Colostomy

A colostomy is a surgical procedure that changes the way stool (poop) exits your body. When medical reasons require you to bypass part of your colon, surgeons make a new opening in your abdominal wall for poop to come out. The poop collects in an attached pouch (colostomy bag). The operation can be temporary or permanent.

Overview Procedure Details Risks / Benefits Recovery and Outlook When To Call the Doctor

A colostomy is a surgery that changes the way stool (poop) exits your body. During the procedure, a surgeon creates a hole (stoma) in your abdominal (belly) wall. They then connect a portion of your colon to it.

Instead of pooping like you used to, waste collects in a pouch (or colostomy bag) on the outside of your belly. Some people only have a colostomy for a few months, while others need one for life.

A colostomy is a type of ostomy. It may be part of a colectomy operation, a procedure to remove part or all of your colon. Other conditions may require you to stop using your colon, either temporarily or permanently. After surgery, “colostomy” also refers to your newly redirected colon. Your healthcare provider will talk to you about living with and caring for your colostomy.

There are several types of colostomies. The names of these procedures correspond with the portion of your colon that a healthcare provider must redirect.

  • Sigmoid colostomy. Connects the lower, S-shaped part of your colon (on the left side of your body) to your abdominal wall. Sigmoid colostomies are the most common type. Stool from a sigmoid colostomy is typically more solid than other types of colostomies. This is because it moves through most of your colon before coming out through your stoma.
  • Descending colostomy. Connects the left side of your colon (the portion just above your sigmoid colon) to your abdominal wall. A descending colostomy is similar to a sigmoid colostomy, but it occurs just above the S-shaped curve in your colon. Stool from a descending colostomy is firmer, like stool from a sigmoid colostomy.
  • Transverse colostomy. Connects the upper portion of your colon (which goes across your abdomen) to your abdominal wall. Transverse colostomies are usually temporary. There are two subtypes — loop colostomy and double barrel colostomy. They share a common goal — to let the affected portion of your colon rest while you heal. People with these types of colostomies may have two stomas — one to pass stool and one to pass mucus. (Even after a colostomy, your colon will still make a protective layer of mucus. This is completely normal.) Stool from a transverse colostomy is usually softer because it’s only traveled about halfway through your colon.

Your healthcare provider will consider many factors. This helps them choose the best option for your situation. Most importantly, it depends on whether you need a temporary or permanent solution.

You may need a colostomy if a health condition keeps you from using your colon or anus like you used to. It might be a temporary intervention that allows your body to heal or it may be a permanent solution for an irreversible condition.

Some conditions that may require a temporary colostomy include:

  • Diverticulitis.
  • Inflammatory bowel disease (IBD).
  • An injury to your colon.
  • An obstruction (or blockage) in your colon or anus.
  • Anal fistula (a tunnel leading from your anal cavity through to your skin or another organ).
  • Partial colectomies (when a surgeon decides it’s safer to reconnect the ends of the bowels in a separate operation after they remove part of the colon).

Some conditions that may require a permanent colostomy include:

  • Incurable fecal (bowel) incontinence.
  • Advanced colorectal cancer.
  • Permanent removal of your rectum and/or anus.

A colostomy is a major surgery, and it involves some preparation.

Before your surgery

You’ll have a pre-op assessment with your surgeon. Before you sign your consent forms, they’ll make sure you understand the procedure, the risks involved and the lifestyle changes you’ll have to make afterward. You may also discuss your pain management options at this time.

They’ll also take a blood sample to check that you are well enough for surgery. They may also run an EKG test to check that your heart is in good health.

Another healthcare provider (usually a nurse) will teach you about your future ostomy. They’ll also help you choose the best location for the colostomy on your abdomen.

On the day of your surgery

You’ll need to avoid eating for six hours before surgery and drinking clear liquids two hours before surgery. Your surgeon might also recommend an enema or bowel prep (like before a colonoscopy) to take at home.

You’ll be under general anesthesia for your colostomy. Depending on your situation, your surgeon may do open surgery or laparoscopic surgery.

Open surgery requires a longer incision across your abdomen. Laparoscopic surgery is less invasive. Instead of making one long incision, your surgeon will make several small incisions. Then, they’ll put a tiny camera and special instruments through the incisions. They’ll use these to perform the surgery inside your belly.

During your colostomy operation, your surgeon creates an opening (stoma) in your abdominal wall. Then, they attach part of your colon to your new stoma. For a sigmoid or descending colostomy, your stoma will be on the lower left side of your belly. If you have a transverse colostomy, your stoma will be somewhere across your upper belly, or on the right or left side.

Once your surgeon completes your colostomy, they’ll attach a colostomy bag to your skin. There are several types of colostomy bags. They include closed bags, drainable bags and mini pouches. Your healthcare provider will help you choose the best option for your needs.

You’ll need to recover in the hospital for the next three to seven days. During this time, you’ll:

  • Resume normal eating gradually. You’ll likely be on a clear liquid diet on the day of and/or after surgery. Then, you’ll have a soft or low-fiber diet before eating a regular solid food again.
  • Learn all about colostomy care. A wound ostomy continence nurse (WOCN) will teach you about living with a colostomy bag. They’ll also teach you how to care for your stoma.
  • Gradually wean from your pain medications. Your healthcare provider may give you a short-term prescription to take home with you.
  • Heal from your wounds, and your bowel movements will begin to regulate. It may take several days before your first one.

A colostomy is often a life-saving intervention. If you need a colectomy or similar operation, a colostomy lets your body keep working after losing a major organ.

Colostomy can also give your colon a “time out” after a procedure. Or you might need to rest your colon following illness or injury. Colostomy allows healing to take place safely without risking further complications.

Colostomy is a common and straightforward surgery. It’s generally safe, but there are always some risks, including:

  • Bleeding
  • Infection
  • Reactions to the anesthesia
  • Injury to nearby organs
  • Skin reactions to the ostomy and its appliances

Even after a successful colostomy, you might develop complications down the road. These may include:

  • Skin irritation. This can occur from contact with stool (poop) — especially the acidic, liquid stool of the upper colon. This is the most common stoma complication. A better-fitting colostomy bag usually solves the issue.
  • Bowel obstructions. Scar tissue or paralytic ileus (slow-moving bowels) can block poop from moving through your colon after surgery. Most of the time, constipation medications can help.
  • Stoma retraction or prolapse. A retracted stoma sinks back below your skin’s surface level. A prolapsed stoma sticks out too far. Both situations can make it difficult to fit your colostomy bag to your stoma securely. If you can’t find a bag that fits, you might need surgical revision on your stoma.
  • Parastomal hernia. This type of hernia occurs when loops of bowel bulge through weak muscles around your stoma. A hernia forms a visible bulge next to your stoma. It can grow over time and block the stoma’s output. Your healthcare provider will discuss ways to prevent a hernia after surgery.

Each person heals at a different pace. But on average, most people recover from colostomy surgery within six to eight weeks.

Be sure to follow your surgeon’s post-op guidelines. It’s important to get lots of rest. But you should also take short walks around your house. Short walks help your bowels move more quickly.

When should I call my doctor?

Contact your healthcare provider if you experience:

  • Constipation or diarrhea that doesn’t go away.
  • Nausea or vomiting.
  • Blood in your stool.
  • A change in your stoma’s regular size or color.
  • Any strange or foul odors coming from your stoma.
  • A blockage in your stoma.
  • American Cancer Society. Caring for a Colostomy (https://www.cancer.org/cancer/managing-cancer/treatment-types/surgery/ostomies/colostomy/management.html). Last revised 10/16/2019. Accessed 11/4/2024.
  • American Cancer Society. What Is a Colostomy? (https://www.cancer.org/cancer/managing-cancer/treatment-types/surgery/ostomies/colostomy/management.html) Last revised 10/02/2019. Accessed 11/4/2024.
  • Cancer.net. Colostomy. Approved 9/2021. Accessed 11/4/2024.
  • Maria A, Lieske B. Colostomy Care (https://pubmed.ncbi.nlm.nih.gov/32809338/). 2023 May 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Accessed 11/4/2024.

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