Loop Ileostomy, Loop Colostomy and Defunctioning Stomas: A UK Guide

What is a loop stoma?

A loop stoma is made by bringing a loop of bowel up through a small opening in your tummy and opening its front wall, so one stoma ends up with two openings joined together at the base.

One opening is the working side. It connects to the bowel coming from your stomach, and that is where output comes out into your stoma bag. The other opening is the resting side. It leads to the part of your bowel further down, which is taking a break. Because the bowel is not cut all the way through, the two openings sit next to each other and usually look like one larger, oval stoma.

Made from the small bowel, it is a loop ileostomy. Made from the large bowel (the colon), it is a loop colostomy. The idea is the same; what changes is the kind of output and how often it comes. Our ileostomy vs colostomy guide explains the two side by side, and types of stoma puts every kind in one place.

What does a defunctioning stoma mean?

In the UK you will often hear a loop stoma called a defunctioning stoma, a defunctioning ileostomy or a defunctioning colostomy. It simply means the stoma takes the work away from the bowel further down for a while, so that part can heal or rest. You may also hear diverting, covering or protective stoma. They describe the same idea, and most defunctioning stomas are made as loops.

The usual reasons are:

• Protecting a new join. After part of the bowel is removed and the ends are joined again, for example in bowel cancer or diverticulitis surgery, the stoma keeps output away from the join while it heals.
• Protecting a J-pouch. People who have their colon removed for ulcerative colitis or familial polyposis and get an internal pouch often have a temporary loop ileostomy first.
• Resting the bowel. Inflammation, an infection, a fistula or a blockage further down can settle while nothing passes through that section.
• A quicker operation. In an emergency, or when someone is too unwell for a bigger operation, a loop stoma can be made faster and is often easier to close later.

A loop stoma is usually temporary, and your colon is not usually removed. Some stay longer than planned, and occasionally one becomes permanent if closing it would not be safe or helpful. Your surgical team will explain the plan for yours.

Loop stoma vs end stoma: the differences that matter

An end stoma is made differently: the bowel is divided and one end is brought out, so there is a single opening. Here is how the two compare day to day.

Loop ileostomy vs loop colostomy

A loop ileostomy usually gives loose, frequent output, from liquid to porridge-like, so drainable bags and drinking enough matter. A loop colostomy, often made from the transverse colon higher up the tummy, tends to give softer, pasty output and can be larger, which is why it is the type most prone to a prolapse. Everyday routines are covered in living with an ileostomy and colostomy care at home.

What a loop stoma looks like and how it behaves

The rod in the first days

Some surgeons place a small plastic rod, sometimes called a bridge, under the loop for the first few days to support it while it settles. It sits across the stoma and is usually removed on the ward or by your stoma nurse, quickly and without much fuss. Your bag fits over it in the meantime.

Swelling and size

Every new stoma is swollen at first, and a loop stoma can look surprisingly big. The swelling usually goes down over the first six to eight weeks, so measure your stoma regularly and adjust the opening in your baseplate as it shrinks. A gap between stoma and baseplate is a common reason for leaks and sore skin.

Mucus from your back passage

The resting part of your bowel still makes mucus, so with a loop stoma it is normal to feel the urge to go and to pass some mucus from your back passage now and then. Sitting on the loo when you feel that urge usually clears it. Mention it to your stoma nurse if it becomes uncomfortable or changes a lot.

Output

Output comes from the working opening. With a loop ileostomy it can be frequent and watery in the early weeks; if your bag fills very often or you feel dizzy and thirsty, read our guide to a high-output stoma and ring your stoma nurse or GP. With a loop colostomy, output usually becomes softer and more regular as you recover.

Choosing and fitting a bag for a loop stoma

A loop stoma is often wider than an end stoma, so the right baseplate and a careful fit make the biggest difference. Your stoma nurse will help you choose, and your stoma products come on prescription through your delivery company or pharmacy, so it is easy to try samples first.

1. Measure both openings

   Use the measuring guide to cover the whole stoma, both openings and the bit of bowel between them, not just the working side.

2. Cut or mould to fit

   Cut-to-fit or mouldable baseplates suit oval loop stomas well. Aim for a snug fit with only a tiny gap around the edge.

3. Choose the right bag

   Drainable bags are usual with a loop ileostomy; with a loop colostomy your nurse may suggest drainable or closed, depending on output.

4. Empty early

   Empty the bag when it is a third to half full, so its weight does not pull on the seal.

5. Fill the gaps

   Seal rings or paste can fill creases and uneven skin around a wide stoma. If one side sits low, ask about a convex baseplate.

6. Re-measure as it shrinks

   Check the size every week or two in the first couple of months and update your template and your prescription.

If leaks keep happening, our guide to a stoma bag that keeps leaking goes through the usual causes, and how to change a stoma bag covers the routine step by step.

Daily life with a loop stoma: clothes, movement and sleep

Clothes that work with a wider stoma

A loop stoma often sits a little higher or wider than an end stoma, so the waistband is where most people notice it. High-waisted pieces that sit above the stoma, rather than across it, are the easy win. In the first weeks, while there is a rod or the area feels tender, soft joggers, dresses and loose tops are the most comfortable. After that, almost any outfit works again.

High-waisted stoma knickers with an inner pocket hold the bag flat against your body, and a soft stoma wrap smooths the outline under fitted clothes. Both hold the weight of the bag close, so there is less pull on the baseplate as it fills.

Moving and lifting

Walking is usually encouraged from the first days after surgery, a little more each day. Your team will tell you when you can lift heavier things and start core exercises again; an NHS physiotherapist can show you gentle exercises that support the area around your stoma. Our guide to exercise with a stoma covers the next steps when you are ready.

Sleep, work and intimacy

Most people sleep on their back or side with the bag emptied before bed. Going back to work, travelling and being intimate are all possible with a loop stoma, temporary or not. If closeness is on your mind, our honest guide to sex and a stoma covers the practical side.

Reversing a loop stoma

Closing a loop stoma, usually called a reversal, reconnects the two sides of the loop so output goes through your bowel again and you no longer need a stoma bag.

• When

  Not before about six weeks, according to the NHS, and often a few months after the first operation, once the part of the bowel that was resting has healed. It can be later, for example if you need chemotherapy first. There is no single right time; your team decides with you.

• Before

  Many teams check the healed join first, often with an X-ray using contrast or a camera test, and may examine your back passage.

• The operation

  Usually done through the stoma site itself, so it is often a smaller operation than the first one, followed by a short hospital stay.

• After

  Your bowel needs time to get used to working again. Frequent or urgent trips to the loo are common at first and usually settle over weeks to months.

It is not always possible or advisable to reverse a stoma, and some people choose to keep theirs because life with it is good. Our guides to ileostomy reversal surgery and life after stoma reversal surgery explain what to expect.

Questions to ask your surgical team

A loop stoma comes with a plan, and knowing it makes the months ahead easier. These are worth asking at your next clinic appointment:

• Is my stoma a loop ileostomy or a loop colostomy, and which opening is the working one?
• Is it defunctioning and temporary, and roughly when would a reversal be considered?
• What tests will I have before a reversal?
• How much should I drink, and what are the signs of dehydration to watch for?
• When can I lift, drive, exercise and go back to work?
• Who do I ring about leaks, sore skin or changes in my stoma?

Loop and defunctioning stomas: your questions