Ostomy Management
Colostomy Care and Complications
Essential guidance for managing a colostomy, including pouching techniques, skin care, dietary advice, and recognizing potential complications.
Reviewed by Allen Kamrava, MD, MBA, FACS, FASCRS · Last reviewed 2025-10-10
Overview
What is a Colostomy?
A colostomy is a surgically created opening from the colon (large intestine) to the surface of the abdomen. This opening, called a stoma, allows stool to exit the body and be collected in a specialized bag, known as a pouching system. A colostomy may be temporary, to allow a downstream portion of the bowel to heal, or permanent, when the rectum and anus have been removed or are no longer functional. Understanding how to care for your colostomy is essential for maintaining your health and quality of life.
Symptoms
Living with a Colostomy
Adjusting to life with a colostomy takes time. Initially, the stoma will be swollen, but it will shrink to its final size over 6 to 8 weeks. A healthy stoma is pink or red, moist, and not painful to the touch. The output from the colostomy will vary depending on its location in the colon. A colostomy in the ascending or transverse colon will have liquid or semi-liquid stool, while one in the descending or sigmoid colon will have firmer, more formed stool. Most people with a colostomy can return to their normal activities, including work, exercise, and travel, once they have recovered from surgery and feel comfortable with their pouching system.
Causes & risk factors
Reasons for a Colostomy
A colostomy may be necessary for a variety of medical conditions, including:
- Colorectal Cancer: Particularly for cancers in the lower rectum requiring removal of the anus (abdominoperineal resection).
- Diverticulitis: A temporary colostomy may be created to manage a severe infection or perforation.
- Inflammatory Bowel Disease (IBD): Such as Crohn's disease or ulcerative colitis, when the colon or rectum is severely diseased.
- Trauma: An injury to the colon or rectum may require a temporary colostomy to divert stool while the injury heals.
- Bowel Obstruction: To relieve a blockage in the colon.
- Congenital Conditions: Such as imperforate anus in newborns.
When to see a doctor
When to Seek Care for Complications
While most people with a colostomy do well, complications can occur. Contact your doctor or ostomy nurse if you experience:
- Skin Irritation: Persistent redness, itching, or sores on the skin around the stoma.
- Leakage: Frequent leakage of stool from under the pouching system.
- Bleeding: A small amount of bleeding from the stoma surface is normal, but you should seek care for continuous or heavy bleeding.
- Changes in Stoma Appearance: If the stoma becomes dark, purple, or black, pale, or retracts below the skin level.
- No Output: If you have no stool or gas output for more than 4 to 6 hours, accompanied by cramping and nausea.
- Bulging around the Stoma: A bulge or hernia next to the stoma (parastomal hernia).
Urgent — get care now
Urgent Medical Attention
Seek immediate medical help if you have signs of a serious complication, such as:
- Bowel Obstruction: No stoma output for more than 6 hours combined with severe cramping, abdominal swelling, and vomiting.
- Stoma Ischemia: The stoma turns dark purple or black, which indicates a loss of blood supply.
- Severe Dehydration: Symptoms include dizziness, dry mouth, decreased urination, and fatigue, often due to very high liquid output.
- Heavy Bleeding: Continuous, significant bleeding from the stoma itself.
Treatment
Care and Management
Proper colostomy care is crucial to prevent complications and ensure comfort. This includes:
Pouching System: Your pouching system consists of a skin barrier (wafer) that sticks to your skin and a collection pouch. Systems can be one-piece or two-piece. The opening of the skin barrier should be cut to fit snugly around your stoma, leaving only about 1/8 inch of skin exposed. The pouch should be emptied when it is one-third to one-half full.
Skin Care: The skin around your stoma (peristomal skin) should be kept clean and dry. Wash the skin with warm water and a soft cloth when changing the pouching system. Avoid soaps with oils or lotions, as they can prevent the barrier from sticking properly. A properly fitting pouching system is the best way to prevent skin irritation.
Diet and Hydration: Most people can return to a regular diet. It is important to chew food thoroughly and stay well-hydrated. Certain foods may cause more gas or thicker/looser output. You may want to introduce new foods one at a time to see how your body reacts.
Self-care
Routine Self-Care
- Change your pouching system on a regular schedule, typically every 3 to 5 days, or sooner if there is any leakage or itching.
- Measure your stoma periodically for the first few months after surgery to ensure your pouching system fits correctly as the stoma shrinks.
- Keep an emergency kit with extra supplies with you when you leave the house.
- Stay hydrated, especially if you have a more proximal colostomy with liquid output.
Frequently asked questions
Will my colostomy be noticeable to others?
Modern pouching systems are discreet and fit flat against the body, making them unnoticeable under most clothing.
Will there be an odor?
Pouching systems are odor-proof. Odor is only present when emptying the pouch. Pouch deodorants are also available.
Can I swim with a colostomy?
Yes, you can swim with a colostomy. Pouching systems are water-resistant. It is a good idea to empty the pouch before swimming and ensure the seal is secure.
Will my sex life be affected?
Having a colostomy should not prevent you from having an intimate relationship. Open communication with your partner is key. Smaller, more discreet pouches are available for intimate moments.