Colostomy formation
An operation that brings part of the large bowel (colon) out through an opening on the tummy, so waste passes into a pouch instead of through the back passage.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A colostomy brings the large bowel out onto the tummy so waste collects in a bag; it can be temporary or permanent.
- Output is usually more formed than from an ileostomy, but you still need to learn new toilet and skin-care routines.
- Most people adapt over weeks to months with support from a specialist stoma nurse, and return to normal activities.
- A 'temporary' colostomy is not always reversed — ask honestly how likely reversal is in your situation.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Removes, rests or bypasses diseased, blocked or damaged bowel that may be causing serious symptoms
When the problem can be safely managed without surgery, or with a different operation that avoids a stoma.
You are monitored on a ward, given pain relief, and helped to start moving. Eating and drinking is reintroduced as your bowel recovers, and a stoma nurse...
A named specialist stoma nurse and a clear way to contact them after discharge.
You are monitored on a ward, given pain relief, and helped to start moving. Eating and drinking is reintroduced as...
You go home once you can manage the stoma reasonably, eat and drink, and your pain is controlled. You will have...
You get more confident emptying and changing the bag. Output and routine settle. Avoid heavy lifting and follow...
Most people return to many normal activities, including work, depending on the operation. Diet usually widens...
What is a colostomy?
A colostomy is an opening (called a stoma) made on the surface of your tummy, where the surgeon brings out part of your large bowel (the colon). Waste then passes through this opening into a bag that sticks to your skin, instead of going through your back passage.
It is usually done when part of the bowel or back passage needs to be removed, rested or bypassed — for example because of bowel cancer, diverticular disease, a blockage, an injury, or problems with bowel control. A colostomy can be temporary (to let bowel heal) or permanent.
Because the waste has passed through more of the bowel, colostomy output is usually more formed than from an ileostomy, and the stoma is often on the left side of the tummy.
This is a major decision. A good team makes sure you understand why it is being recommended, whether it is likely to be temporary or permanent, and what living with it really involves.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Colostomy vs ileostomy
| Colostomy | Ileostomy | |
|---|---|---|
| Bowel used | Large bowel (colon) | Small bowel (ileum) |
| Usual output | More formed | Loose/watery |
| Usual position | Often left side | Often right side |
| Hydration risk | Lower | Higher |
Which one you have depends on the disease and which part of the bowel is affected, not on preference. Your surgeon will explain the choice.
Preparing for your surgery
- Make sure you understand why a colostomy is advised, whether it is likely to be temporary or permanent, and what the alternatives are.
- Ask to meet a specialist stoma nurse before surgery; they often mark the best site for the stoma on your tummy.
- Tell the team about all your medicines and supplements, and follow advice on which to stop or adjust.
- Stop smoking if you can, as it slows healing and raises the risk of complications.
- Plan practical support at home for several weeks, and arrange help with lifting, shopping and transport.
- Ask how stoma supplies are ordered and delivered, and how to get prescriptions once you are home.
- If surgery is planned (not an emergency), ask about enhanced recovery, eating and drinking before the operation, and pain relief afterwards.
What happens
A colostomy is usually formed under general anaesthetic, often as part of a larger bowel operation. The surgery may be done by keyhole (laparoscopic) or open surgery, depending on your situation and whether it is an emergency.
The surgeon brings a section of the large bowel through the abdominal wall, usually on the left side, and stitches it to the skin to form the stoma. The stoma is pink and moist, like the inside of your mouth, and has no nerve endings so it is not painful to touch.
After the operation you are looked after on a ward, usually for several days. A stoma bag is fitted, and a specialist nurse helps you learn to empty and change it before you go home. Eating and drinking is reintroduced gradually as the bowel wakes up.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- When the problem can be safely managed without surgery, or with a different operation that avoids a stoma.
- When someone is too unwell to undergo major surgery, so the risks outweigh the benefits.
- When a person, after full discussion, decides a stoma is not right for them and a different pathway is reasonable.
- When the planned operation does not actually require diverting the large bowel.
Delay surgery if…
- There is an active, treatable infection or other unstable problem that should be settled first (unless surgery is an emergency).
- Important results, scans or specialist opinions needed to plan the operation are missing.
- Medicines that affect bleeding or healing have not yet been reviewed.
- The person has not had time to meet a stoma nurse, have the site marked, or understand what living with a stoma involves (for planned surgery).
Alternatives to discuss
- Medical treatment of the underlying bowel disease, where appropriate.
- A different operation that may avoid a stoma, or rejoining the bowel directly if it is safe to do so.
- An ileostomy rather than a colostomy, depending on which part of the bowel is affected.
- Watchful waiting or supportive care where surgery is not clearly beneficial.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Removes, rests or bypasses diseased, blocked or damaged bowel that may be causing serious symptoms
- Can be life-saving in a bowel emergency such as obstruction, perforation or severe infection
- Can protect a healing join lower in the bowel when used temporarily
- Can improve bowel control and quality of life for people with severe symptoms or incontinence
- Lets many people return to work, travel, exercise and relationships once they have adapted
Risks & complications
- Sore, irritated skin around the stoma, often from leaks
- Wind, odour and learning-curve worries while you get used to the bag
- Mucus discharge from the back passage if the rectum is still present
- Tiredness and a recovery period after major surgery
- Wound or stoma infection
- The stoma narrowing, retracting (pulling in) or prolapsing (sticking out too far)
- A bulge around the stoma (parastomal hernia)
- Bowel blockage (obstruction), with cramping, vomiting and swelling
- Bleeding or a leak from a bowel join needing further surgery
- Blood clots in the legs or lungs after surgery
- Damage to nearby organs during the operation
- Serious complications that, very rarely, can be life-threatening, especially in emergency surgery
The risks of forming a colostomy depend heavily on why it is being done and whether it is planned or an emergency. Common longer-term issues include skin problems, a parastomal hernia and stoma changes such as narrowing or prolapse. Ask your team how to recognise a blockage and a stoma problem, and exactly who to contact if your output stops or your stoma looks unhealthy.
Published figures to discuss
Complication rates after stoma surgery vary widely depending on the underlying disease, whether surgery is planned or an emergency, the person's general health, and how complications are defined. Many problems are stoma-management issues (such as leaks, skin soreness and hernias) rather than rare emergencies. Published ranges are broad because some studies count only clinical problems, while others also count CT-detected hernias.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Peristomal skin problems | Common; around a quarter had moderate/severe skin problems in one study | Closely linked to leaks and bag fit; good stoma nurse support reduces this. | Guide sourcesClinical context |
| Parastomal hernia | End-colostomy rates are reported from about 4–50%; some reviews quote around 48% for permanent colostomy | Risk rises with time, obesity, emergency surgery and heavy lifting; many are managed without surgery. | Complications and costs in the first year after stoma formation — PubMedpubmed.ncbi.nlm.nih.govPublished figure |
| Other stoma problems (narrowing, retraction, prolapse) | Stoma-related complications overall are often reported in roughly 20–70%, depending on definitions and follow-up | Includes skin injury, leakage, retraction, prolapse, stenosis and hernia; some need stoma nurse input or surgical revision. | Complications and costs in the first year after stoma formation — PubMedpubmed.ncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery has two parts: healing from the operation itself, and learning to live with and manage the stoma. The first weeks are usually the steepest part of the learning curve.
- More formed output, often becoming more predictable over time
- Some wind and noise from the stoma, which usually settles
- Tiredness for several weeks after major surgery
- A learning period of leaks or skin soreness while you find the right products
- Feeling emotional or low at times as you adjust to the change
Aftercare
- Follow your stoma nurse's advice on emptying, changing and fitting the bag, and on caring for the skin around the stoma.
- Reintroduce foods gradually and note which ones cause wind, odour or looser output.
- Drink enough fluids, and ask about managing constipation or looser output if it becomes a problem.
- Avoid heavy lifting and straining in the early weeks to reduce the risk of a hernia.
- Keep a supply of stoma products and know how to reorder before you run low.
- Take any prescribed medicines and attend follow-up appointments if advised.
- Keep the stoma nurse's contact details handy and use them early if something is not right.
- Stoma site marked by a specialist nurse before surgery
- Starter supply of stoma bags and accessories ready at home
- Knowing how to reorder supplies on prescription
- Help arranged at home for lifting and chores for several weeks
- A plan for managing wind, odour and diet changes
- Stoma nurse and out-of-hours contact numbers saved
- Clear signs of a blockage or stoma problem written down
Scars and how they heal
You will have one or more wounds from the operation, plus the stoma itself. Keyhole surgery leaves several small scars; open surgery leaves a longer scar. The stoma is a permanent (or, if reversed, temporary) opening rather than a scar, and an experienced team places it where bags fit well and clothing hides it.
⚠ Get urgent help if…
- No output from the stoma with cramping, a swollen tummy, nausea or vomiting (possible blockage)
- The stoma turning dark, dusky or black, rather than pink/red
- Heavy bleeding from the stoma (a little blood when cleaning can be normal)
- Severe tummy pain, fever or a hot, red, spreading area around the wound
- The stoma pulling well below skin level, or sticking out much further than before
- A large or painful bulge around the stoma that will not go back
- Calf pain, swelling, chest pain or breathlessness after surgery (possible clot)
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the underlying problem is being managed, the stoma works reliably, and you can care for it and get on with daily life. It does not undo the original bowel disease, and it does change your body and your toilet routine while the stoma is in place.
How well things go depends a lot on support: a specialist stoma nurse, the right products, and time to adjust make a big difference.
Some colostomies are lifelong; others are temporary and reversed later. Even a colostomy described as temporary is not always reversed — this depends on whether the bowel below can be safely reconnected, your overall health, and your own wishes. It is fair to ask, before surgery, how likely reversal is in your particular case.
Combining with other procedures
A colostomy is usually formed as part of another bowel operation, such as removing part of the colon or the rectum. Sometimes it protects a join lower down or relieves a blockage. The reasons for the wider operation should be discussed alongside the stoma itself.
Follow-up & long-term care
You will usually be reviewed after surgery by the surgical team and a specialist stoma nurse, who checks healing, the stoma and your confidence with it. If reversal is planned, you should be told who will arrange it and roughly when; reversal of a temporary colostomy is often considered some months after the first operation.
- Regular stoma care and skin checks to prevent soreness and leaks
- Reordering bags and accessories on prescription before you run out
- Managing diet, wind and odour with guidance from your stoma nurse
- Watching for and managing a parastomal hernia, including advice on support garments
- Reviews with your stoma nurse, and the surgical team if problems arise
Revision and secondary surgery reality
- A stoma may need surgical revision if it narrows, retracts, prolapses or develops a troublesome hernia.
- A 'temporary' colostomy is not always reversed; reversal depends on the bowel below, your health and your wishes.
- Reversal is itself an operation with its own risks and is not guaranteed to be straightforward.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- A named specialist stoma nurse and a clear way to contact them after discharge.
- Written advice on recognising blockage and stoma problems, with an escalation plan.
- A reliable system for ordering and delivering stoma supplies.
- Planned reviews of the stoma and (where relevant) reversal, plus access to psychological and peer support.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether surgery is planned or an emergency, and how complex the underlying operation is
- Surgeon and assistant fees and the anaesthetic
- Theatre and facility costs, and whether keyhole or open surgery is used
- Length of hospital stay, which varies with recovery and complications
- Specialist stoma nurse input and the ongoing cost of stoma supplies
- Follow-up appointments and treatment of any complications
- The surgeon's and anaesthetist's fees
- Theatre, hospital stay and facility costs, with an estimate of the likely length of stay
- Specialist stoma nurse support before and after surgery
- How stoma supplies will be provided and reordered
- Follow-up appointments
- What happens, and what it costs, if a complication or longer stay occurs
- Whether reversal (if planned) is included or charged separately
On the NHS? Colostomy formation is commonly carried out on the NHS when it is clinically needed, including emergencies; private care is mainly used for choice of surgeon or faster access to planned surgery.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Describing a stoma as 'temporary' without explaining that reversal is not always possible.
- Not arranging a specialist stoma nurse or site marking before planned surgery.
- Glossing over the day-to-day realities of leaks, wind, skin care and emotional adjustment.
- No clear, written plan for who to contact about blockage or stoma problems after discharge.
Marketing red flags
- Suggesting stoma surgery is a quick or simple fix without explaining the major operation behind it.
- Promising reversal will definitely happen when this cannot be guaranteed.
- Downplaying the learning curve, leaks and lifestyle changes of living with a stoma.
- Pushing surgery without a clear discussion of alternatives and the underlying diagnosis.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Why is a colostomy being recommended for me, and what happens if I don't have it?
- Is mine likely to be temporary or permanent, and how likely is reversal in my case?
- Will it be an end or loop colostomy, and where will the stoma be placed?
- How will you help me manage diet, wind and the risk of a hernia?
- Who is my specialist stoma nurse, and how do I contact them after I go home?
- What are my specific risks given my health and whether this is planned or an emergency?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is a colostomy permanent?
Will people be able to see or smell it?
Can I eat normally with a colostomy?
Can I still exercise, swim and travel?
Is this done on the NHS or privately?
Why do I still pass mucus from my back passage?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Colostomy NHS inform (Scotland) — Colostomy Colostomy UK — A charity supporting people with a stoma Complications and costs in the first year after stoma formation — PubMed Parastomal hernia: avoidance and treatment — review (PMC) Incidence and risk factors of parastomal hernia — Annals of Coloproctology
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Ileostomy formation · Stoma reversal · Ileal pouch surgery · Abdominoperineal resection (removing the rectum and anus) · Anal fissure surgery