What Is Ostomy?

Medically Reviewed by Jabeen Begum, MD on February 20, 2024
15 min read

An ostomy is a surgery that creates a hole to allow stool (poop) or urine (pee) to leave your body through your belly. It’s a new exit route for waste if you can’t poop or pee the way you usually would. Your ostomy’s exact spot on your abdomen will depend on your reason for the surgery.

What is a stoma?

After the surgery, a small open end of your small or large intestine sticks out through your skin where the hole was made. This is called a stoma. It’s the lining of your intestine and looks red or pink. It has no nerve endings, so it shouldn’t be painful. Your surgeon will teach you how to use a special pouch, which collects urine or stool from your stoma.

Ostomy vs. colostomy

Ostomy is a general term used to describe a surgery that creates a stoma. A colostomy is a specific type of ostomy. It’s when your surgeon takes out part or all of your colon or rectum so stool can pass through the new opening in your belly wall. A urostomy is for creating a way for pee to travel out of your body.

An ostomy bag (also called a pouch or appliance) collects pee or poop. You attach it to your stoma. A barrier secures the bag to your skin and protects it from waste. A secure fit is important. Because without a good seal, pee and poop could get on the skin around the opening and cause irritation. 

Your doctor or a nurse will teach you how to use your ostomy bag. The skin barrier has to fit around your stoma. If your stoma isn't round, you might have to measure it and then cut the skin barrier to fit. After that, you place the sticky part securely around your stoma to secure the bag in place. 

Most ostomy bags have a one or two-piece pouching system:

  • One-piece pouching system: The ostomy bag and the skin barrier are one thing.
  • Two-piece pouching system: The skin barrier (also called a flange or landing zone) comes separate from the ostomy bag. The sticky part goes on your skin. Then, you can take the pouch on and off without removing the barrier.    

Someone on your medical team will help you decide which one is right for you.

You’ll want to empty the pouch when it’s about one-third full. You may do this two to six times a day, depending on what type of ostomy you have and how much waste you produce. 

You can sit on the toilet to drain the pouch, just like you would if you were going to the bathroom before your surgery.  Then you’ll want to: 

  • Put down a layer of toilet paper to prevent splashing.
  • Pull your clothes away from the bag. 
  • Remove the clip or plug at the bottom of the pouch. 
  • Press on the bottom (or tail) of the pouch to empty it into the toilet. 
  • Wipe any waste from the tail with toilet paper. 
  • Put the clip back in place (keep a spare in case you flush it by accident). 
  • Wash your hands (just like you should anytime you go to the bathroom). 

With new kinds of ostomy bags, you shouldn’t have to rinse the inside of the pouch after you empty it. 

Ostomy bag change

You’ll probably change the bag completely (which is different than emptying it) every 3-4 days, or about twice a week. But some bags may be designed for one-day use only.

When you change your ostomy bag, you should: 

  • Wash your hands beforehand.
  • Put all your supplies within reach.
  • Empty your pouch in the toilet before you take it off.
  • Remove the bag once you drain it.
  • Put the used ostomy bag into a plastic bag and throw it away in the trash. 

After you remove and dispose of your used ostomy bag, you’ll want to clean the skin around your stoma with warm water. Do this in the shower or with a clean washcloth or paper towel. You can use soap, but don’t use anything with fragrance or cream (like a lotion). These can make it hard for the barrier to stick to your skin. 

Then you’ll want to: 

  • Rinse your skin and wipe away any mucus or waste. 
  • Pat your skin dry with a clean paper towel (or hair-dryer on low). 
  • Cut the new skin barrier and stick it to your skin (if you have a 2-pouch system).
  • Attach a new ostomy bag.

You’ll cut the skin barrier and attach everything at the same time if you have a one-piece pouching system. Talk to your doctor or a nurse if you’re unsure how to change your ostomy bag, your barrier doesn’t stick for very long, or you have any skin or stoma pain. 

Your doctor might recommend ostomy to treat serious bowel problems. It can be permanent or temporary while your body heals.

  • You might need a temporary ostomy if you:
  • Have a bad infection that causes bowel problems
  • Have a lot of irritation in your colon from irritable bowel syndrome (IBS)
  • Had a serious injury to your colon
  • Have a blockage in your colon

You might need a permanent ostomy if you

  • Are incontinent and it can't be cured
  • Have a defect in your colon or bladder
  • Have cancers that affect your colon or bladder
  • Have had part of your rectum or anus removed

Two main kinds of ostomy help remove poop, and one type diverts pee:

Ileostomy. The bottom of your small intestine, called the ileum, is brought up through your abdominal wall to make a stoma. This is often done if you have rectal cancer or inflammatory bowel disease.

Colostomy. If you have part of your colon removed, a colostomy can attach the remaining colon to the outside of your body.

Urostomy. The tubes that carry urine to your bladder are routed to your stoma. You might get this if you have cancer or other diseases that cause serious bladder problems or you need to have your bladder removed.


You have options besides traditional ostomy. One is putting a pouch inside your body to collect poop, which exits directly through the anus. It lets you pass stool through your anus, where poop normally comes out. You won’t need a permanent stoma. 

During a J-pouch surgery, your doctor connects the end of the small intestine to your anus. You’ll be able to pass stool through this opening after your doctor closes your temporary stoma (another procedure you’ll get a few months later). 

You may get a J-pouch if you have: 

  • Ulcerative colitis that doesn’t respond to medication
  • Colon or rectal cancer
  • Precancerous cells in your colon
  • Familial adenomatous polyposis (FAP)
  • Another genetic condition that raises your risk of colon or rectal cancer

You’ll be in the hospital and under general anesthesia, which means you won’t be awake or feel any pain during your surgery.

Before the operation, your surgeon or specially trained nurse will find the best spot for your stoma -- usually the flat front part of your abdomen.

The surgery will differ based on the type of procedure you need. Generally, your surgeon takes part of an internal organ, such as the bowel, and connects it to an opening in your abdominal wall.

Here’s more about each type of ostomy: 

Colostomy. Your doctor removes the diseased or damaged part of your colon or rectum. They connect what’s left to the opening in your abdominal wall. 

Ileostomy. Your takes the lower part of your small intestine (ileum) and brings it to the opening of your belly wall. This bypasses your large intestine, or your colon and rectum. 

Urostomy. Your doctor will detach the tubes from your kidneys that usually go to your bladder. They’ll reattach them to part of your small or large bowels so urine can flow out of the new opening in your belly wall. 

Ostomy surgery is commonly done one of two ways, including: 

Laparoscopy. Your doctor makes a few small cuts in your belly. A light with a camera goes through one opening, and surgical tools go through the others. Recovery time tends to be faster with this type of surgery compared to other procedures. And you’ll usually have smaller scars. 

Laparotomy. Also called “open” surgery, this is when your doctor operates through a long cut in your belly. Recovery from laparotomy tends to take longer than from laparoscopy. But your surgeon might recommend this kind of major surgery if they need to be able to see your organs really well. 

A nurse will go over everything you should know ahead of time. This pre-op visit will help you learn how to care for your ostomy during recovery and what symptoms to expect.  

Your care team will give you specific steps to take during recovery. Some of the things they might tell you include:

  • Expect to stay in the hospital for at least a day or two, maybe longer. 

  • Don’t lift anything heavier than 10 pounds for up to 6 weeks.

  • Clean the skin around your stoma with warm water. 

  • Cut the right size opening in your ostomy bag to protect your skin from waste. 

  • Watch for ostomy complications, like bleeding or infection. 

Your stoma will be swollen right after surgery. It may be oval or round and stick out over your skin. But the size and shape may change for up to 6 weeks as the swelling goes down. Your doctor will have you measure it every 2 weeks or so to make sure you cut the opening of your skin barrier to the correct size. 

You can usually start eating within several hours to a day after surgery. You may start off with clear liquids and then switch to easy-to-digest foods after that. You’ll likely be able to eat most anything you want several weeks into your recovery

Talk to a dietitian about what’s safe and comfortable to eat. Some diet changes to follow during recovery may include:  

  • Drink enough liquid so you don’t get dehydrated.
  • Stop eating high-fiber foods like raw fruits and veggies.
  • Avoid other foods like nuts, seeds, or corn that might be hard on your gut. 
  • Don’t eat anything too spicy or fatty.

Some digestive symptoms that may happen after surgery include: 

  • Less solid stool
  • Diarrhea, gas, constipation
  • Feeling like you need to poop even though you don’t have a rectum 
  • Mucus that leaks from your anus

Your doctor will have you come back for a follow-up appointment a couple weeks after surgery. They’ll make sure you’re healing well, that your bowel swelling has gone down, and you know how to use your ostomy bag. 

Reach out to your doctor before your follow-up visit if you have questions about your symptoms or how to care for yourself or your stoma after surgery.  

All medical treatments come with risks. Have your doctor go over all the pros and cons of the type of procedure you get. In general, some problems that may come up after ostomy surgery include: 

Skin problems. The area around your stoma may get Itchy, red, irritated, or infected. 

Complications from surgery. You may bleed inside your body or be exposed to germs that cause infections. 

Blockage. Food may get stuck in your small or large intestine. You may be able to fix the problem by drinking clear liquids. Call your doctor if nothing comes out of your stoma for 4 to 6 hours or if you have a lot of pain or nausea.    

Hernia. You may get a weakening of the abdominal wall around the stoma or prolapse (when the bowel pushes through the stoma).

Malabsorption. You may have trouble absorbing water, vitamins, and minerals. This can boost your odds of problems like dehydration or a  vitamin B12 deficiency.

An electrolyte imbalance. You may have a harder time keeping the right amount of minerals called electrolytes in your blood if you don’t have a colon to absorb them. Your odds of an electrolyte imbalance also go up if you have diarrhea, throw up, or sweat a lot. 

Discharge from your bottom. Mucus may come out of your anus.

Narrowing of your stoma. This is called a stricture. It can make it harder for stuff in your intestines to come out.

Feeling the urge to poop. You may have a sense that you need to have a bowel movement even though your waste comes out of a stoma. This is called phantom rectum, and the feeling may come and go for years. The urge may pass if you sit on the toilet and act like you're pooping. 

Short bowel syndrome. This is when you don’t have enough of the small intestine to absorb the energy you need from food. Your doctor can help you manage this, and they’ll make sure you get enough calories and other key nutrients to stay healthy. 

Pouchitis. You may get inflammation of the pouch inside your body if you get a J-pouch or other internal pouch. This can cause symptoms like diarrhea, belly pain, fever, or dehydration. You may need antibiotics to get better. 

Tell your doctor if you have any of the above symptoms or notice unusual changes in your stoma. =

Call your doctor right away if you: 

  • Have stomach pain that lasts for 2-3 hours
  • Constantly feel sick to your stomach or throw up
  • Don’t see any new waste in your ostomy bag for 4 to 6 hours
  • Have a lot of watery discharge for several hours
  • Notice a bad smell from your stoma (could be an infection)
  • Cut or hurt your stoma 
  • Have a lot of bleeding or sores on your skin around the stoma 

Expect to stay in the hospital for at least a day or two after surgery. You may need to stay longer depending on what type of surgery you had. Your medical team will check in every now and then just to make sure everything went well during the procedure.  

Once you’re home, give yourself about 6 to 8 weeks to fully recover. You can and should walk around while you get better, but you may need to avoid any heavy lifting for up to 3 months. Your doctor will give you more specifics about what you can and can’t do during this time. 

Questions you should ask your doctor about your recovery may include: 

  • What exercise is safe during recovery?
  • When can I go back to work or school?
  • What can I eat after surgery?
  • What are signs that I’m not healing correctly?
  • Who do I call in case of an emergency?

It will take time to get used to going to the bathroom in a different way. How often you’ll poop or pee will depend on what you eat, the type of procedure you had, and your bathroom patterns before the surgery. You may need to change your diet to control your bowel movements for a little while after surgery. But you should be able to eat what you want once you fully recover.

You might worry about negative reactions from your friends, family, or sexual partner. When you’re out, your clothing will cover your ostomy, so most people won’t even know about it. If you have a hard time with the social, emotional, and practical changes in your life, talk to your doctor, family, and friends. You might join a support group or work with an enterostomal therapist, who’s trained on the day-to-day issues of living with a stoma. It can be easier for you to adjust when you have support from others.

Sex with an ostomy

When you have to get a stoma or ostomy bag as part of your colorectal cancer treatment, it takes some getting used to. The surgery may change the way you feel about yourself, your body, and sex for a while.

If you’re curious about sex and intimacy after an ostomy, it’s a good sign that your body and mind are ready to move forward. These tips will help.

Take your time. Doctors often recommend waiting 4 to 8 weeks after the surgery. Some people head back to the bedroom as soon as they can as a way to connect with their partner and their pre-surgery life. Others may not think about it for months or years. It’s most important to be comfortable with your body and confident with your stoma first. Once it feels like part of you, the rest will follow.

Things may be different. After ostomy surgery, common sexual side effects may include erection problems, vaginal dryness, not being able to reach orgasm, and pain. But those problems may be temporary. So if you still have any of these issues after the first few times you have sex after your surgery, tell your doctor. Some medications can also lower sexual desire and cause ejaculation and erection issues.

Prep your pouch. You might feel less spontaneous about sex when you have a pouch. Before you head behind closed doors, empty and clean your pouch, and then make sure the seal is tight. If it makes you feel better, use paper tape for an added layer of security. Once you do that, focus on being present in the moment, not on the pouch.

Ease the odor. If you’re worried that the smell of your pouch might be a distraction, try a deodorizer. Various brands make them in tablets, drops, and sprays. There are also pills you can take to curb the odor of your own waste. See what your doctor recommends.

What to wear. A “passion pouch” is smaller than a regular bag and has a closed end instead of a drain. (You’ll need to switch back to your regular pouch later.) You can also use a pouch cover to camouflage things a bit. You can find clothing that gets you in the mood and hides your pouch at the same time. Special boxer shorts and cummerbunds for men and crotchless lingerie help hide a pouch, for instance.

Take sides. Get creative with positioning that doesn’t hurt and keeps your pouch out of the way. Try the side position on the same side as your stoma.

Talk it out. Just like in any relationship, communication is key. As much as you’re comfortable, share any fears and physical issues with your partner. Talk about what you like, don’t like, and what you’re willing to try. Being open is just as important as being a good listener when it’s your partner’s turn to talk.

When it’s time to stop talking and start trying, it’s not unusual for anxiety to follow you into the bedroom. Take a deep breath and remember, nothing’s sexier than a good attitude and a sense of humor about whatever comes up along the way.

An ostomy creates a hole in your belly that you can pass waste through. You might need this surgery if you have serious problems with your digestive system or bladder. You can get back to normal life after the procedure, and your doctor will help you adjust to life with an ostomy bag. 

What is the purpose of an ostomy?

An ostomy surgery gives you a new way to pee or poop if you can’t pass waste normally. It’s a type of procedure you might need if you have a disease or damage to your small or large intestine or bladder. An ostomy may be permanent or temporary. 

Can you live a normal life with an ostomy bag?

You may need to make some adjustments, but you can do most anything while wearing an ostomy bag. This includes going to work, swimming, playing sports, having sex, and having a baby.

Do you still use the toilet with an ostomy bag?

You may empty your ostomy bag while sitting on the toilet, but you’ll pass waste directly into the pouch if you’ve had parts of your intestine or bladder removed. 

Does an ostomy bag smell?

It shouldn’t, at least not when it’s attached to your body. That’s because the bags are designed to be “odor-proof.” If you do notice a bad smell, that could mean there’s a leak in your ostomy bag or it doesn’t fit securely.