If you have surgery to remove certain parts of your colon, rectum, anus or bladder, you may no longer be able to poop or pee the same way you did before your surgery. In that case, your surgeon will connect a piece of your intestine to the outside of your skin — called a stoma — so that waste can exit from the body into a bag that hangs from your stomach. This procedure is called an ostomy.
Ostomies can be permanent or temporary. If you have a permanent ostomy, you will have it for the rest of your life. Some ostomies — particularly those used for rectal cancer surgeries — are temporary.
Depending on which part of the body has had surgery, there are different types of ostomies. This section will mostly focus on colostomies and ileostomies. If you have questions about other types of ostomies, join COLONTOWN and ask our community!
For a colostomy, the surgeon removes the lower part of the colon and/or rectum and brings the lower part of the large intestine out to the skin to form a stoma. A colostomy bag is placed over the stoma for waste to exit the body. If you have a colostomy, your poop will probably come out on a fairly regular schedule and look very similar to what it looked like before your surgery.
With an ileostomy, the surgeon removes part of the large intestine and/or rectum and brings the end of the small intestine — also called the ileum — out to the skin of the stomach to form a stoma. An ileostomy bag fits over the stoma so that waste can exit the body into a bag. If you have an ileostomy, your poop will exit your body without passing through your large intestine. While your small intestine is responsible for absorbing most of the nutrients from your food, your large intestine is responsible for absorbing water so that your stool exits your body in a solid, formed state. Because an ileostomy bypasses your large intestine, waste comes out very regularly throughout the day and tends to be more liquid than a colostomy. Depending on what you have had to eat or drink, it may be completely liquid or more like the texture of nut butter.
There are two main types of urostomies. In one type, the surgeon will take a small piece of your bowels (about 5-6 inches) and connect it to the ureters, which carry urine from your kidneys. The surgeon will then bring the piece of bowels outside of the body to form a stoma. A bag is placed over the stoma for the urine to flow into.
In the second type of urostomy, the surgeon will remove the bladder and attach both ureters to a stoma, which will bring the urine into a bag that connects to the stoma on your abdomen.
If you have a nephrostomy, the surgeon connects a tube to your kidney or kidneys, which will then come out of a small incision in your side or back. This tube hooks up to a bag that collects urine outside of your body.
Your ostomy will be placed during the same procedure as your bowel surgery. So the prep work you do for your bowel surgery will be good preparation for your ostomy surgery. Your surgeon will give you specific advice and instructions for preparing for surgery. It’s important to follow these guidelines exactly. Some requests may include laxatives, enemas, and fasting after midnight the day before your surgery.
Right after surgery, you will likely have a clear bag over your stoma. This is so your healthcare team can monitor how you are healing.
You might be alarmed by the size or shape of your stoma. For the first few weeks after surgery, your stoma will be swollen. It may also bleed for the first few days. Your surgeon will have placed stitches around the outside of the stoma to connect your bowels to the skin on your stomach. These stitches will either be dissolvable, or you may need to get them removed.
Two or three days after your surgery, an ostomy nurse will teach you how to clean your stoma and change your pouch. It will take a few days for your bowels to wake up and for your stoma to start having any output. You will be on a liquid diet directly after surgery, so once your stoma does start working, you may have loose stools. This should firm up with time.
Managing an ostomy can take some getting used to. Your body is learning a whole new way of going to the bathroom and emptying and changing your ostomy bag may take some troubleshooting in the beginning. But don’t worry! Learning how to handle an ostomy takes time.
After your surgery, your ostomy nurse at the hospital will help teach you how to empty and change your ostomy bag. They will also give you advice related to daily activities and diet and will probably send you home with lots of reading material and an initial stock of ostomy supplies. You should be offered a home health nurse who can visit your house for several weeks after the surgery to help support you with bag changes or anything else you need. If this is not offered and you don’t feel comfortable managing your ostomy by yourself when you are discharged, you should be able to request a referral from your surgeon or ostomy nurse.
For more information on managing your ostomy, check out our ostomy management section.
Most ostomates do not have any major complications. However, here are some things to look out for:
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