy. Familial adenomatous polyposis, a genetic condition that causes hundreds of precancerous growths in the colon, is another indication.
Temporary vs. Permanent Ostomy
Not every ostomy is lifelong. Surgeons often create a temporary ostomy to divert waste while a diseased or injured section of bowel heals. A loop ostomy, where the intestine is pulled through the abdominal wall but not completely divided, is the most common approach when reversal is planned. A reversal reconnects the bowel and closes the stoma, typically three to twelve months after the original surgery, once healing is confirmed.
Whether an ostomy can be reversed depends on the underlying condition, how much bowel remains, and how well you recover. If the rectum and anus have been removed entirely, as sometimes happens with cancer, the ostomy is permanent. Your surgeon will discuss this possibility before the initial procedure.
What Happens During Surgery
Before surgery, a specialized nurse examines your abdomen in both sitting and standing positions, noting skin folds, scars, and your beltline. The goal is to mark a stoma site on a flat, visible area of skin that you can easily reach and that won’t be covered by clothing seams. This step matters because poor stoma placement is a leading cause of complications later on.
During the procedure itself, the surgeon removes a small disc of skin about 2.5 centimeters wide, separates the underlying muscle fibers, and brings the divided end of the intestine through the opening. The bowel is then sutured directly to the skin in a process called maturation. Colostomy stomas are left protruding just slightly, about half a centimeter to one centimeter. Ileostomy stomas are made taller and folded back on themselves like a cuff to keep the more corrosive small-intestine output away from the surrounding skin. The surgery can be performed through a large incision or laparoscopically through several small ones.
Recovery After Surgery
Hospital stays range from a few days to about a week, depending on whether the surgery was open or laparoscopic. The stoma typically begins producing output within a few days. At first the output is liquid, but for colostomies it usually thickens over the following weeks as swelling decreases and the bowel adapts.
The first two weeks at home are focused on rest and gentle walking, gradually increasing the distance as you feel stronger. You’ll feel weak initially, but most people reach full recovery within a few weeks. During this early period, you’ll also learn to change and empty your pouching system, which becomes routine fairly quickly.
Living With a Pouching System
The pouching system is the primary tool for managing an ostomy day to day. It consists of a skin barrier (a flat adhesive wafer that protects the skin around the stoma) and a collection bag that snaps or adheres onto it. Some systems are one piece, others are two pieces that let you swap out the bag without removing the skin barrier.
On average, people in the U.S. change their pouching system every 4 to 5 days. Urostomy and ileostomy pouches tend to last about 5 days, while colostomy pouches average closer to 4.5 days. Wear time varies with activity level, body shape, and how well the barrier fits. A properly fitted system lies flat against the skin, doesn’t leak, and is invisible under most clothing.
Diet Changes to Expect
For the first few weeks after surgery, a bland, low-fiber diet helps the bowel heal and reduces the risk of blockages. That means avoiding raw vegetables (except lettuce), whole grains, raw fruits with skin, and dried beans. Foods are added back one at a time so you can identify anything that causes problems.
Once healed, most people return to a varied diet, but certain foods continue to cause gas, odor, or both. Common culprits include broccoli, cabbage, cauliflower, onions, garlic, eggs, beer, and carbonated drinks. Eating habits matter as much as food choices. Eating six smaller meals instead of three large ones, chewing thoroughly, and drinking about 8 to 10 glasses of water daily all help regulate output. Chewing gum, drinking through a straw, and eating too fast can introduce extra air and increase gas in the pouch.
Staying well hydrated is especially important with an ileostomy, since the colon, which normally absorbs most of the body’s water, is no longer in the digestive path.
Common Complications
Skin irritation around the stoma is by far the most frequent complication. Studies report that between 36% and 74% of people with an ostomy experience some form of peristomal skin problem, ranging from mild redness to erosion or ulceration. The causes include contact with stool or urine leaking under the skin barrier, allergic reactions to adhesive materials, friction from the pouching system, or irritation of hair follicles. Most skin issues are manageable with proper pouch fit, barrier products, and help from an ostomy care nurse.
Parastomal hernia, where abdominal tissue bulges around the stoma, is another recognized complication. It can develop months or years after surgery, particularly with heavy lifting or significant weight changes. Other possible complications include the stoma retracting below skin level, narrowing of the opening, or the bowel telescoping outward (prolapse). These are less common but sometimes require surgical correction.