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Stoma reversal: when it happens and how it is done | CION Cancer Clinics
A temporary stoma is usually reversed a few months after the first operation, once the join inside has been shown to have healed, any chemotherapy is finished and you are fit for another anaesthetic. Not every stoma can be reversed. This page explains what the surgeon checks first, how the operation differs for an ileostomy and a colostomy, and who reversal does not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- When can a stoma be reversed?
- How does a reversal happen, step by step?
- What does the surgeon weigh before offering a date?
- Ileostomy closure and colostomy reversal, compared
- Four things families ask about reversal, and what is true
- Words you will meet, in plain language
- Who reversal does not suit, and what this page cannot tell you
- Common questions about stoma reversal
The short answer
When can a stoma be reversed?
A temporary stoma is usually reversed a few months after the first operation, once the join inside has healed, any chemotherapy is finished and you are fit for another anaesthetic. Not every stoma can be reversed, and your surgeon will have told you at the first operation whether yours was made to be temporary.
What reversal actually means
Reversal means putting the stoma back inside and joining the two ends, so that motions pass through the back passage again. For a loop ileostomy, the commonest temporary stoma, the surgeon works through the stoma site itself. For an end colostomy, the surgeon has to go back into the tummy to find the lower end of bowel and join it. That is a bigger operation.
Why there is a wait
The stoma was made to protect a fresh join lower down while it healed. Reversing it before that join is sound would send everything through a weak point. If chemotherapy is planned, most surgeons wait until it is complete, because a second operation interrupts the course and heals more slowly.
Ask at the first operation whether your stoma is meant to be temporary. It is easier to plan for than to find out later.The pathway
How does a reversal happen, step by step?
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A check that the join has healed
Before a date is offered, the join below the stoma is tested, usually with a contrast study, where dye is passed into the back passage and an X-ray shows whether any leaks out. If the join is not sound, reversal waits.
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Chemotherapy finished, fitness checked
If you had chemotherapy after the first operation, the team waits for the course to end and blood counts to recover. You have the same fitness checks as before any operation.
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The operation
A loop ileostomy is usually closed through the stoma site alone. The two ends are joined with staples or stitches and dropped back inside. An end colostomy is reversed through a fresh cut in the tummy, sometimes by keyhole.
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Waiting for the bowel to wake up
You start with sips and build up to food as the bowel begins to move. The first motions through the back passage are often loose and urgent. That is expected.
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Going home and the first weeks
Most people go home within a few days of a loop ileostomy closure, longer after a colostomy reversal. The stoma wound is often left partly open to heal from inside, and needs dressing at home.
Not sure whether this applies to you?
Ask an oncologistThe decision
What does the surgeon weigh before offering a date?
Reversal is offered when the balance of these is right. Your team decides this with you, not for you.
Is the join sound?
A leak or narrowing at the join lower down is the commonest reason reversal is delayed. A narrowing can sometimes be stretched. A leak that has not sealed means more time.
Is the cancer treatment complete?
If chemotherapy is still running or a scan is due, most teams finish that first. Reversal is a planned operation with no urgency, so it fits around the cancer treatment rather than the other way round.
Will the muscle at the back passage cope?
If the rectum was operated on, or you had radiotherapy to the pelvis, the muscle that holds motions in may be weaker. Poor control is a reason some people choose to keep the stoma.
This is a choice, not a failure. Some people live better with a well-managed stoma than with poor control.Are you fit for another anaesthetic?
Heart, lungs, diabetes and how well you recovered the first time all count. Someone who struggled after the first operation may be asked to build strength before the second.
Side by side
Ileostomy closure and colostomy reversal, compared
Loop ileostomy closure
End colostomy reversal
Done through the stoma site alone, one small wound
The tummy is opened again, by keyhole or a longer cut
Usually a short stay of a few days
Usually a longer stay, closer to the first operation
Loose, frequent motions for weeks afterwards are the main issue
A bigger recovery, and a higher chance the reversal is not possible
Most often after rectal or left-sided colon surgery
Most often after an emergency operation for a blocked or burst bowel
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Commonly believed
Four things families ask about reversal, and what is true
"If the stoma is temporary, reversal is automatic."
It is planned, not automatic. The join must be shown to have healed, the cancer treatment must be at a point where a pause is safe, and you must be fit. In some people the join never heals well enough, or control is poor, and the stoma stays.
"Reversal is a small operation, nothing to worry about."
Ileostomy closure is smaller than the first operation, but it is still an anaesthetic and a new join in the bowel, with the same risks of a leak or a blockage. Colostomy reversal is a major operation in its own right.
"Once reversed, my bowel will be back to normal."
It will work, but differently. Loose, frequent and urgent motions are common at first and settle over months. If part of the rectum was removed, some change is usually permanent.
"Waiting for reversal means the cancer is still there."
The wait is about healing and finishing treatment, not about the cancer. A stoma is reversed when the bowel is ready. The timing says nothing about the cancer itself.
On your notes
Words you will meet, in plain language
- Loop ileostomy
- A loop of small bowel brought out through the tummy to divert motions away from a fresh join lower down. The commonest temporary stoma.
- Hartmann's procedure
- An operation, often done in an emergency, where the diseased colon is removed, the lower end is closed off inside, and an end colostomy is made.
- Anastomosis
- The join between two ends of bowel. Reversal creates a new one.
- Contrast enema
- The X-ray test that checks the join has healed before reversal. Dye is passed gently through the back passage.
- Stricture
- A narrowing at the join. It may need stretching before reversal can go ahead.
- Sphincter
- The ring of muscle at the back passage that holds motions in. Its strength is one of the things weighed before reversal.
Being straight with you
Who reversal does not suit, and what this page cannot tell you
This page cannot tell you whether your stoma can be reversed or when. That depends on what was done at the first operation, how the join has healed and what treatment is still planned.
Who it does not suit
A stoma made because the whole rectum and its muscle were removed is permanent. Reversal is also unwise for someone whose muscle control was poor before surgery, whose heart or lungs would not stand a second anaesthetic, or whose cancer treatment has no safe pause. Some people choose to keep the stoma, and that is a reasonable choice.
What to ask your surgeon
Ask whether the stoma is temporary, what test will confirm the join has healed, whether reversal waits for chemotherapy, and what bowel function is realistic afterwards. If you are travelling from a district, ask whether the contrast study can be done on the same visit as the clinic.
If you have been told your stoma is temporary and months have passed with no plan, call the helpline. Someone will help you find out where things stand.Questions we are asked
Common questions about stoma reversal
How long after the first operation is a stoma usually reversed?
Commonly a few months, and later if chemotherapy comes in between. The wait is set by healing of the join and by the cancer treatment plan, not by a fixed calendar. Your surgeon will give you a likely window once the contrast study and your treatment plan are both known.
Is the reversal done through the same cut?
For a loop ileostomy, yes. The surgeon works through the stoma opening itself and the original tummy wound is not reopened. For an end colostomy the tummy has to be entered again, because the closed lower end of bowel has to be found and joined. Ask which kind you have.
Can reversal be done during chemotherapy?
Most teams prefer to finish chemotherapy first. A second operation would interrupt the course, and healing is slower while the drugs are in your system. Occasionally a stoma causing serious problems is reversed sooner. Your oncologist and surgeon decide this together, and will tell you why.
What if the test shows the join has not healed?
Reversal is delayed and the test is repeated after more time. A narrowing can sometimes be stretched. A small leak that persists may need a repair before the stoma can go. This is disappointing but common, and it does not mean the stoma is permanent.
Will I have a stoma bag again after reversal?
Rarely, but it can happen. If the new join leaks or you cannot manage the loose motions, a stoma may be made again, sometimes for good. Your surgeon should tell you this risk honestly before you decide, and it is a fair question to ask directly.
Will my bowel be normal straight after reversal?
No. Expect loose, frequent motions with some urgency in the first weeks, because the lower bowel has been resting. This improves over months for most people. If the rectum was operated on, some change in habit is usually permanent, and there is a whole page on managing it.
Is reversal covered by Aarogyasri or insurance?
It is usually treated as part of the cancer surgery pathway, and Aarogyasri, CGHS, ECHS, EHS and most cashless insurers cover it when it was planned at the first operation. Approval is separate, so start the paperwork early. Call the helpline with your card details to check.
Can I refuse reversal and keep the stoma?
Yes. Some people manage well with a stoma and do not want a second operation or the months of loose motions that follow. Tell your surgeon what matters to you. It is your decision, and the team's job is to give you an honest picture of both options.
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Sources
- NHS — Ileostomy
- NHS — Colostomy
- Cancer Research UK — Bowel cancer treatment
- NICE — Colorectal cancer (NG151)
- American Cancer Society — Colorectal cancer surgery
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Bowel Function After Stoma ReversalWhat the first weeks and months are like once the stoma is goneTemporary vs Permanent Stoma After Bowel SurgeryHow to tell which kind you haveWhat an Anastomosis IsThe join that has to heal before reversalDo You Need Chemotherapy After Colectomy?Why reversal usually waits for itFitness, Tests and PrehabilitationGetting ready for a second anaesthetic
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