What is a Colostomy? Types, Care, and What to Expect

I have an ileostomy, so this one comes from research rather than personal experience. I wanted to write it because colostomies are the most common ostomy type, and I wanted people in our community who have one to feel seen here too. As always, your medical team will know your specific situation best.

What is a Colostomy?

A colostomy is a surgical opening in the abdomen where part of the large intestine (the colon) is brought through to create a stoma. Waste exits through the stoma into a pouch worn on the outside of the body. Unlike an ileostomy (which uses the small intestine), a colostomy uses the large intestine, and that difference has a big impact on what daily life actually looks like.

Colostomies are usually located on the left side of the abdomen, though that depends on which part of the colon is used. Common reasons someone gets a colostomy include colorectal cancer, diverticulitis, Crohn's disease, bowel obstruction, or trauma. Some are temporary and can be reversed once healing is complete; others are permanent.

The Four Types

The type of colostomy someone has depends on where in the colon the stoma is created. There are four main types, and each one produces a different kind of output.

A sigmoid colostomy is the most common. It's formed from the last section of the colon, closest to the rectum. Because waste has travelled through most of the large intestine by this point, the output is typically well-formed and more predictable. Many people with sigmoid colostomies empty their pouch once or twice a day, and some use a technique called irrigation (more on that below) to have even more control.

A descending colostomy is similar to a sigmoid colostomy in terms of output but sits slightly higher on the left side of the abdomen. Output tends to be semi-formed to formed.

A transverse colostomy is created from the middle section of the colon, across the upper abdomen. Because waste hasn't finished its journey through the large intestine, the output is softer and less predictable. There are two subtypes: loop (usually temporary) and double-barrel.

An ascending colostomy is the least common and sits on the right side. Because it's the earliest part of the large intestine, the output is quite liquid, which makes it more similar to an ileostomy in terms of management.

How It Differs from an Ileostomy

The biggest difference is output consistency. Because the large intestine absorbs more water from waste as it passes through, colostomy output is generally more formed and less frequent than ileostomy output. For someone with a sigmoid colostomy, this can mean one or two emptying sessions per day instead of six or more.

Dehydration is less of a concern too. The colon's water-absorbing function means you're not losing as much fluid, which makes hydration management simpler for most colostomy users compared to ileostomy users. Skin around the stoma is also generally less vulnerable to output damage, since colostomy output doesn't contain the digestive enzymes that make ileostomy output so corrosive.

Gas and odour tend to be more of a factor with colostomies. Stool that has passed through more of the large intestine has had more time to ferment, which produces more gas. Most colostomy pouches come with built-in filters to help manage this, and there are odour-reducing drops available that go directly in the pouch.

Irrigation: A Game-Changer for Some

This is something that doesn't exist for ileostomy users, and it's worth knowing about if you have a sigmoid or descending colostomy. Irrigation is a technique where you flush water through your stoma at a regular time each day (or every other day), which empties the colon and trains the bowel to produce output only during that window.

If irrigation works well for someone, they can wear just a small cap or patch over the stoma between sessions instead of a full pouch. For people who want more predictability and discretion, it can genuinely be life-changing. It takes time to establish the routine and isn't suitable for everyone, but it's worth asking your ostomy nurse about if you have a sigmoid colostomy.

Pouching Systems

Colostomy pouches come in one-piece and two-piece systems, same as ileostomy options. The difference is that a lot of colostomy users go with closed-end pouches, meaning you swap the whole thing out once or twice a day instead of emptying it. When output is more formed and only happening once or twice a day, that's usually just easier.

If your output is less formed, which is more common with transverse or ascending colostomies, a drainable pouch tends to work better. It's worth trying both and seeing what actually fits your routine.

Diet and Daily Life

One of the upsides of a colostomy compared to an ileostomy is more dietary flexibility. Because you still have your large intestine, you retain more of the digestive process, and blockages from high-fibre foods are much less of a concern. Most people with colostomies can eat a fairly normal diet, though certain foods (beans, cabbage, onions, carbonated drinks) tend to increase gas, and others (spicy foods, alcohol) can affect output consistency.

Swimming, physical activity, and travel are all manageable with a colostomy. Waterproof pouching systems exist, belts and wraps can help with security during exercise, and planning ahead for bathroom access (especially while travelling) becomes second nature over time. People with colostomies ski, swim, run, and do all of it. It just takes a bit of adjustment to figure out what works.

If you have a colostomy, there are people in this community who get it. The specifics vary, but the experience of figuring out your routine, dealing with the unexpected, and getting back to normal life is something a lot of us have been through. You don't have to sort it all out on your own.

← Back to Articles