Ileostomy & Colostomy (Ostomy) Reversal
If you have a colostomy or ileostomy and your condition has improved, you might be a candidate for ostomy reversal. This is an elective surgery to reconnect your bowels and close your stoma. After ostomy reversal, you can poop in the old-fashioned way again.
An ostomy reversal is an operation to reverse an existing colostomy or ileostomy. You might have an ostomy if you’re recovering from an injury or disease in your bowel that prevented you from using it normally. After your bowel has recovered, you might be a candidate for ostomy reversal surgery.
A surgeon creates a colostomy or ileostomy by splitting your bowel and redirecting the end of your large intestine (colon) or small intestine (ileum) to an opening in your abdomen (a stoma). Ostomy reversal surgery connects your bowels and closes your stoma, allowing you to poop out of your anus (butthole) once again.
Ostomy reversal is an elective procedure that you can choose to have if your condition allows for it. Most people choose to have it because they’d prefer to use the bathroom in the old-fashioned way again. This procedure represents a chance to return to the way life was before ostomy surgery.
After your reversal, you’ll no longer have to worry about managing an ostomy bag or caring for your stoma, or the various complications that can come with having an ostomy, like leaked fluids and irritated skin. In short, reversal offers relief from the practical and psychological burdens of living with an ostomy.
Your surgeon will discuss the possibility of ostomy reversal with you before your original colostomy or ileostomy procedure. This possibility will depend on the nature of your condition, the type of treatment you need and how well you recover from it. Ostomy reversal may not be an option for everyone.
If your surgeon expects your ostomy to be permanent, they might complete it in a more permanent way (end ostomy). But if they expect it might be temporary, they can complete it in a less permanent way (loop ostomy). They’ll consider ostomy reversal after you’ve healed, usually after three to 12 months.
If you want to have an ostomy reversal, your surgeon will want to make sure that:
- Surgery in your bowel has healed completely, and there’s no leak where the bowels are joined.
- Disease in your bowel has cleared, and there’s no active infection or inflammation.
- Your anal nerves and muscles are still functional enough to control your bowel movements.
- Your overall condition is well enough to have surgery again.
Your healthcare provider will do the appropriate tests to make sure you’re in good condition for ostomy reversal surgery. This might include:
- Endoscopy in your bowels to look for signs of disease or obstruction.
- Gastrointestinal X-ray exam with contrast fluid to check for bowel leaks.
- A digital rectal exam to test your anorectal muscle control.
- Blood tests to review your nutritional status and other health concerns.
You should expect to be in the hospital for a few days, so plan accordingly. Your surgeon might ask you to fast overnight before the procedure and/or to clean out your bowels with an enema or laxative formula. They’ll also ask you to avoid tobacco and alcohol use before the procedure since these can affect your recovery. They’ll explain the risks of the procedure and ask for your informed consent.
You’ll have general anesthesia during surgery, so you’ll be asleep and won’t feel anything. In general, your surgeon will:
- Detach your bowel from the opening in your abdomen (stoma).
- Reattach it to the lower part of your bowel (anastomosis).
- Close all incisions, including your former stoma.
Ostomy reversal is generally a simpler procedure than ostomy creation. But this can vary, depending on the type of ostomy you have, whether there are any complications your surgeon needs to address during surgery and the method they use. Surgeons can — and often do — use minimally invasive surgery methods for ostomy reversal, but some conditions are better managed with open abdominal surgery.
Under normal circumstances, an ostomy reversal takes one to two hours. It might take longer if your surgeon needs to add extra steps to the procedure to address an issue or complication. For example, they might need to break up scar tissue from your previous surgery or repair a hernia that’s developed.
You’ll spend a few days recovering in the hospital after your procedure. Your bowels will be slow to start moving again, so you’ll be on a liquid diet at first. When your bowels start to move again, you’ll progress to a soft diet. You’ll be able to go home when you can eat, drink and poop without major complications.
General risks of surgery include:
- Infection.
- Bleeding.
- Blood clots.
- Injury to organs or nerves.
Anastomotic leak is one specific risk of ostomy reversal surgery. It’s rare, but if your bowel leaks at the place where it was joined together (anastomosis), it could have serious consequences. Bacteria from inside your bowel could infect your abdominal cavity. From there, it could spread to your bloodstream, leading to sepsis. Signs of a possible leak include fever and dull pelvic pain. Some leaks, but not all, require surgical repair. Leaks that don’t heal are the main reason why an ostomy reversal might fail.
Common short-term side effects include:
- Some discomfort. Most people are sore after surgery, but most can manage with household pain relievers. Your abdomen might feel bloated or swollen at first, and you might feel tired.
- Paralytic ileus. It’s typical for your bowels to be temporarily paralyzed after abdominal surgery. Your healthcare team will expect this and treat you accordingly. It should resolve in a few days.
- Poop changes. Your bowels may take some time to regain their normal functioning. Some of the nerves and muscles involved will be out of practice, and swelling from surgery can also have an effect. Diarrhea is common, but constipation can also occur. You might also feel you have to go more frequently or urgently than before. This may last from a few days up to a few months.
Possible long-term side effects include:
- Hernias. Since repeat abdominal surgeries weaken your abdominal wall, it’s possible you could develop a hernia at the incision site. That’s when an organ or tissue pokes through the weak spot. Some hernias never need treatment, but some may eventually need surgical repair.
- Abdominal adhesions. Abdominal surgery can sometimes cause bands of scar tissue, called adhesions, to develop in your abdomen that make your tissues stick together. They don’t always cause trouble, but occasionally they might obstruct your bowels and need to be removed.
- Fecal incontinence. Some people may continue to have difficulties with bowel control after ostomy reversal if their anorectal muscles and nerves remain weak or uncoordinated. In this case, healthcare providers recommend physical therapy to help retrain the muscles.
It takes an average of six to eight weeks after surgery to feel fully recovered. During this time, you’ll gradually regain your energy and strength and broaden your diet as your symptoms allow. You should take it easy and avoid heavy lifting and driving until your surgeon says it’s safe to do so. If you have digestive symptoms, like gas, constipation or diarrhea, your healthcare provider can give you more specific dietary advice.
During your recovery, you should:
- Start with easy-to-digest, low-fiber foods (like the BRAT diet).
- Make sure to drink plenty of fluids, especially if you’re constipated.
- Avoid alcoholic, carbonated and caffeinated drinks.
- Try eating several small meals a day instead of three main meals.
- Notice which foods cause uncomfortable symptoms and avoid them for now.
- Slowly broaden your diet to include more variety and nutrition.
When should I see my healthcare provider?
Your healthcare provider will schedule follow-up appointments after your surgery to check on your recovery. But make sure to contact them sooner if you’re having difficulties or feeling unwell. Watch out for symptoms like:
- Worsening pain and/or swelling.
- Nausea and vomiting.
- Fever.
- Discharge from your incision wound.
- Persistent diarrhea or constipation.
- Difficulties keeping food or fluids down.
References
- Bladder & Bowel Community. Stoma Reversal (https://www.bladderandbowel.org/bowel/stoma/stoma-reversal/). Accessed 10/28/2023.
- National Health Service (U.K.) Reversal of Stoma (Ileostomy or Colostomy) (https://www.nbt.nhs.uk/sites/default/files/attachments/Reversal%20of%20Stoma_NBT002926.pdf). Accessed 10/28/2023.
- Sherman KL, Wexner SD. Considerations in Stoma Reversal (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498167/). Clin Colon Rectal Surg. 2017 Jul;30(3):172-177. Accessed 10/28/2023.
- United Ostomy Associations of America. Facts About Ostomy Reversals (https://www.ostomy.org/facts-ostomy-reversals/). Published 2/13/2018. Accessed 10/28/2023.
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