Ileostomy formation
An operation that brings the end of the small bowel (ileum) 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
- An ileostomy brings the small bowel out onto the tummy so waste collects in a bag; it can be temporary or permanent.
- Output is usually loose, so staying hydrated and watching for blockages and high output really matters.
- Most people adapt over weeks to months with support from a specialist stoma nurse, and return to normal activities.
- A 'temporary' ileostomy 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 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 an ileostomy?
An ileostomy is an opening (called a stoma) made on the surface of your tummy, where the surgeon brings out the end of your small bowel (the ileum). Waste then passes through this opening into a bag that sticks to your skin, instead of going through your large bowel and back passage.
It is usually done when the large bowel needs to be removed, rested or bypassed — for example because of ulcerative colitis, Crohn's disease, bowel cancer, or a serious bowel emergency. An ileostomy can be temporary (to let bowel further down heal) or permanent.
A stoma changes how you go to the toilet, but most people learn to manage it well and get back to work, exercise, swimming and relationships. The output from an ileostomy is usually loose or porridge-like, because it leaves the body before the large bowel has reabsorbed water.
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.
Ileostomy vs colostomy
| Ileostomy | Colostomy | |
|---|---|---|
| Bowel used | Small bowel (ileum) | Large bowel (colon) |
| Usual output | Loose/watery | More formed |
| Usual position | Often right side | Often left side |
| Hydration risk | Higher | Lower |
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 an ileostomy 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
An ileostomy 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 small bowel through the abdominal wall, usually on the right 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. 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 small 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 a colostomy rather than an ileostomy, depending on the disease.
- In some cases, an ileoanal pouch instead of a permanent stoma after the colon is removed.
- 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 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
- Often improves day-to-day life for people who were very unwell with their bowel disease
- Lets many people return to work, travel, exercise and relationships once they have adapted
Risks & complications
- Loose, high-output stool that can lead to dehydration and salt imbalance
- Sore, irritated skin around the stoma, often from leaks
- Wind, odour and learning-curve worries while you get used to the bag
- 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), which can cause cramping, vomiting and swelling
- Vitamin B12 or other nutrient problems if a lot of bowel is removed
- 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 an ileostomy depend heavily on why it is being done and whether it is planned or an emergency. Dehydration from high output is one of the most common practical problems, especially early on. Ask your team how to recognise high output and a blockage, and exactly who to contact if your output stops or becomes very watery.
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 high output) rather than rare emergencies. Because of this, qualitative wording is often more honest than a single percentage.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| High-output stoma in the first year | Common; reported around a third of patients in one UK series | Often manageable but can cause dehydration and salt imbalance; figures vary by definition and follow-up. | Complications and costs in the first year after stoma formation — PubMedpubmed.ncbi.nlm.nih.govSource-linked context |
| 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 and other stoma problems (narrowing, retraction, prolapse) | Reported in a meaningful minority over time; ranges vary widely between studies | Risk rises with time, weight gain and heavy lifting; exact rates are not robust. | Complications and costs in the first year after stoma formation — PubMedpubmed.ncbi.nlm.nih.govSource-linked context |
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.
- Loose or porridge-like output, often several times a day
- 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.
- Drink enough fluids and watch for signs of dehydration; your team may advise rehydration drinks if output is high.
- Reintroduce foods gradually and note which ones cause problems; chew well to reduce the risk of blockage.
- 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 and blood tests 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
- Rehydration drinks or advice for high output
- Help arranged at home for lifting and chores for several weeks
- Stoma nurse and out-of-hours contact numbers saved
- Clear signs of a blockage or high output 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)
- Very watery, high-volume output with thirst, dizziness or passing little urine (dehydration)
- 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
- 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 permanently 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 ileostomies are lifelong; others are temporary and reversed later. Even a stoma 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
An ileostomy is usually formed as part of another bowel operation, such as removing the large bowel or part of it. Sometimes it protects a more complex reconstruction lower down. 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. Blood tests may be done to check hydration and nutrition. If reversal is planned, you should be told who will arrange it and roughly when.
- Regular stoma care and skin checks to prevent soreness and leaks
- Reordering bags and accessories on prescription before you run out
- Watching fluid intake and salt balance, especially in hot weather or illness
- Blood tests for nutrients such as vitamin B12 if a lot of bowel was removed
- 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' ileostomy 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, high output and dehydration, with an escalation plan.
- A reliable system for ordering and delivering stoma supplies.
- Planned reviews of the stoma, nutrition 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, blood tests 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 and any blood tests
- 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? Ileostomy 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 high output, leaks, skin care and emotional adjustment.
- No clear, written plan for who to contact about blockage, high output 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 an ileostomy 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 ileostomy, and where will the stoma be placed?
- How will you help me manage high output and avoid dehydration?
- 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 an ileostomy permanent?
Will people be able to see or smell it?
Can I eat normally with an ileostomy?
Can I still exercise, swim and travel?
Is this done on the NHS or privately?
What is 'high output' and why does it matter?
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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 — Ileostomy NHS — Ileostomy complications NHS inform (Scotland) — Ileostomy Colostomy UK — Living with a stoma Complications and costs in the first year after stoma formation — PubMed
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.
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