What is a colostomy?

A colostomy is a surgically created opening (stoma) that brings part of the large bowel (colon) through the abdominal wall so that stool leaves the body into a sealed pouch instead of through the rectum and anus. It may be temporary or permanent, and it is created when the lower bowel, rectum or anus cannot safely do its normal job. The stoma has no nerve endings, so it is not painful to touch.

Colostomy at a glance

A colostomy is one of the most frequently performed life-saving operations in abdominal surgery. The points below summarise the essentials before the detail that follows.

• What it is: a surgical opening (stoma) between the colon and the surface of the abdomen.
• How stool leaves the body: into a flat, sealed, odour-proof pouch worn on the skin.
• Why it is made: bowel cancer, complicated diverticular disease, bowel obstruction, injury, some congenital conditions, or incontinence that has not responded to other treatment.
• Temporary or permanent: both are possible; the decision depends on the underlying disease and on whether the rectum and anus can be preserved.
• Named by position: sigmoid, descending, transverse and ascending colostomy.
• Named by construction: end colostomy and loop colostomy.
• Output consistency: formed with a sigmoid colostomy; softer or liquid the higher up the colon the stoma is formed.
• Sensation: the stoma itself has no nerve endings and is not painful to touch.
• Everyday life: the great majority of people return to work, exercise, travel, swimming and sexual relationships.

What does a colostomy actually look like?

A colostomy stoma is a small, round or oval piece of bowel tissue, usually 2 to 4 cm across, that sits at or slightly above the level of the skin. It looks and feels rather like the inside of the cheek — moist, warm, deep pink or red, and richly supplied with blood. Touching or cleaning it produces a sensation of pressure but not pain, because the lining of the bowel contains no pain nerve endings.

The stoma has no sphincter muscle. That is the single most important practical fact about living with one: there is no conscious control over when wind or stool is passed. Control comes instead from the pouching system, from the natural rhythm of the bowel, and, for some people with a sigmoid colostomy, from a technique called irrigation (described later).

A newly formed stoma is often swollen and larger than it will eventually be. It usually settles to its final size over about six to eight weeks, which is why stoma care nurses re-measure it rather than relying on the size recorded in hospital. Stomas also vary in shape: some sit proud of the skin, some are flush, and some are slightly recessed. The shape matters, because the pouching system must fit closely around the stoma to protect the surrounding skin from stool.

A small amount of bleeding when the stoma is rubbed or cleaned is common and usually harmless, since the surface is rich in tiny blood vessels. Bleeding that appears to come from inside the stoma, or blood mixed into the output, is different and should be reported.

The skin around the stoma has normal sensation, and it is this skin — not the stoma — that is most vulnerable day to day. If a pouch leaks, the skin becomes sore quite quickly, which is why a well-fitting pouching system is the foundation of comfortable living with a colostomy.

Why might someone need a colostomy?

A colostomy is created when the lower bowel, rectum or anus cannot safely do its normal job, whether because of disease, injury, or as a planned step in a larger operation. The most common reasons include:

• Colorectal cancer, when the diseased section of bowel is removed. A colostomy may be permanent if the rectum and anus have to be removed, or temporary if they can be preserved.
• Diverticular disease complicated by perforation, abscess or severe infection.
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis), although an ileostomy is more often used in these conditions because the disease may affect the whole colon.
• Bowel obstruction that cannot be relieved by other means, including obstruction caused by a tumour or by adhesions.
• Severe trauma, such as a penetrating injury to the abdomen.
• Faecal incontinence that has not responded to other treatments.
• Congenital conditions, including imperforate anus and Hirschsprung’s disease, in newborns and children.
• Radiation damage to the rectum after pelvic cancer treatment, which can leave the rectum unable to function.
• A planned protective step after lower bowel surgery, so that a new join (anastomosis) can heal without stool passing over it.

Planned and emergency colostomies

Some colostomies are planned weeks in advance. When that happens, there is time for stoma site marking, for meeting a stoma care nurse, for talking to someone who already lives with a stoma, and for choosing equipment calmly. Planned surgery is generally associated with a smoother adjustment.

Other colostomies are created in an emergency, usually during surgery for a perforated bowel, a strangulated hernia or an acute obstruction. In these situations the priority is saving life, and there may be no opportunity for site marking or preparation. People who wake up with an unplanned stoma often need extra support in the first weeks, and it is worth asking specifically for it.

Protective colostomies

A protective (or defunctioning) colostomy is made upstream of a newly joined section of bowel so that stool does not pass across the healing join. It is usually temporary and is often a loop colostomy. It does not mean that the original operation failed; it is a deliberate safety measure that reduces the consequences if the join leaks.

Whether a colostomy ends up temporary or permanent depends on the underlying condition and on what the surgical team can safely preserve. This is one of the first questions most people ask, and it is reasonable to ask it directly, more than once, as the plan becomes clearer.

What are the different types of colostomy?

Colostomies are described in three ways: by the part of the colon they come from, by how the bowel is brought to the surface (end or loop), and by whether they are expected to be temporary or permanent. All three descriptions matter, because they influence stool consistency, pouch routine and the likelihood of particular complications.

Sigmoid colostomy

The most common type. The stoma is formed from the sigmoid colon, the S-shaped section just above the rectum, and usually sits on the lower-left side of the abdomen. Because stool has travelled almost the full length of the colon, output is typically formed and predictable, and the pouch usually needs emptying one to three times a day.

Descending colostomy

Formed from the descending colon, slightly higher than a sigmoid colostomy and also on the left side of the abdomen. Output is similar — semi-formed to formed — and the routine is broadly comparable.

Transverse colostomy

Formed from the transverse colon that runs across the upper abdomen, with the stoma usually in the upper-right or upper-middle abdomen. Output is softer and more frequent, because less water has been reabsorbed by the time stool reaches this point. Transverse colostomies are most often temporary, for example to protect a lower bowel join.

Ascending colostomy

The rarest type. The stoma comes from the ascending colon on the right side of the abdomen. Output is liquid to semi-liquid and frequent, and fluid and salt balance needs more attention — in many ways it behaves like an ileostomy.

End colostomy versus loop colostomy

The second classification describes how the bowel is brought to the surface.

• An end colostomy uses the cut end of the colon, which is brought through the abdominal wall and stitched to the skin. It has a single opening. It is usually created when the rectum and anus are removed, and so is usually permanent — although an end colostomy can sometimes be reversed if the rectum is intact and healthy.
• A loop colostomy brings a loop of bowel up to the skin and opens it across the top, producing a stoma with two openings: the proximal opening passes stool, while the distal opening usually passes only mucus. Loop colostomies are technically easier to reverse and are therefore typically used as temporary protective stomas.

Temporary versus permanent colostomy

A temporary colostomy is expected to be reversed once the bowel below it has healed. A permanent colostomy is created when reversal is not possible, most often because the rectum and anus have been removed. The word permanent can feel daunting, but it describes the anatomy rather than the quality of life: most people with a permanent colostomy settle into a full and active routine.

Colostomy surgery: how it is planned and performed

Colostomy formation is usually carried out under general anaesthetic and takes roughly two to four hours, depending on what else is being done at the same time, such as removing a section of bowel or a tumour. Occasionally a colostomy is formed as a smaller, separate operation.

Stoma site marking

Before planned surgery, a stoma care nurse usually marks the proposed stoma site on the abdomen with the patient awake, sitting and standing. The ideal site is flat, within the patient’s line of sight, clear of skin creases, scars, the waistband, the bony pelvis and any existing belts or braces. Site marking is one of the strongest predictors of long-term comfort and a low complication rate, and it is worth asking for if it has not been offered.

How the operation is carried out

The surgeon brings a section of healthy colon through the abdominal wall and secures it to the skin, then closes the abdomen around it.

The approach may be:

• Open surgery, through one larger abdominal incision.
• Laparoscopic (keyhole) surgery, through several small incisions using a camera.
• Robotic-assisted surgery, a variation of laparoscopic surgery.

The choice depends on the underlying condition, previous surgery, body shape and the surgeon’s assessment. Whichever approach is used, the stoma itself looks the same afterwards.

Hospital stay

Most people stay in hospital for around three to ten days after a colostomy, depending on the size of the operation and how quickly the bowel recovers. During that time the stoma care nurse begins teaching pouch care, and a discharge plan and initial supplies are arranged.

Recovery after colostomy surgery

Recovery has three strands running side by side: healing the abdominal wound, getting the bowel working again, and learning the pouching routine with confidence.

The first 24 to 72 hours

The stoma is usually inspected within the first day. It may look swollen and dark pink at first, and it may produce a little blood-stained fluid before it produces anything else. The first output is typically wind, then thin liquid, then gradually thicker stool as the bowel wakes up — a process called return of bowel function. Until it happens, eating and drinking are usually built up gradually.

Learning to pouch

Most people are taught to empty and change the pouch while still in hospital, and to inspect the stoma and surrounding skin. It is common to feel clumsy at first; the routine becomes second nature within a few weeks for most people. Ask to practise while a nurse is present, and ask for written instructions to take home.

The first six weeks at home

• Avoid heavy lifting — many teams advise nothing heavier than roughly 4 to 5 kg at first, so the abdominal muscles can heal and the risk of a parastomal hernia is reduced.
• Walk daily. Short, gentle walks support bowel function and reduce the risk of blood clots.
• Eat smaller, more frequent meals initially, chew thoroughly, and drink regularly.
• Keep spare pouches, wipes and a change of pouch with you when out, and keep a small kit at work or in the car.
• Expect emotional ups and downs. They are normal, they are common, and they usually settle as confidence grows.

Longer-term recovery and returning to work

Many people feel physically ready to return to office-based work within four to eight weeks, and to heavier physical work within eight to twelve weeks. Your own timeline will depend on the operation you had, your general health and your job. A phased return, or a temporary change of duties, is often sensible and can be arranged with an occupational health team.

Living with a colostomy

The day-to-day routine is usually simpler than people expect before surgery.

Emptying the pouch

A drainable pouch is emptied into the toilet when it is roughly one-third to one-half full — typically two to six times a day with a sigmoid colostomy, and more often with a transverse or ascending colostomy. Emptying before it becomes full prevents weight pulling on the adhesive and reduces the risk of a leak. Closed-end pouches are not emptied; they are removed and replaced.

Changing the pouching system

A one-piece system is changed completely each time. With a two-piece system, the pouch can be changed without removing the baseplate, which some people prefer. Most people change the full system every one to four days, depending on output, skin condition and the products used. The skin is cleaned with warm water, dried thoroughly, and a fresh barrier applied. With practice, the change usually takes 5 to 10 minutes.

Diet, wind, odour and blockage

There is no single colostomy diet, and most people return to eating a wide range of foods within a few months. Practical principles include:

• Eat slowly, chew food well, and avoid rushing meals, which reduces swallowed air and lowers the risk of a blockage.
• Drink regularly through the day. Many ostomy teams suggest around 1.5 to 2 litres of fluid daily for adults, more in hot weather or during illness — your own team will give you personal targets.
• Introduce new foods one at a time so that you can identify your own triggers.
• Foods that commonly increase wind: beans, cabbage, broccoli, onions and fizzy drinks.
• Foods that commonly increase odour: eggs, fish, garlic and asparagus.
• Foods that commonly thicken output: bananas, white rice, pasta, smooth peanut butter and applesauce.
• Foods that are harder to digest and more likely to cause a blockage if eaten in quantity without chewing: sweetcorn, mushrooms, nuts, seeds, raw crunchy vegetables and dried fruit.

Wind and odour are governed partly by diet and partly by the pouch. Modern pouches contain filters and odour-barrier film, and the smell is usually noticeable only to the person wearing the pouch, and only at the moment of emptying.

Irrigation

Some people with a sigmoid or descending colostomy choose colostomy irrigation: a planned routine, taught by a specialist nurse, which uses warm water to stimulate the bowel to empty at a chosen time. It suits a predictable bowel and can give greater control over when output happens. It is not suitable for everyone, particularly with a transverse or ascending colostomy, and should only be started with specialist training.

Clothing, sleep, showering and swimming

No special clothing is needed. Most pouches sit flat under normal waistbands; some people prefer high-waisted underwear or a soft support belt for extra security during exercise or intimate occasions. These are personal choices, not medical requirements.

Empty the pouch before bed. Most people sleep in their usual position, and some like a support garment overnight for peace of mind.

A pouching system is waterproof and can be worn in the shower, bath, pool, sea or hot tub. Some people prefer to shower with the pouch off, which is also safe — water will not enter the stoma.

Sex and intimacy

A colostomy does not prevent a normal, satisfying sex life. Confidence often takes time to rebuild; pouch covers, intimacy wraps and open conversation with a partner all help. Pelvic surgery can affect nerve function and erectile or ejaculatory function in some people, and there is specialist support available for this. Stoma care nurses and ostomy associations can discuss it discreetly.

Work, travel, sport and exercise

People with colostomies work in every field, from office roles to construction, nursing and the armed forces. Air travel is straightforward: carry spare supplies in hand luggage, and consider an ostomy travel certificate, which most national ostomy associations publish as a template, for security checks. Swimming, cycling, yoga, running, weightlifting and many contact sports can be resumed with appropriate support garments and medical guidance. Build up gradually, and ask your team about core rehabilitation, which can reduce hernia risk.

Colostomy reversal

A temporary colostomy is created to give the bowel below it time to heal — for example after removal of a cancer with a new join, or after a perforation has been repaired.

When a reversal is considered

Reversal is usually considered three to twelve months after the original operation, once healing is confirmed, general health is stable and any cancer treatment is complete. Before deciding, the surgical team normally checks the remaining bowel with imaging or an examination to confirm it is healthy and connected to a working anus.

What the operation involves

Reversal is a separate operation, usually shorter and less complex than the original. The stoma is taken down, the bowel is rejoined, and the abdominal wall is closed. Most people are in hospital for around two to five days and are eating normally quite quickly. Not everyone is well enough for reversal, and some people choose not to have it after weighing up the risks and benefits with their team.

Bowel habits after reversal

After reversal, stool passes through the rectum and anus again, but bowel habits rarely return to their previous pattern immediately. Frequency, urgency, clustering of bowel movements, and some leakage are common at first, and it often takes three to twelve months to settle. When the original operation removed part of the rectum, this pattern is known as low anterior resection syndrome, and it is a recognised condition rather than a failure of surgery. Pelvic floor exercises, dietary adjustment, medication and specialist follow-up can all help.

When reversal is not possible

A permanent colostomy is usual when the rectum and anus have been removed, most often during an operation called abdominoperineal resection for low rectal cancer, or when the anal sphincter is permanently damaged. In these circumstances the focus shifts to long-term quality of life, which is good for the large majority of people, supported by a settled pouch routine and regular stoma care follow-up.

What complications should I be aware of?

Most people live with a colostomy for years without serious problems, but some complications are common enough to recognise early.

• Skin irritation around the stoma — usually caused by a pouch that does not fit well or by leakage under the adhesive. A stoma care nurse can re-measure the stoma and suggest a different pouching system or skin-protective products.
• Parastomal hernia — a bulge around the stoma caused by abdominal contents pushing through the muscle weakness. It becomes more common after the first year and is managed with support garments, physiotherapy and sometimes surgical repair.
• Prolapse — the stoma becomes longer than usual. Often managed conservatively; surgery is rarely needed unless the blood supply is affected.
• Retraction — the stoma sinks to or below the skin line, making a secure pouch fit harder. A change of pouching system often solves it.
• Stenosis — the stoma opening narrows over time, which can make output difficult and cause cramping. It should be assessed by the surgical team.
• Leakage — usually a sign that the pouching system needs adjusting, and not something to simply put up with.
• Dehydration and electrolyte imbalance — more common with transverse and ascending colostomies, and during episodes of very loose output. Seek advice early rather than trying to manage it alone.
• Mucus discharge from the rectum — normal when the rectum remains in place but disconnected.

When to seek medical help

Contact your stoma care nurse, GP or surgical team if you notice any of the following:

• The stoma changes colour to dark purple, brown or black instead of its usual pink-red.
• No stool or wind from the stoma for more than 12 hours, particularly with abdominal pain, nausea or vomiting.
• Severe watery output that does not settle within 24 hours, or signs of dehydration such as dizziness, dark urine or confusion.
• Bleeding from inside the stoma, or blood mixed into the output.
• Significant swelling, redness, warmth or pain around the stoma, or a rash that does not improve.
• A new bulge around the stoma that does not reduce when you lie flat, especially if it is painful.
• Fever, chills or feeling generally unwell.

When in doubt, call. Stoma care teams would much rather hear from you early than late, and most problems are easier to solve when they are small.

Emotional wellbeing and support

Adjusting to a colostomy is as much an emotional journey as a physical one, and it is common to grieve for the body you had, even when the operation has saved your life. Body image, intimacy, work identity and the unpredictability of the early weeks all take time to process.

Trusted support is widely available and usually free of charge:

• Stoma care nurses at your hospital or in the community — your most useful long-term resource.
• National ostomy associations, which run helplines, peer-visitor programmes and local groups.
• Online peer communities, useful for day-to-day practical questions and shared experience.
• Specialist counselling through hospital teams or community mental health services if adjustment feels harder than expected.

Talking to someone who has lived well with a colostomy for years — and is thriving — is one of the most effective steps for anyone newly diagnosed.

The bottom line

A colostomy is a temporary or permanent surgical opening of the colon onto the abdominal wall, created to manage a wide range of bowel diseases, injuries and complications. It may be formed from the sigmoid, descending, transverse or ascending colon, as an end or a loop stoma, and it may later be reversed if the bowel below it is healthy enough.

With a well-fitting pouching system, expert nursing support and good information, the great majority of people with a colostomy live full, active and confident lives — at work, in relationships, in sport and in travel.

If you or someone you care about is preparing for a colostomy, the most useful next steps are:

1. Meet a stoma care nurse before surgery for stoma site marking, which makes a measurable lifelong difference.
2. Read one or two trusted overviews such as this one, and set aside anything that frightens you without citing reputable sources.
3. Connect with a peer-support visitor through your national ostomy association; hearing from someone who has been through it is uniquely reassuring.
4. Ask questions. There is no question too small, and a good stoma team welcomes every one.

This article is general information and is reviewed periodically against the NHS and NIDDK patient information listed in Sources. It is not personal medical advice. Always discuss your own stoma, diet, medicines and symptoms with your stoma care nurse or clinician.