Stoma surgery creates an opening in the abdomen that allows waste to leave the body through a new route. A surgeon brings a section of the intestine (or, in some cases, the urinary tract) through the abdominal wall, forming a small, round opening called a stoma. Waste then passes into an external pouch worn over the stoma instead of exiting through the anus or urethra. About 130,000 new ostomy surgeries are performed in the United States each year, and roughly 750,000 Americans currently live with one.
Three Main Types of Stoma Surgery
The type of stoma you get depends on which part of the body needs to be bypassed or removed. All three involve the same basic principle: rerouting waste to an opening on the abdomen. But the organ involved and the type of output differ significantly.
A colostomy diverts the large intestine (colon) to the surface of the abdomen. Because stool has already had most of its water absorbed by the time it reaches the colon, the output tends to be more formed. A colostomy is the most common type and can be placed at different points along the colon.
An ileostomy brings the end of the small intestine through the abdominal wall. This is typically done after the colon has been removed entirely. Because the large intestine is no longer absorbing water, the output is looser and more liquid, which means the pouch fills faster and staying hydrated takes more attention.
A urostomy redirects urine. Rather than flowing from the kidneys to the bladder and out through the urethra, urine is channeled through a small piece of intestine that the surgeon fashions into a new pathway. Unlike the other two types, urostomies are never reversible.
Conditions That Lead to Stoma Surgery
The most common reason for stoma surgery is colorectal cancer. When a tumor has grown through the wall of the colon or rectum, or is causing a blockage, removing part of the bowel and creating a stoma may be the safest option. Other conditions include Crohn’s disease and ulcerative colitis, both of which can damage the intestinal lining severely enough that the affected section needs to be removed or rested.
Serious complications from diverticulitis, such as tears or deep infections in the colon wall, can also require emergency stoma creation. Traumatic injuries from accidents or gunshot wounds, bowel obstructions from scarring, and conditions present from birth (like Hirschsprung disease, where nerve cells in the colon don’t develop normally) are less common but well-established reasons. Bladder cancer, spinal cord injuries, and chronic bladder infections are the main conditions leading to urostomy.
Temporary vs. Permanent Stomas
Not all stomas are lifelong. A temporary stoma gives a damaged or surgically repaired section of bowel time to heal without waste passing through it. This healing period typically lasts several months. Once the tissue has recovered, a second surgery reconnects the bowel, and normal function resumes. Temporary stomas are common after cancer surgery, diverticulitis repair, and procedures that construct an internal pouch from the small intestine.
A permanent stoma is necessary when the colon, rectum, or anus has been removed entirely or is too damaged to repair. Advanced cancer and severe traumatic injuries are the most frequent reasons. With a permanent stoma, waste will always exit through the abdominal opening.
What Happens During the Surgery
Before the operation, a nurse or surgeon marks the ideal spot on your abdomen for the stoma. The location matters: it needs to sit on a flat area of skin where you can see it, reach it easily, and where a pouch will seal well against clothing and skin folds.
During surgery, the surgeon removes a small disc of skin and works through the underlying tissue and muscle layers to create a passage. A section of intestine is then pulled through this opening and folded back on itself, like rolling a cuff on a sleeve, before being stitched to the skin surface. This “cuffing” technique helps the stoma protrude slightly above the skin, which keeps waste flowing into the pouch rather than pooling against the surrounding area.
In a loop stoma, instead of cutting the intestine completely, the surgeon pulls a loop of bowel through the opening and creates a hole in one side. This is often used for temporary diversions because it’s easier to reverse later. Stoma surgery can be performed as open surgery through a larger incision or with laparoscopic (keyhole) techniques. Hospital stays after the initial procedure typically range from about five to six days.
Recovery and Returning to Normal Activity
The first six weeks after surgery come with clear physical restrictions. You should not lift or carry anything heavier than 10 pounds (about 4.5 kilograms) during this period, and pushing or pulling heavy objects should be avoided as much as possible. Sit-ups, push-ups, and other strenuous exercise are off-limits for two to three months. These precautions exist because the abdominal wall is healing around the stoma, and straining too soon raises the risk of a hernia forming at the surgical site or around the stoma itself.
Your first follow-up appointment will generally be around two weeks after surgery. At that point, your surgical team will assess how you’re healing and whether you can begin expanding your diet and activity level. Gentle walking is encouraged early on, but high-effort activities take longer to resume safely.
Diet in the First Weeks
For the first several weeks after surgery, the goal is to eat bland, low-fiber foods in small, frequent meals. Six small meals a day is easier on the healing digestive system than three large ones. Memorial Sloan Kettering Cancer Center recommends sticking to foods like white bread, white rice, pasta, well-cooked vegetables without skins or seeds, peeled fruits, lean meats, eggs, and smooth nut butters. Drinking eight to ten glasses of water a day helps prevent dehydration, which is especially important with an ileostomy since the body is no longer absorbing as much water from food.
During this phase, you’ll want to avoid high-fiber foods like whole grains, raw vegetables, fruits with skin, dried beans, and nuts. Fried and high-fat foods, carbonated drinks, and alcohol are also best left out. When your surgical team gives the go-ahead to reintroduce higher-fiber foods, add them one at a time so you can identify anything that causes problems like gas, blockage, or loose output.
Living With a Pouching System
The pouch (sometimes called a bag or appliance) collects waste as it exits the stoma. There are two basic designs, and the choice between them comes down to personal preference and lifestyle.
- One-piece systems combine the adhesive skin barrier and the pouch into a single unit. They tend to sit flatter against the body, making them less noticeable under clothing. The tradeoff is that every pouch change means removing and replacing the adhesive barrier too, which can be an issue if your skin is sensitive.
- Two-piece systems use a separate adhesive barrier that stays on the skin while the pouch snaps or clips onto it. This means you can change or empty the pouch without disturbing the barrier each time, and you can swap between different pouch styles (larger for overnight, smaller for swimming, for example). Some people find the connection ring feels slightly bulkier.
Most people try both and settle on what works best for their body shape, skin sensitivity, and daily routine. Stoma care nurses are specifically trained to help with this process and are one of the most valuable resources in the first months after surgery.
Common Complications
Stoma surgery is generally safe, but complications are not rare. The most common long-term issue is a parastomal hernia, where tissue bulges through the abdominal wall around the stoma. This affects roughly 50% of people with a colostomy over time. It doesn’t always require treatment, but large or painful hernias may need surgical repair.
Skin irritation around the stoma is the other very common problem, affecting up to 45% of patients. It happens when waste leaks beneath the adhesive barrier and contacts the surrounding skin, causing redness, burning, or a rash similar to a chemical burn. Getting a well-fitted pouching system and maintaining a good seal are the main ways to prevent it.
Less common complications include stoma retraction (where the stoma pulls below the skin surface, occurring in 2 to 16% of cases) and stoma prolapse (where too much intestine pushes out through the opening, occurring in roughly 1 to 12% of cases). Both can usually be managed, but severe cases may need surgical correction.