Colostomy: Procedure, Types, and Recovery
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
A colostomy is an operation that connects part of the colon to a new opening in the abdomen, called a stoma, so stool bypasses damaged sections of the intestine and collects in an external bag [1]. It treats conditions like colorectal cancer, diverticulitis and bowel obstructions [1]. A colostomy can be temporary or permanent, and many people live active lives afterward [1].
What the research says
Marking the stoma site before surgery may reduce complications, but the evidence is weak. A systematic review and meta-analysis of 2 randomized trials and 25 non-randomized studies found that preoperative site marking was associated with fewer stoma-related complications (OR 0.45; 95% CI 0.31–0.65), less leakage (OR 0.14; 0.06–0.37), fewer skin complications (OR 0.38; 0.29–0.50), and less surgical revision (OR 0.09; 0.02–0.49). The authors rated the certainty of the evidence as moderate to very low because of high risk of bias (PubMed: Ambe et al., Colorectal Dis, 2022) [2].
Preventive mesh lowers hernia rates at an end colostomy, though recent trials are less clear. A meta-analysis of 12 randomized trials (581 patients with prophylactic mesh, 671 without) found fewer parastomal hernias with mesh (OR 0.60; 95% CI 0.46–0.80). The difference was no longer significant when only trials from the last 5 years were analyzed (P = 0.10), and there was no significant difference in postoperative complications or deaths (PubMed: McKechnie et al., J Gastrointest Surg, 2022) [3].
Living with a colostomy can affect quality of life, which is why support matters. A systematic review of 14 mostly descriptive cross-sectional studies in people with long-term colostomies (largely after colorectal cancer) found that all 14 reported a negative effect on quality of life. Reported problems included sexual difficulties, depressive feelings, gas, constipation, dissatisfaction with appearance, clothing changes, travel difficulties, tiredness, and worry about noises (PubMed: Vonk-Klaassen et al., Qual Life Res, 2016) [4].
What are the types of colostomy procedures?
The type of colostomy performed depends on which section of the colon needs to be redirected [1]. Surgeons choose the location based on the patient's specific medical needs and whether the redirection is intended to be temporary or permanent. Each type results in a different consistency of stool, influenced by how much of the colon the waste passes through before exiting the body [1].
Type of Colostomy | Location in Colon | Stool Consistency | Typical Duration |
Sigmoid | Lower, S-shaped part | Solid and formed | Often permanent |
Descending | Left side of abdomen | Firm | Permanent or temporary |
Transverse | Upper abdomen | Soft or liquid | Usually temporary |
Why is a colostomy performed?
A colostomy may be required for various medical reasons, ranging from acute injuries to chronic diseases. In temporary cases, the procedure provides a "time out" for the colon to rest and heal following an infection or surgery. Permanent colostomies are used when the lower part of the digestive tract, such as the rectum or anus, must be removed or can no longer function correctly [1].
Common conditions that may necessitate a colostomy include advanced colorectal cancer, inflammatory bowel disease (IBD), and severe diverticulitis [1]. It is also a critical intervention for bowel obstructions or serious injuries to the abdominal area. By redirecting waste, the procedure prevents further complications and allows the patient to maintain essential bodily functions.
How should you prepare for colostomy surgery?
Preparation for a colostomy involves both medical assessments and personal education. Patients undergo a pre-operative assessment where surgeons explain the risks, benefits, and expected lifestyle changes [1]. Blood tests and heart evaluations, such as an EKG, are standard to ensure the patient is fit for general anesthesia [1]. A crucial part of preparation is meeting with an ostomy nurse to select the best location for the stoma on the abdomen [1].
On the day of surgery, patients must follow strict fasting guidelines, typically avoiding food for six hours and clear liquids for two hours prior to the procedure [1]. Some surgeons may also require a bowel prep or enema to clear the colon [1]. These steps are vital for reducing the risk of infection and ensuring the surgery proceeds smoothly.
What are recovery and life like with a colostomy?
Recovery usually involves a hospital stay of three to seven days [1]. During this time, the medical team monitors the patient as they transition from a liquid diet back to solid foods. A specialized ostomy nurse provides hands-on training for stoma care and bag management [1]. It may take several days for bowel movements to become regular as the digestive system adjusts to its new path [1].
Living with a colostomy requires learning how to change and empty the collection pouch and maintain the skin around the stoma. While the initial adjustment period can be challenging, most individuals can return to their normal activities, including work, exercise, and travel, once they have healed. Regular follow-ups with healthcare providers ensure that any potential complications, such as skin irritation or stoma issues, are addressed promptly.
Conclusion
A colostomy is a transformative and often life-saving procedure that allows the body to function when the colon is compromised. While it requires significant adjustment, modern medical techniques and support systems make it possible to lead a full and active life. By working closely with a healthcare team and focusing on proper care, patients can successfully navigate the transition and maintain their long-term health and well-being.
Consult your provider: If you experience severe abdominal pain, a sudden change in stoma color, or skin irritation that does not improve, contact your ostomy nurse or surgeon immediately. Early intervention is key to managing complications and ensuring the health of your stoma.
Frequently Asked Questions
1. What is a stoma?
A stoma is the actual opening created on the abdomen during surgery where the colon is attached to allow waste to exit.
2. Is a colostomy always permanent?
No, colostomies can be temporary to allow the colon to heal after an injury or illness, or permanent if the lower bowel is removed.
3. Does a colostomy bag smell?
Modern colostomy bags are designed with odor-proof materials and filters to ensure that there is no noticeable smell when the bag is secure.
4. Can I still exercise with a colostomy?
Yes, once fully recovered, most people can return to their usual exercise routines, though you should consult your doctor about heavy lifting.
5. How often do I need to change the bag?
This depends on the type of bag used; some are changed daily, while others can stay in place for several days.
6. Will I need a special diet?
Initially, you will follow a low-fiber diet, but most people eventually return to eating a regular, balanced diet.
7. Is the surgery painful?
The surgery is performed under general anesthesia, so you won't feel pain during the procedure, though you will have soreness during recovery.
8. Can people see the bag under my clothes?
Modern pouches are very low-profile and are typically not visible under regular, loose-fitting clothing.
9. What is an ostomy nurse?
A Wound Ostomy Continence Nurse (WOCN) is a specialist who teaches you how to care for your stoma and manage your equipment.
10. What are the main risks of the surgery?
Risks include infection, bleeding, skin irritation around the stoma, and potential hernias or prolapses at the stoma site.
11. How do I prepare for a colostomy?
You'll meet your surgeon beforehand to go over the operation, its risks and the lifestyle changes ahead, and you can ask about pain control at that visit. [1] Blood tests check that you're fit for surgery, and you may also have an EKG to check your heart. [1] A nurse will explain life with an ostomy and help choose the best spot on your abdomen for the stoma. [1] On the day, stop eating about six hours before and clear liquids about two hours before; your surgeon may also suggest an enema or bowel prep. [1]
12. When should I call my doctor after a colostomy?
Call your doctor if you have constipation or diarrhea that doesn't go away, or nausea or vomiting. [1] Blood in your stool also needs a call. [1] Watch your stoma closely: contact your care team if it changes from its usual size or color, gives off strange or foul odors, or seems blocked. [1] Skin irritation around the stoma is the most common later problem and can often be fixed with a better-fitting bag, so ask your ostomy nurse about it rather than putting up with it. [1]
Related Reading
Pelvic Exenteration: Types, Surgery and Recovery explains pelvic exenteration surgery.
When diverticulitis needs an operation: Diverticulitis Surgery: Types, Procedure, Recovery and Risks
References
Cleveland Clinic. Colostomy. Cleveland Clinic. November 4, 2024. https://my.clevelandclinic.org/health/procedures/22100-colostomy
Ambe PC, Kugler CM, Breuing J, et al. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy - a systematic review and meta-analysis. Colorectal Dis. 2022;24(8):904-917. doi:10.1111/codi.16118. PMID: 35297146.
McKechnie T, Lee J, Lee Y, et al. Prophylactic mesh for prevention of parastomal hernia following end colostomy: an updated systematic review and meta-analysis of randomized controlled trials. J Gastrointest Surg. 2022;26(2):486-502. doi:10.1007/s11605-021-05174-z. PMID: 34671916.
Vonk-Klaassen SM, de Vocht HM, den Ouden MEM, Eddes EH, Schuurmans MJ. Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review. Qual Life Res. 2016;25(1):125-133. doi:10.1007/s11136-015-1050-3. PMID: 26123983.
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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