By Ritha Belizaire, MD, FACS, FASCRS | Board-Certified General and Colorectal Surgeon

Quick Insights

An ostomy is an opening on the belly that lets stool leave the body into a pouch. It can be temporary or permanent. For many people, an ostomy is what makes a life-saving or life-improving operation possible. When it's temporary, a reversal can often restore normal bowel function, and the right evaluation is the key to a safe reversal.

Key Takeaways

• An ileostomy comes from the small intestine; a colostomy comes from the colon.
• Marking the best stoma spot before surgery lowers the chance of leaks and skin problems.
• Many temporary ileostomies are closed about 2 to 3 months after surgery, sometimes later.
• Fewer than half of people who have a Hartmann's procedure (a colostomy after emergency colon surgery) ever have it reversed. A second opinion can help.

Why an Ostomy Is Created

• To protect a new bowel connection while it heals, often after rectal cancer surgery
• During emergency surgery for perforated diverticulitis or a blockage
• For ulcerative colitis or Crohn's disease
• For a small number of people with severe bowel leakage when every other treatment has failed and quality of life is still poor

Colostomy vs. Ileostomy

• Ileostomy: made from the end of the small intestine. Output is looser and more frequent, so staying hydrated is important.
• Colostomy: made from the colon. Output is usually thicker and more like a normal bowel movement.
• Loop vs. end: a loop ostomy is usually temporary and easier to reverse. An end ostomy may be temporary or permanent.

Before Surgery: Getting the Spot Right

The American Society of Colon and Rectal Surgeons (ASCRS) recommends marking the stoma site before planned surgery. My team or an ostomy nurse looks at your belly while you sit, stand, and lie down, and picks a spot you can see, away from creases, scars, and your waistband. A well-placed stoma means fewer leaks, healthier skin, and more freedom in what you wear.

Living With an Ostomy

People with ostomies work, travel, swim, exercise, and have intimate relationships. Most of my patients are surprised by how quickly the routine becomes normal. Common issues to know about:

• Skin irritation from leaks, usually fixed with a better-fitting pouching system
• Dehydration with an ileostomy, especially in the Houston heat
• Parastomal hernia, a bulge around the stoma. I repair these, and I can also fix a stoma that leaks or causes other problems.
• Changes in body image, which are real and worth talking about

Ostomy Reversal

Am I a Candidate?

Before a reversal, I make sure the rest of your bowel is ready and healthy. The evaluation usually includes:

• A review of your original operation and any complications
• A scope or X-ray dye test to check the bowel downstream from the ostomy
• An exam of your sphincter muscles and bowel control
• Making sure any cancer treatment, such as chemotherapy, is finished

Timing

A temporary loop ileostomy is often closed about 6 to 12 weeks after the first operation, and later if you need chemotherapy. A colostomy after a Hartmann's procedure is usually reversed after several months, once inflammation has settled. Reversing a Hartmann's is a bigger operation and is often performed with robotic surgery.

Life After Reversal

Your bowels need time to relearn. Frequent, urgent, or clustered bowel movements are common at first, especially after rectal surgery. This is sometimes called low anterior resection syndrome (LARS). It usually improves over months, and fiber, medicines, and pelvic floor therapy help.

Told You Can't Be Reversed?

Some patients are told their ostomy is permanent without a full explanation. Sometimes that's the right answer. Sometimes reversal is still possible with careful planning. If you've been living with an ostomy and want to understand your options, I'm happy to review your case.

Schedule a Consultation

If you're dealing with any of these symptoms, you don't have to wait. Call my Houston office at 832-979-5670 to request a same-day or next-day appointment. My office is at 427 W. 20th Street, Suite 710, in Houston Heights, and I operate at several hospitals across Houston.

Medical Disclaimer

This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always talk with your physician about your own situation.

Frequently Asked Questions

Is an ostomy permanent?

Not always. Many ostomies are temporary and can be reversed. Whether yours can be depends on why it was created, your health, and the condition of your bowel and sphincter muscles.

How long is recovery after ostomy reversal?

For a loop ileostomy closure, most people stay in the hospital a few days and return to normal activities within a few weeks. A Hartmann's reversal is a bigger operation with a longer recovery.

Will my bowel movements be normal after reversal?

Most patients improve steadily over several months. Changes are more common after rectal surgery. We'll talk about what to expect for your situation.

Can I get a second opinion on reversal?

Yes. If you've been told reversal isn't possible, a second opinion can confirm that or open new options.