You can have surgery to reverse your colostomy or ileostomy. It's called an ostomy reversal. Your surgeon will sew the ends of your intestine (bowel) back together. This surgery "reverses" your temporary stoma.
Your stoma is the opening in your belly (abdomen) created by your surgeon where part of your intestines comes through the skin. Your stoma bag catches your stools. After an ostomy reversal, you'll be able to empty your bowels normally.
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Is Reversal an Option?
You and your surgeon will decide if ostomy reversal is a good option. It often depends on your health condition, age, and your treatment plan.
Good health can help you recover from your ostomy reversal. You also need enough rectum left over from your original surgery. Your surgeon will also check your muscle strength. Your bowels need to push out your food waste through the chamber.
Your doctor will talk to you and give you an exam. They'll look at your bottom and likely test how strong your muscles are in there. Ostomy reversals are very common. In fact, one study reported about 80 out of every 100 people with diverticulitis had it done.
The ideal time to close your ostomy is about three months after your surgery. But it can be up to a year later, too. You'll probably be done with chemotherapy or other treatments. It's also possible to wait several years to do a reversal.
Ask your surgeon if you should do exercises or physical therapy before your surgery. Sometimes, they help work the muscles in your rectum. This can help you resume your normal bowel movements sooner.
Colostomy Reversal
After healing from your colostomy, you may decide on a reversal. A colostomy closure usually happens after you've healed from your medical condition. It can take three to six months or longer for inflammation to go down.
Your colostomy surgery creates a stoma. It's the opening in your belly (abdomen) where your large intestine (colon) exits to release stool.
Here's what to expect if you're considering a colostomy reversal:
- Before your surgery, you'll get medication (anesthesia) through your IV line (a tube placed in your vein) to put you to sleep.
- The surgery typically takes two to four hours. But it can take longer if you need scar tissue or hernia repair.
- Your reversal surgery can often be done with a few cuts (minimally invasive). But sometimes you may also need a larger cut (open surgery).
- Your surgeon will free the loop of intestine from your abdomen.
- After it's free from your belly, they'll put the ends together, end to end.
- Next, a tube (channel) between the two ends is created.
- The two ends of your bowels are connected (anastomosis) — stapled or handsewn together.
- Then, your incision (cuts) and stoma are closed.
After your reversal, you'll stay in the hospital for at least three to five days to recover. Your doctor will prescribe medication to help manage your pain. You'll need to have a bowel movement before returning home.
As your bowels heal, you'll start with a liquid diet. Your surgeon will monitor your progress. Over the next few days, you'll slowly start to eat soft foods. Once you can eat, drink, and pass waste without problems, you can return home.
How dangerous is a colostomy reversal?
Colostomy reversals can be more difficult and are not done as often. The problems after a colostomy reversal can be serious.
These can include:
- Wound infection
- Ileus, air, fluid, and food stop moving normally through your intestines
- Sepsis, a life-threatening infection that can cause organ damage, inflammation, or death
To lower your risk of infection and other problems, talk to your surgeon. They'll help you decide on the best time to reverse your stoma.
Ileostomy Reversal
Ileostomy reversal surgery reconnects your small intestine (ileum) to your colon. It will close your stoma. The surgery allows you to use your anus again. You'll be able to have bowel movements like before.
About eight weeks to three months after your ileostomy, your bowel will have healed. Your surgeon likely sews your ileum through a small hole in your belly (stoma). The reversal surgery will close this loop.
But you may need to wait longer for some medical conditions. For example, you'll want to finish your chemotherapy or other treatments first. Once you and your surgeon decide on surgery, here's what to expect:
- You'll get medicine (anesthesia) in your IV to make you sleepy.
- After you're asleep, your surgeon will free the small intestine (ileum) from your belly.
- Next, they'll reattach it to your colon.
- Once they reconnect your bowels end to end, they'll staple it together (anastomosis).
- Finally, the incision site, including the former stoma, will be closed.
The reversal is typically simpler than the ileostomy. It depends on your health condition, complications, and how your surgeon performs surgery.
Your surgery usually lasts two hours or more. You'll recover in the hospital over the next three to five days. You'll also get medicine to help manage your pain.
You'll start on a liquid diet as your intestines heal. Your surgeon will monitor you and slowly add soft foods. As your bowel function returns, you'll have a bowel movement and return home.
You may have short-term side effects, such as pain or bowel movement changes. Talk to your doctor to know what to expect.
What is the success rate of ileostomy reversal surgery?
Ileostomy reversals are preferred over colostomy reversals. That's because ileostomy closure typically has fewer problems (complications). The most common issues are wound infection or small bowel obstruction.
Smoking can increase your risk of wound infection after surgery. Try to quit smoking or cut back to lower your risk.
Ileostomy and Colostomy Reversal Complications
Many surgeries to undo a colostomy or ileostomy are fairly simple. But closures can be harder if all or much of your colon is gone or not working.
"If none of the large intestine or rectum was taken out at the time of ileostomy or colostomy creation, the patient's diet and lifestyle will not change at all after the acute post-op recovery period, which lasts about two to four weeks," says Ritha Belizaire, MD, general and colorectal surgeon at Houston Community Surgical, Houston, TX.
This can also extend your recovery. After reversal surgery you may notice problems, such as:
- Temporary bowel paralysis (ileus)
- Stool leaking inside your belly
- Scar tissue making it hard or impossible to poop
- Hernia, when your bowel pokes through the cut made for your stoma
- Bleeding or infection, such as a bladder infection
- Trouble peeing or having sex because of nerve damage
- Constipation or diarrhea
- Blockage in your intestines
Your body is getting used to having bowel movements again. At first, you may notice more bowel movements than before. This is common.
You may also notice urgent bowel movements. Usually, these symptoms will go away after some time. Talk to your doctor about the symptoms and problems to look for.
Preventing hernia
After ostomy reversal, you're at a higher risk for hernia. It can happen near your ostomy site.
About 1 in every 3 stoma closures cause hernia, and half require surgical repair. Some studies suggest using mesh. It's placed in your belly for support. But it's still unclear if it lowers hernia risk.
When to call your doctor
Call your doctor if you:
- Have a fever of 100.4 F or higher
- Get chills, redness, or swelling around your cut (incision)
- Have nausea or vomiting for more than two days
- Get serious belly pain, bloating, or swelling
- Have constipation or more than 10 liquid bowel movements in a day
- Get black, bloody, or tar-colored stools
Colostomy and Ileostomy Reversal Recovery
You'll usually stay in the hospital for 3-10 days. It can depend on your medical conditions, the type of surgery you have, and complications. You'll leave after you begin eating solids again and your bowels move normally.
It may take some time for you to poop normally again. At first, you may:
- Have loose or watery stools
- Need to poop more often
- Feel your bowels aren't completely empty after going to the bathroom
- Have stool leakage
If a large part of your colon is removed, you may have loose stools. But it might not change the types of food you eat, says Belizaire.
"People who have lost a substantial part of their large intestine may also need to be on medication — like fiber or antidiarrheal medications — to help slow the amount of stool that comes out," Belizaire says.
You probably won't have to limit anything in your diet. But it may affect the type of food your stomach can tolerate.
Diet for recovery
Give yourself extra time to heal. Your doctor may ask you to follow a special diet at first. They may suggest adding back fiber slowly. You may need to follow a low-fiber diet at first.
Tender care for your gut can help you get regular more quickly. Talk to your doctor or dietitian about what to eat. You can try to:
- Stay away from fatty or spicy dishes.
- Eat small meals with low fiber.
- Increase portions slowly.
- Avoid cabbage, onions, or other gassy foods.
- Limit fizzy drinks, alcohol, and caffeine.
Stay hydrated
Get plenty of fluids after your surgery. Drink water and other fluids to help your bowels move. As your intestines heal, it's key to stay hydrated. Try oral rehydration solutions (ORS), electrolyte beverages, or pediatric oral rehydration solutions.
If you get constipated, avoid taking any medicine. Talk to your doctor first. Even if you get diarrhea, call your doctor before taking any medication.
Life after reversal
With your doctor's OK, you can do light exercises, such as walking. You won't be allowed to lift anything heavy for a month or more. You probably won't be able to drive for some time either. Talk to your doctor about resuming activities.
Your surgeon may suggest pelvic floor exercises, too. These can strengthen muscles and help improve your bowel control.
If your surgeon takes out a large part of your rectum, you may notice urgency issues. You might feel a strong need to have a bowel movement. This can cause you to rush to the bathroom to prevent accidents, says Belizaire.
"In these cases, patients are referred for pelvic floor physical therapy," says Belizaire. "And they're given fiber supplementation to help with that urgency."
Get rest
After your colostomy or ileostomy reversal, it's normal to need some time to get back to feeling like yourself. Once you're home from the hospital, you may feel weak or tired, so make sure to rest often.
Try to eat well, get plenty of sleep, and exercise lightly. Ask your doctor about what activities are OK to support your energy during recovery. Over this period, you'll slowly build back your energy and strength.
"In the acute postoperative period, patients require about two to four weeks of wound care, or waiting until the skin closes," says Belizaire. "We always leave the skin open because this wound is at higher risk of infection."
Be sure to clean your incisions (cuts) well. And follow your doctor's instructions for showering, too.
"During this time, patients are able to shower," says Belizaire. "But we do not recommend they submerge in a bathtub or pool."
Everyone recovers differently. But most people feel fully recovered in about six to eight weeks. You'll have follow-up visits with your doctor to manage your recovery. But if you get symptoms or aren't recovering, talk to your doctor sooner.
Takeaways
If you decide to reverse your colostomy or ileostomy, talk with your doctor about the best time for surgery. It often depends on your health, medical conditions, and age. Although easier to recover from, the surgery still takes time to get back to normal. Follow your doctor's advice, take it easy and give your body the time it needs to heal.
Ileostomy and Colostomy Reversal FAQs
How dangerous is a colostomy reversal?
A colostomy reversal is generally a safe and successful procedure. But like any surgery, it comes with risks such as infection, ileus, or intestinal blockage. A rare but serious risk is an anastomotic leak. This means your bowel doesn't heal properly and can cause infection or sepsis.
What are the pros and cons of colostomy reversal?
The pros of a colostomy reversal are your bowel movements work like they did before surgery. And you won't need to wear or manage your ostomy bag.
As for the cons, you may be sore, get bowel changes (diarrhea or constipation), or have long-term issues, such as hernias or adhesions.
What is the success rate of ileostomy reversal surgery?
The success of ileostomy or colostomy reversal can depend on many factors. Stoma reversal surgery is generally safe with good long-term results. One study reported only about 28% of patients had problems with ileus, hernia, or infections.
After reversal of colostomy, what is the life expectancy?
How long you live after a colostomy reversal can depend on many factors. These include your health conditions, the reason for your colostomy, and your recovery.
But studies aren't clear on how long people live after colostomy reversal. In general, many people can expect to live a normal lifespan after it.
What happens to your anus after a colostomy?
After a colostomy, stool is released through a stoma in your abdomen. Your anus no longer works like it once did. If your anus is left intact, it may release tiny amounts of stool or liquids for weeks or months. But your new stool will now pass through your stoma.
What foods should you avoid after colostomy reversal?
During your recovery, stick to easy-to-digest foods. Avoid high-fiber foods like dried or canned legumes (beans, peas, or lentils).
It's best to avoid caffeinated, carbonated, or alcoholic drinks. Try breaking up your meals, too. Eat smaller portions during the day instead of three large meals.
