Colostomy surgery

What is colostomy surgery?

Colostomy surgery brings part of your large bowel, the colon, out through an opening made in your belly. That opening is called a stoma. After the operation, stool no longer leaves through your bottom: it comes out of the stoma into a pouch that sticks to your belly.

According to the NHS, a healthy stoma is soft, slippery and pink, like the inside of your mouth. It may sit flat against the skin or stick out a little. It shouldn't hurt, but it can bleed easily when it's wiped or scratched.

A colostomy can be temporary, and reversed later, or permanent, depending on why you need it. If you'd like to see what the pouch itself looks like and how it works, read what a colostomy bag is.

Why colostomy surgery is done

A colostomy is done when part of the colon, the rectum or the anus needs to be removed, or needs to rest after surgery. The NHS lists these reasons:

• a growth in the large bowel, such as bowel cancer or polyps;
• a bowel condition such as inflammatory bowel disease;
• an infection such as diverticulitis, or an abscess;
• a bowel obstruction, when the bowel is blocked;
• not enough blood reaching the bowel, such as ischemic bowel disease;
• a large bowel that has become very swollen;
• an injury to the bowel, or to the spinal cord or nerves, that means you can't control when you have a bowel movement.

Some colostomies are planned. Others are done as an emergency, when there may be no time to prepare. Either way, a stoma nurse will help you learn to look after your stoma afterwards.

Preparing for colostomy surgery

If your operation is planned, you'll usually see a stoma nurse at the hospital beforehand. The NHS describes what that visit usually covers:

• Siting your stoma. The nurse looks at and feels your belly to find the best spot, and marks it with long-lasting ink for the surgeon.
• Trying pouches. You get different types of pouch to try and are shown how to use them. Practicing at home can build confidence and show whether one irritates your skin.
• Your questions. Information about the operation, and time to ask what worries you.
• Contact details. The phone numbers of the stoma nurses at the hospital.
• Bowel preparation. Instructions for the days before, which usually means a special diet and possibly laxatives, so your bowel is empty on the day.

Talking about your worries before the operation can make it easier to adjust afterwards. Our preparing for ostomy surgery checklist covers the questions to ask, what to pack and how to set up your home for the first weeks.

How colostomy surgery is done

During the operation, part of your colon is separated from the rest of the bowel and brought out through an opening in your belly. Sometimes part of the large bowel is removed as well. There are two main ways to do it, and both use a general anesthetic, so you're asleep and won't feel any pain:

Loop colostomy or end colostomy

Wondering how a colostomy compares with an ileostomy, where the small bowel is used instead? Our ileostomy vs colostomy guide explains the difference.

In hospital, right after the operation

1. When you wake up

   You'll already have a pouch on your belly. Your belly may feel bloated and sore; ask for pain relief if you need it.

2. The days on the ward

   The NHS says you'll usually stay in hospital for around 2 to 7 days.

3. Going home

   Before you leave, your stoma nurse makes sure you're comfortable wearing and changing your pouch. Soft, loose clothes you packed ahead make the trip home easier.

Those first changes at home are where most people learn the most. Our new ostomy patient guide walks through the first weeks, and our colostomy care guide turns pouch changes and skin care into a simple daily routine.

Recovery after colostomy surgery

The NHS says it usually takes around 8 weeks to recover from a colostomy and get back to your usual activities. In that time:

• Rest, and take the time you need to adjust to the change in your body.
• Eat a low-fiber diet while your bowel heals, as your team advises, and bring your usual foods back once things settle.
• Move gently. A short walk when you feel ready is a good start.
• Avoid strenuous activity and heavy lifting for 8 weeks while your belly muscles heal.
• Wait until you've recovered before you drive.
• Eat regularly and chew well, which helps stop the stoma getting blocked, and drink plenty of fluids.
• Ask about your medicines. Some tablets are designed to dissolve slowly and may pass into your pouch before they work. Your doctor can suggest other forms, such as liquids or powders. Don't stop a prescribed medicine without asking first.

According to the NHS, many people find daily life improves after a colostomy, because the pain or symptoms that led to surgery are gone. You should be able to go back to work when you feel well enough and comfortable looking after your stoma; talk to your employer if your job involves heavy lifting. For what comes after the first weeks, from food to travel and intimacy, read our guide to life after ostomy surgery.

Getting dressed when you're back home

The NHS says pouches are well designed and you should be able to wear your usual clothes. In the first weeks, pick what feels good on a sore belly: soft fabrics, and waistbands that sit above or below your stoma rather than across it.

When your stoma nurse says pressure over the area is fine, a soft ostomy belt can hold the pouch flat and close to your body, so it doesn't swing or pull as it fills. It sits over the pouch; the barrier is still what keeps it sealed.

Back in your own clothesThe SIIL Ostomy BeltA soft, wide belt with an inner pocket that keeps the pouch flat and close under everyday clothes, for women and men.See the ostomy belt →

Can a colostomy be reversed?

Sometimes. A temporary colostomy can be reversed with a further operation. The reversal joins the bowel back together and closes the opening in your belly. Afterwards you have bowel movements through your bottom again and no longer need a pouch.

According to the NHS, reversals usually happen for loop colostomies that were done in an emergency, and it isn't always possible to reverse a colostomy. Your surgeon is the person to ask whether it's an option for you, and when. If it is, our guide to ostomy reversal surgery explains what to expect.

Possible complications, and when to call

As with any operation, complications can happen. Your doctor will explain the risks before the procedure. The NHS mentions an infection around the stoma (usually treated with antibiotics), dehydration, a bowel blockage, and problems with the stoma itself, such as a hernia (a bulge around it), a stoma that sinks back into the belly, a stoma that pushes out too far, or sore skin around it.

These can be signs of an infection or a blockage, so call your surgical team, your stoma nurse or your doctor straight away; in an emergency, call 911. For anything less urgent, such as a problem with your stoma or sore skin around it, contact your stoma nurse or doctor; they can advise on products that help. Our guide to stoma blockage explains the early signs.

Colostomy surgery: common questions