A stoma is an opening of the bowel on the surface of the abdomen, through which stool passes into a sealed pouch. It can be temporary (protecting an anastomosis while it heals, then reversed) or permanent. A colostomy is made from the large bowel; an ileostomy from the small bowel. With proper training from a stoma care nurse, the large majority of people live full, active lives.
For many patients, the word "stoma" causes more anxiety than the operation itself. In practice, a stoma is a well-established, safe tool of bowel surgery — and very often a temporary one. This guide explains, in plain terms, what it is, why it may be needed, the difference between a colostomy and an ileostomy, and what daily life with a stoma is really like.
What a stoma is
A stoma is the opening a surgeon creates by bringing a segment of bowel to the surface of the abdomen. The bowel is stitched to the skin and forms a small, pink-red projection that is moist and delicate — with no pain-sensing nerves, so it does not hurt when touched. A sealed pouch is worn over the stoma to collect stool. Because a stoma has no sphincter, output is not consciously controlled; that is why the pouch is essential.
Colostomy vs ileostomy: the difference
The key difference is which part of the bowel the stoma is made from — and this determines the consistency and frequency of output:
- Colostomy — from the large bowel, usually in the lower left of the abdomen. Because the colon has already absorbed most of the water, stool is more formed and output less frequent (once or a few times a day). The stoma sits roughly flush with the skin.
- Ileostomy — from the small bowel (ileum), usually in the lower right. It protrudes slightly (a small "spout") so the liquid content does not sit on the skin. Output is looser, more frequent and almost continuous, with a higher risk of dehydration, salt loss and skin irritation — so fluids and skin care need particular attention.
Temporary or permanent?
This is the question that worries patients most — and the good news is that many stomas are temporary.
A temporary (protective) stoma is created to divert stool away from a part of the bowel that needs to heal — typically an anastomosis (the join where the bowel is reconnected) low in the rectum. By keeping the anastomosis "dry" for a few weeks, the risk of a leak is reduced. Once healing is confirmed, the stoma is reversed in a second, smaller operation. These are usually loop stomas.
A permanent stoma is needed when the bowel cannot be rejoined — for example when the anal sphincter is removed for a very low rectal cancer (abdominoperineal excision), or in some cases of severe incontinence or extensive disease. These are usually end stomas.
Why a stoma may be needed
Stomas are not only about cancer. The most common reasons include:
- Rectal or colon cancer — a protective stoma after a low resection, or a permanent one for very low tumours. See also the article on sphincter-preserving surgery.
- Complicated diverticulitis — e.g. perforation or abscess (Hartmann's procedure), where the stoma is often temporary. See diverticular disease.
- Bowel obstruction or perforation in an emergency setting.
- Inflammatory bowel disease (ulcerative colitis, Crohn's disease).
- Trauma or severe incontinence.
Before surgery: stoma siting & the stoma nurse
When a stoma is planned, a crucial step is marking the stoma site by a specialist stoma care nurse. The position is chosen with you standing, sitting and lying down, so that skin folds, the beltline and old scars are avoided. Good pre-operative siting significantly reduces later fitting problems and leaks, and makes self-care much easier. The stoma nurse then becomes your main point of support for training and choosing supplies.
Stoma care: the basics
Care quickly becomes routine. The essentials:
- Pouching system — one-piece or two-piece, drainable (emptied) or closed. The type is chosen to suit your stoma and preferences.
- Changing — the pouch is emptied when about 1/3 full and changed on a regular schedule. The skin around the stoma is cleaned gently with water and dried well.
- Skin protection — cutting the baseplate to the correct stoma size and, where needed, using protective pastes/rings. Irritated skin is the most common minor issue and is nearly always preventable.
- Odour & gas — modern pouches have charcoal filters; diet helps with control.
Diet with a stoma
There is no single "stoma diet", and most people return to a normal, balanced diet. A few practical principles help:
- Chew well and eat at a calm pace.
- Introduce new foods gradually, one at a time, to see how each one suits you.
- Hydration — especially with an ileostomy, where more fluid and salt are lost; make sure you take in enough fluids and salt.
- In the first weeks, be careful with hard-to-digest foods (nuts, skins, mushrooms, sweetcorn, celery strings) that can cause a temporary blockage.
Daily life: work, exercise, travel, relationships
This is perhaps the most important message of the article: a stoma does not stop you living a full life. Most people:
- Return to work after recovery.
- Exercise and swim — the pouch is discreet and waterproof; for weights/intense exercise there are support belts.
- Travel freely, with a little extra planning (spare supplies in hand luggage, a travel certificate for a stoma).
- Wear their usual clothes — the pouch is not visible under most clothing.
- Keep relationships and a sex life — psychological adjustment is a normal part of the journey, and support (stoma nurse, patient associations, counselling) genuinely helps.
When to seek help: warning signs
Contact your stoma nurse or doctor — or seek urgent care — if you notice:
- No output/gas together with abdominal pain, bloating and vomiting — possible obstruction (emergency).
- Signs of dehydration from high output (intense thirst, little/dark urine, dizziness, cramps) — especially with an ileostomy.
- A stoma that turns dark, dusky or pale — a possible blood-supply problem (emergency).
- Severe, persistent skin irritation or breakdown, or repeated leaks.
- A bulge around the stoma (parastomal hernia) or a noticeable prolapse/retraction of the stoma.
Stoma reversal
When a stoma is temporary, reversal is usually planned about 2–3 months later, once clinical and imaging checks confirm the anastomosis has healed. If adjuvant chemotherapy is planned, reversal is usually done after it is completed. The reversal operation is smaller, but it is still surgery with its own recovery time.
An honest note: after reversal of a stoma that followed a low rectal resection, some patients temporarily experience urgency, frequent or clustered bowel movements (low anterior resection syndrome, LARS), which usually improves over time and with targeted support. The timing and suitability of reversal are always individualised.
Is a stoma always permanent?
No. Many stomas are temporary and protective: they divert stool so that an anastomosis further down the bowel can heal safely, and they are reversed later. A permanent stoma is needed mainly when the sphincter is removed or the bowel cannot be rejoined.
What is the difference between a colostomy and an ileostomy?
A colostomy is formed from the large bowel (usually lower left) and produces more formed stool at less frequent intervals. An ileostomy is formed from the small bowel (usually lower right), protrudes slightly, and produces looser, near-continuous output with a higher risk of dehydration and skin irritation.
Can I live a normal life with a stoma?
Yes. Most people return to work, exercise, swimming, travel and relationships. With proper training from a stoma care nurse and the right supplies, a stoma becomes a manageable part of everyday life.
When is a temporary stoma reversed?
Usually after about 2–3 months, once the anastomosis is confirmed to have healed, often with an imaging check. If adjuvant chemotherapy is planned, reversal is usually done after it is completed. The timing is individualised.
What should I watch in my diet with a stoma?
There are no strict blanket restrictions. Chew well, introduce new foods gradually, and stay well hydrated — especially with an ileostomy, which needs enough fluid and salt. In the first weeks, be careful with hard-to-digest foods (nuts, skins, mushrooms, sweetcorn) that can cause a blockage.