I have an ileostomy, so everything in the ileostomy article comes from personal experience. This one is different. I don't have a colostomy, so what I'm sharing here comes from research and conversations with others in the ostomy community. I wanted to write it because colostomies are actually the most common type of ostomy, and I wanted people in our community who have one to see their experience reflected here too. As always, your own 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.
The type of colostomy you have makes a real difference to your routine. A sigmoid colostomy and an ascending colostomy can look pretty different day to day, even though they're both colostomies.
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 pouching systems come in one-piece and two-piece designs, similar to ileostomy options. One difference is that many colostomy users prefer closed-end pouches, which are sealed at the bottom and disposed of rather than drained. Because output is more formed and less frequent, swapping out a closed-end pouch once or twice a day is often simpler than draining a drainable pouch.
For people with less formed output (transverse or ascending colostomies), drainable pouches make more sense. Your ostomy nurse can help you figure out which system suits your output type and lifestyle.
There's no single "right" system. The best setup is the one that fits your output type, your skin, and how you actually live your life.
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 and want to connect with others who understand the specifics, you're not alone in this community. Everyone's ostomy experience is a little different, but the core stuff, including figuring out your routine, managing the unexpected, and getting back to the life you want, is something we all navigate together.
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