What Is the Difference Between an Ostomy and a Colostomy?

An ostomy is the umbrella term for any surgery that creates an opening through the abdominal wall so waste can leave the body through a new route. A colostomy is one specific kind of ostomy, the kind that reroutes part of the large intestine (colon) to that opening. The confusion between the two terms is understandable because colostomies are among the most common ostomies performed, so people sometimes use the words interchangeably. But the distinction matters, because other types of ostomy, particularly ileostomies and urostomies, involve different organs, produce different output, and require different daily care.

The Three Main Types

The surgically created opening itself is called a stoma. It looks like a small, round, pinkish piece of tissue on the surface of the abdomen, and it has no nerve endings, so it is not painful to touch. What varies between ostomy types is which organ is being redirected to that stoma. A colostomy connects the colon (large intestine) to the abdominal wall. An ileostomy connects the ileum, the last section of the small intestine, to the abdominal wall. A urostomy reroutes urine from the bladder, usually by using a small segment of intestine as a conduit. Each type is named for the organ or intestinal segment involved.¹

Of the three, colostomies and ileostomies are the most frequently discussed together because both handle fecal output and share many of the same pouching supplies. However, the differences in what comes out of each one are significant enough to change the daily routine, the risk of complications, and even the dietary adjustments you need to make.

Why These Surgeries Are Performed

All three types of ostomy are typically indicated when disease, injury, or a birth defect prevents waste from leaving the body through its normal route. Cancer is one of the leading reasons, along with inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, diverticulitis, and traumatic injuries to the abdomen.² A study at an Ethiopian hospital found that among patients receiving colostomies specifically, the three most common reasons were gangrenous sigmoid volvulus (a twisted colon cutting off its own blood supply), colorectal cancers, and abdominal injuries.³

Ileostomies tend to be more common in people with inflammatory bowel disease, especially when the entire colon needs to be removed. Urostomies come into play when the bladder itself is damaged or has to be removed due to bladder cancer. So while the surgical technique of creating a stoma is broadly similar across all three, the underlying disease and the part of the body involved determine which type you get.

Where Along the Colon a Colostomy Is Made

Even within the colostomy category, there is more variation than most people realize. The colon is a long organ with distinct sections, and where the surgeon attaches it to the abdominal wall matters for what your output looks like and what complications you might face. A sigmoid colostomy, placed near the end of the colon closest to the rectum, tends to produce output that looks and behaves more like a normal bowel movement because most of the water absorption has already happened. A transverse colostomy, placed higher up, produces softer, less formed stool because less of the colon has had a chance to do its job.

A cohort study comparing the two found that transverse colostomies had higher rates of stoma prolapse, a complication where the bowel telescopes outward through the stoma, compared to sigmoid colostomies.⁴ This is partly because the transverse colon is more mobile and less fixed in the abdomen. For people with colorectal cancer, sigmoid colostomies are often preferred when the anatomy allows it.

How Output Differs and Why It Matters

The single most practical difference between a colostomy and an ileostomy comes down to what comes out of the stoma. With a colostomy, especially one placed in the sigmoid or descending colon, stool is generally semi-solid. Your colon has already absorbed most of the water, so the output resembles a soft but formed bowel movement. With an ileostomy, the colon is bypassed entirely. Stool arrives at the stoma before any colonic water absorption has occurred, so it is watery, sometimes almost liquid, and it contains a high concentration of digestive enzymes.⁵

That high water content in ileostomy output is not just a minor inconvenience. Because the colon’s fluid-absorbing capacity has been removed from the equation, anyone with an ileostomy faces an ongoing risk of dehydration and electrolyte imbalance. The remaining small intestine does gradually adapt over weeks to months by increasing its own absorptive efficiency, but if output spikes from an illness like gastroenteritis or a dietary trigger, the risk of dangerous fluid depletion rises quickly.⁶ People with colostomies rarely face the same degree of dehydration risk because their colon is still doing most of the water-recovery work.

This also affects how often the pouch needs to be emptied. Ileostomy output flows more continuously and in greater volume, so people with ileostomies typically empty their pouches more frequently throughout the day. Colostomy output, being more formed, tends to follow a more predictable schedule, and some people with sigmoid colostomies can even learn to irrigate their stoma on a timetable that gives them hours without needing a pouch at all.

Skin Complications Around the Stoma

The skin immediately surrounding a stoma, called peristomal skin, takes a beating in all types of fecal ostomy. But the risk is not equal. Ileostomy output, being more liquid and enzyme-rich, is particularly corrosive. Those digestive enzymes break down both the protein and fat-based components of the skin’s protective barrier, leading to a condition called peristomal moisture-associated skin damage. Research has found that this damage occurs at a higher rate around ileostomies than colostomies.⁷

When effluent leaks under the adhesive seal of the pouching system, it can cause painful erosion of the peristomal skin. Treatment options include specialized skin barriers and protective products like cyanoacrylate liquid skin protectants, which create a thin film over denuded skin to allow it to heal underneath a fresh pouch seal.⁸ Getting a good seal is trickier with an ileostomy because the output is constantly flowing and more likely to undermine adhesive barriers. With a colostomy, the firmer output and less frequent flow make pouch changes somewhat simpler, though skin problems can still develop.

Parastomal Hernia and Other Long-Term Complications

Regardless of the type of ostomy, anyone with a stoma faces the possibility of long-term complications including parastomal hernia (where tissue bulges through the abdominal wall around the stoma), prolapse, retraction (where the stoma sinks below skin level), and less commonly, varices around the stoma site.⁹

Parastomal hernia is the single most common long-term complication. One study found that about half of all loop stoma patients developed a parastomal hernia, with the strongest risk factor being whether the stoma was properly placed through the center of the rectus abdominis muscle.¹⁰ A separate study found a lower overall incidence of about 14%, but within that group, roughly two-thirds had colostomies and one-third had ileostomies, suggesting that colostomies may carry a somewhat higher hernia risk.¹¹ Precise rates vary widely across studies depending on how hernias are detected and how long patients are followed, but the message is consistent: hernias are common enough that most people with a stoma should be aware of the risk.

Loop Versus End Stomas

Both colostomies and ileostomies can be constructed as either a loop stoma or an end stoma. In a loop stoma, the surgeon pulls a loop of bowel through the abdominal wall, opens one side of it, and leaves both the upstream (functioning) and downstream (resting) portions connected. In an end stoma, the bowel is divided completely. The upstream end becomes the stoma, and the downstream portion is either sealed off inside the abdomen or removed entirely.

The choice between loop and end has real consequences, especially when it comes time for reversal. A study comparing the two approaches in colostomy reversal found that patients who had an end colostomy were far more likely to need a full midline incision to reverse it, had roughly two and a half times as much blood loss during the operation, stayed in the hospital about three days longer, and had significantly more overall complications compared to those who had a loop colostomy reversed.¹² Loop stomas are generally considered the easier option to reverse because the bowel was never fully divided, and the reversal often involves a smaller, local incision around the stoma itself.

Temporary Versus Permanent

Not all ostomies are lifelong. Many colostomies and ileostomies are created with the intention of being temporary, giving a diseased or newly operated section of bowel time to heal. Once healing is confirmed, the stoma can be reversed and normal bowel continuity restored. This is common after surgeries for diverticulitis, colorectal cancer, and inflammatory bowel disease, where the stoma protects a fresh surgical connection (anastomosis) from leaking while it heals.²

The reality, though, is that a meaningful number of stomas that were intended to be temporary never get reversed. Postoperative complications, the need for additional cancer treatment like chemotherapy, or other health conditions that make another surgery too risky can all prevent reversal.² This is worth knowing before surgery, because the psychological adjustment to living with a stoma can be harder when you expected it to be temporary and then learn it is permanent.

Dietary Adjustments

Dietary needs diverge between colostomies and ileostomies in important ways. Because ileostomy output is so liquid and voluminous, people with high-output ileostomies need careful nutritional management to prevent dehydration, sodium depletion, and malabsorption of certain nutrients. Evidence-based guidance for managing high-output ileostomy covers nutritional risk screening, specific dietary recommendations, behavioral guidance around eating and drinking, and ongoing follow-up care.¹³

For colostomies, the dietary picture is less intense. A survey of people living with ostomies found that the large majority, about 88%, reported not following any special diet because of their stoma. Among those who did modify their eating, the changes were mostly about avoiding specific foods known to cause gas, odor, or blockage risk, including fresh fruits, nuts, corn, popcorn, cabbage, beans, and onions.¹⁴ With an ileostomy, avoiding blockages is a bigger concern because the stoma opening is narrower and high-fiber, poorly chewed foods can physically obstruct it.

About 70% of people living with a stoma of any type adjust their dietary habits to some degree, and changes like eating smaller meals, chewing thoroughly, and avoiding carbonated drinks are common across both colostomy and ileostomy groups.¹⁵

Psychological and Social Impact

Having any kind of ostomy changes how you see your body. Research on body image among stoma patients found that younger patients and those who were overweight experienced significantly more body image disturbance than others. Men scored higher on body image disturbance than women. One finding that surprised researchers was that people with temporary stomas had higher body image disturbance scores than those with permanent stomas, possibly because the uncertainty of waiting for reversal and the anticipation of further surgery created additional stress.¹⁶ Whether the stoma was a colostomy or an ileostomy did not significantly affect body image scores; the type of surgery and the underlying diagnosis were not major predictors either.

Quality-of-life studies tell a broader story. More than half of stoma patients in one study reported feelings of depression after surgery. Only about a third resumed sexual activity, and just 11% reported being satisfied with it. Whether the stoma was temporary or permanent, and whether the person had changed their diet or clothing to manage it, were both associated with quality-of-life scores.¹⁵ One striking finding: none of the participants in that study were enrolled in a stoma support group or association, suggesting that many people navigate these challenges without the peer support networks that do exist.

The Financial Side

Ostomy supplies, including pouching systems, skin barriers, adhesive removers, and deodorizing products, are an ongoing expense that most people do not anticipate before surgery. A Canadian cost analysis found that 58% of people with ostomies paid at least part of their supply costs out of pocket, and among those, 62% reported spending more than $500 Canadian per year. Three-quarters of those paying out of pocket said they had been forced to choose between buying ostomy supplies and covering other basic expenses like food or prescription medications.¹⁷

Coverage varies wildly depending on where you live and what insurance you have. In the United States, Medicare covers ostomy supplies under its durable medical equipment benefit, but the allowable quantities and reimbursement rates do not always match what individuals actually need. Private insurance coverage is inconsistent. This financial burden is functionally the same whether you have a colostomy, ileostomy, or urostomy, though people with ileostomies may go through supplies faster because of the higher output volume and more frequent pouch changes.

How Stoma Care Technology Has Evolved

The history of ostomy surgery stretches back to antiquity, but meaningful progress in both surgical technique and the devices used to collect output really only took off in the nineteenth and twentieth centuries.¹⁸ Early patients had nothing resembling a modern pouching system. They relied on crude bandages and makeshift containers. The development of adhesive skin barriers and drainable pouches in the mid-twentieth century was transformative, making it possible for people with ostomies to leave the house, hold jobs, and live independently.

Modern pouching systems are far more discreet and reliable than even a generation ago. Two-piece systems allow you to change the pouch without removing the adhesive wafer from the skin, reducing irritation. Convex wafers help create a better seal for people with flush or retracted stomas. Filters built into pouches neutralize gas. For colostomy patients who produce firmer stool, closed-end pouches that can be discarded after a single use are an option, while drainable pouches with a clip or integrated closure remain the standard for ileostomies. Research into new barrier materials continues, including ceramide-infused barriers designed to protect peristomal skin more effectively and reduce the cost of managing skin breakdown over time.¹⁷

1
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PubMed Central. The Differences in Postoperative Nursing Between Temporary Ileostomy and Temporary Colostomy: A Retrospective Cohort Study
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PubMed Central. Ileostomy diarrhea: Pathophysiology and management
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PubMed Central. Ostomy Care Peristomal Moisture-Associated Skin Damage and Independence in Pouching System Changes in Persons With New Fecal Ostomies
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PubMed. Peristomal Moisture-Associated Skin Damage Treatment: Use of Cyanoacrylate Liquid Skin Protectant: A Case Series
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PubMed Central. Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery era
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PubMed Central. Quality of Life in Patients Living with Stoma
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PubMed Central. Psychological Adaptation to Alteration of Body Image among Stoma Patients: A Descriptive Study
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PubMed Central. A Cost-Effectiveness Model to Determine Ostomy-Related Costs of Care and Health Outcomes Among People With an Ostomy in Canada Using a Ceramide-Infused Skin Barrier
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PubMed. History of enterostomy devices: Yesterday, today, and tomorrow?