Colostomy

Overview

A colostomy is an opening made by a surgeon that connects part of your large bowel (colon) to the outside of your tummy. The small piece of bowel you can see on the skin is called a stoma. It looks a bit like the inside of your mouth — pink, soft and moist. Poop (stool) no longer comes out of your bottom; instead it passes through the stoma into a small pouch stuck over it. You empty the pouch yourself, usually several times a day. Some colostomies are temporary and are closed later; others are permanent. A colostomy is not an illness. It is a way of letting waste leave your body when part of your bowel cannot work normally or has been removed.

Yes. Many thousands of people around the world live with a colostomy, and thousands more have one each year. It is a routine operation for bowel surgeons and stoma nurses, so you will not be the first person they have helped through it.

It can affect anyone at any age, from newborn babies to people in their nineties. It is more common in older adults, because bowel conditions such as bowel cancer and diverticular disease (small pouches in the bowel wall that can become inflamed) become more common with age. Babies and children sometimes need one for problems they are born with, and younger adults may need one because of inflammatory bowel disease, injury or an emergency operation.

Symptoms

Common symptoms

• A colostomy is not an illness, so it does not have 'symptoms' in the usual way. Instead, people have symptoms from the bowel problem that leads to the colostomy, such as a change in bowel habit lasting three weeks or more.
• Blood in your poop, or poop that looks black and sticky.
• Ongoing tummy pain, bloating, cramping or lots of wind that does not settle.
• Losing weight without trying, or feeling very tired and short of breath (signs of low iron).
• A lump you can feel in your tummy, or feeling that your bowel never fully empties.
• After surgery, common day-to-day issues include sore skin around the stoma, pouches that leak or lift at the edges, and changes in how thick or loose your output is.

Symptoms in children

• In babies, a colostomy is often needed for a problem present at birth, such as the bottom opening not forming properly or part of the bowel lacking the nerve cells that help it push poop along.
• Warning signs in a newborn include not passing the first dark poop (meconium) within the first day or two, a swollen tummy, and vomiting green or yellow fluid.
• In older children, signs of a bowel problem can include long-standing constipation, poor growth, or repeated severe tummy pain.
• Children usually cope well with a stoma and often adapt faster than parents expect. Play specialists and children's stoma nurses can help.

Symptoms in older adults

• Older adults are more likely to need a colostomy because of bowel cancer, diverticular disease or a blocked bowel.
• Dehydration can happen faster if the stoma produces a lot of loose output, so drinking enough through the day matters more.
• Skin around the stoma can become sore more easily, especially if the skin is thin or the tummy is less firm.
• Recovery after surgery may take longer, and other health conditions may need to be managed at the same time.
• Memory problems, poor eyesight or shaky hands can make pouch care harder — a stoma nurse can suggest simpler products and extra support.

Causes

Main causes

• Bowel (colorectal) cancer — the most common reason in adults.
• Diverticular disease — inflamed or narrowed pouches in the bowel wall that can block or burst.
• Inflammatory bowel disease, such as ulcerative colitis or Crohn's disease, when medicine no longer controls it.
• An emergency problem such as a blocked, twisted or torn bowel, or a severe infection in the tummy.
• Injury to the lower bowel or bottom.
• Problems present at birth, such as an opening that has not formed properly.
• Sometimes as part of a bigger operation, or to help a join in the bowel heal by resting the lower part.
• Occasionally for severe bowel leakage (incontinence) when other treatments have not helped.

Risk factors

• Getting older — bowel cancer and diverticular disease are more common over 50.
• A family history of bowel cancer or inherited bowel conditions.
• Long-standing inflammatory bowel disease.
• Low-fibre diet, lots of processed meat, little physical activity, smoking and higher alcohol intake (these raise bowel cancer risk).
• Having had bowel surgery before, or needing emergency tummy surgery.
• Being overweight or having type 2 diabetes, which are linked to several bowel problems.

When to see a doctor

See a doctor urgently if:

• Blood in your poop, black tarry poop, or bleeding from your bottom with no clear cause.
• A change in bowel habit lasting three weeks or more, especially in someone over 45.
• Severe or constant tummy pain, or a tummy that feels hard and swollen.
• Vomiting and not passing wind or poop.
• Unexplained weight loss, or feeling very tired and short of breath.
• After stoma surgery: no output for many hours with cramps and nausea, a dark or black stoma, or wound infection signs.

Book a routine appointment if:

• You are offered a colostomy and want to talk through what it means, including whether it could be temporary.
• You have questions about pouch products, leaks, odour, skin soreness or clothing.
• You want advice on diet, travel, swimming, sports, work or intimacy.
• You are thinking about whether the stoma could be reversed (closed) and when.
• You feel low, anxious or isolated since your operation.
• You are due bowel cancer screening or have a strong family history and want to discuss it.

Diagnosis

A colostomy is not something you are 'diagnosed' with — it is an operation that is planned as part of treatment for another condition, or done in an emergency. Your doctor works out what is wrong with your bowel first, using your history, an examination and tests. If surgery is considered, you will meet the surgical team and usually a specialist stoma nurse, who will explain what the operation involves and where the stoma would sit on your tummy.

Tests that may be done

• Blood tests, including a full blood count and tests of how well your liver and kidneys are working.
• Stool tests, and a test to check for blood in your poop.
• Colonoscopy — a tiny camera looks inside your bowel, and small samples (biopsies) can be taken.
• CT or MRI scans to see the bowel, the surrounding organs and whether anything has spread.
• A CT colonography (a scan-based look at the bowel) if a camera test is not suitable.
• An examination and 'site marking' by the stoma nurse, who checks where a pouch would sit comfortably on your tummy.
• A pre-operative assessment to check your fitness for surgery and plan your recovery.

What to expect at your appointment

Before planned surgery you will usually have a conversation about the reason for the operation, whether the stoma is likely to be temporary or permanent, and the risks and benefits. You may be shown pouches and given time to practise. You should be told how to prepare — for example, when to stop eating. In an emergency, there may not be time for this, and the stoma nurse will support you afterwards instead.

Treatment

The colostomy itself is part of the treatment for your bowel problem; the operation is done under general anaesthetic (you are asleep). After that, 'treatment' mainly means good stoma care: choosing the right pouch, keeping the skin healthy, managing diet and output, and regular follow-up. Any other treatment you need — for example for bowel cancer or inflammatory bowel disease — is planned alongside this by your specialist team.

Self-care at home

• Empty your pouch when it is about a third to a half full — this keeps it comfortable and less likely to leak.
• Change your pouch on a routine that suits you (often every one to three days), and always carry spare supplies.
• Clean gently around the stoma with warm water and a soft cloth or wipe; the skin should be dry before you fit a new pouch.
• Check the fit of the pouch each time — a snug seal is the best protection against sore skin and leaks.
• Drink plenty of fluids, especially in hot weather or if your output is loose, and watch for dark urine or dizziness.
• Eat regularly and chew well; add new foods one at a time so you can spot what suits you.
• Keep moving — short walks help your recovery and help your bowel settle.
• Carry a small 'just in case' kit with a spare pouch, wipes and a sealable bag.
• Tell your stoma nurse about any leak, skin soreness or change in output early — small fixes are easier than big ones.

Medical treatments

There are no medicines that 'treat' a colostomy — the pouch and good skin care do the main job. Your team may prescribe medicines for the condition that led to surgery, such as treatment for bowel cancer or inflammatory bowel disease. Sometimes medicines are also used to help make output thicker or looser, or to reduce wind or odour; your doctor or pharmacist will explain what is suitable for you. Some people are offered a 'stoma reversal' operation (closing the stoma) at a later date if the lower bowel has healed and is working.

When is surgery considered?

Surgery is needed when part of the bowel must be removed or rested, or when poop cannot safely pass through the lower bowel. This may be planned (for cancer, long-standing disease or severe leakage) or done as an emergency (for a blocked, twisted or torn bowel). Your surgical team will explain what will be done, whether the stoma is likely to be temporary, and what to expect afterwards.

Living with this condition

At first, pouch care can feel like a lot to learn, but it soon becomes a quick routine — a bit like brushing your teeth. Most people empty their pouch a few times a day and change it every one to three days. Output may be firm and predictable, or softer, depending on which part of the bowel the stoma comes from. Wind is normal and can be released quietly by loosening the pouch or using products that let gas escape. You can shower, bathe and swim with a stoma — the pouch stays on, and you can shower with it off if you prefer and the timing suits you.

Lifestyle tips

• Wear whatever you like — modern pouches are flat and slim, and nothing needs to show.
• Go back to work, study, driving and hobbies as your recovery allows; ask your stoma nurse about heavy lifting and when to start again.
• Swim, cycle, run and play sport — you may want a support belt or a smaller pouch for activity.
• Travel with spare supplies in your hand luggage, and ask your nurse for a travel letter for airport security.
• Intimacy is possible; talk to your partner, and ask your nurse about smaller pouches, covers and, if relevant, sexual health support.
• Keep up your vaccinations and general health checks as usual.
• Register for any local stoma supply scheme and keep a simple stock at home so you never run out.

Diet and exercise

Most people can eat a normal, balanced diet. Eat regularly, chew well, and try new foods one at a time. Some foods can loosen output (spicy food, too much fruit juice, some sugar-free sweets), and others can thicken it (porridge, bananas, white rice, marshmallows — in moderation). High-fibre foods are good for you, but add them gradually to avoid blockages, and peel or cook tough foods. Drink plenty of water. If output is very loose, ask your nurse or pharmacist about rehydration drinks. Gentle exercise helps recovery — start with short walks and build up, and ask your team before returning to heavy lifting or core exercises.

Mental health and emotional wellbeing

It is very common to feel shocked, anxious, or worried about how you look and what others think, especially in the first weeks. Some people grieve for how their body worked before. These feelings usually ease as you get used to the pouch and get back to normal life, but they can come back around follow-up appointments. If low mood, worry or sleep problems last more than a couple of weeks, or if you have thoughts of harming yourself, please speak to your doctor or stoma nurse straight away. If you feel you are in crisis, contact your local emergency number or a local mental health crisis service right away — you deserve support and you are not alone.

Prevention

You cannot always prevent needing a colostomy — some are done in emergencies or for problems present at birth. But you can lower your risk of the bowel diseases that most often lead to one: take part in bowel cancer screening when invited, eat plenty of fibre and fruit and vegetables, limit processed meat, keep active, stay a healthy weight, do not smoke, and keep alcohol within recommended limits. If you have inflammatory bowel disease, staying on your agreed treatment and going to check-ups helps keep it controlled.

Vaccines

There is no vaccine that prevents a colostomy. Keep up routine vaccinations, and ask your doctor whether you need any extra ones because of your bowel condition or its treatment.

Screening programmes

Bowel cancer screening is offered to adults in many countries, usually from around age 50 to 60, using a simple home test and sometimes a camera test. If you have a strong family history of bowel cancer or long-standing inflammatory bowel disease, your doctor may suggest earlier or more frequent checks. Ask your local health service what you are eligible for.

Complications

If left untreated

• A colostomy is itself a treatment, so 'not having it' when it is needed can mean the serious problem goes on: a blocked bowel, a torn bowel, spreading infection, or untreated cancer.
• Complications linked to the stoma can include sore or broken skin, leaks and odour problems if the pouch does not fit well.
• Dehydration and salt imbalance, especially with very loose output.
• Bowel blockage, often from eating tough or high-fibre foods too quickly without chewing well.
• A parastomal hernia — a bulge next to the stoma, which is common and often harmless but can grow.
• Stoma prolapse (the stoma sticks out further), narrowing of the stoma, or bleeding from the stoma surface.
• Emotional effects such as anxiety, low mood or feeling isolated.

Long-term outlook

Most people live full, active lives with a colostomy. The first few weeks are the hardest while you learn pouch care and your bowel settles, but the routine gets much easier with practice. Many people say they feel better than before surgery, especially if they had been living with pain, bleeding or unpredictable bowels. Some colostomies are closed later. Your stoma nurse, doctor and support groups are there to help at every stage — ask for help early and often.

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