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Will I wake up with a stoma? | CION Cancer Clinics
Most people who have part of the colon removed for cancer do not need a stoma. The bowel is joined back together inside the belly. A stoma is more likely when the join is low near the rectum, when the operation is an emergency, or when healing is expected to be slow. This page explains how that decision is made and what to ask your surgeon before you sign. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Will I wake up with a stoma after a colectomy?
- When is a stoma more likely?
- How and when the stoma decision is made
- Words you will see on the consent form, in plain language
- Three things families tell us about stomas, and what is true
- What to ask before you sign, and what this page cannot tell you
- Common questions about stomas after colectomy
The short answer
Will I wake up with a stoma after a colectomy?
Most people who have part of the colon removed for cancer do not need a stoma. The two cut ends of the bowel are joined back together, and stool leaves the body the usual way. A stoma is needed only when that join cannot be made safely, or when the surgeon wants to protect it while it heals.
What a stoma actually is
A stoma is an opening on the belly wall where the end of the bowel is brought out and stitched to the skin. Stool passes through it into a bag. It is pink, moist and has no feeling, rather like the inside of the cheek. Made from the colon it is called a colostomy; made from the small bowel it is called an ileostomy.
Why the answer depends on where the tumour sits
The higher up in the colon the tumour is, the easier the join and the less likely a stoma. A tumour on the right side or in the middle of the colon is almost always joined straight away. A tumour low in the sigmoid colon or in the rectum sits close to the muscles of the back passage, and a join there is harder to make and slower to heal. That is where a stoma is more often used, usually as a temporary measure.
Your surgeon should tell you before the operation whether a stoma is likely, unlikely or possible. If nobody has said, ask directly.The deciding factors
When is a stoma more likely?
Four situations account for most stomas after bowel cancer surgery.
A join low down near the rectum
The lower the join, the poorer its blood supply and the harder it is to keep watertight. Surgeons often make a temporary stoma above the join so stool bypasses it while it heals.
Emergency surgery
If the bowel is blocked or has burst, it is swollen, full of stool and often infected. A join made then leaks far more often, so the surgeon usually brings out a stoma and rejoins the bowel at a second, calmer operation.
Typical emergencies
- A complete blockage from the tumour
- A hole in the bowel wall
- Infection spreading in the belly
Things that slow healing
Poor nutrition, uncontrolled diabetes, long-term steroid use, heavy smoking and radiotherapy to the pelvis before surgery all make a join less likely to heal well. Your surgeon weighs them together.
Nothing left to join to
If the tumour sits very low in the rectum and the muscles of the back passage must be removed with it, there is no lower end to join to. The stoma is then permanent from the start. This is much less common with colon cancer than with rectal cancer.
A permanent stoma is planned and explained before you go to theatre. It is not a surprise on the day.Not sure whether this applies to you?
Ask an oncologistHow it is decided
How and when the stoma decision is made
At the planning appointment
Your surgeon looks at the scans and the colonoscopy report and tells you where the tumour is. You will hear one of three things: a stoma is not expected, a stoma is possible, or a stoma is planned.
Marking the skin
If a stoma is possible or planned, a stoma nurse draws a small mark on your belly while you sit, stand and bend. It goes where you can see it and a bag will sit flat, away from creases and your waistband.
During the operation
The final decision is made once the surgeon can see the bowel. If the tissue is healthy and the join comes together without tension, no stoma is made. If the join looks fragile or the bowel is unwell, the surgeon makes the stoma at the marked spot.
When you wake up
A nurse or doctor will tell you plainly whether a stoma was made, and you will see a clear bag over the marked spot if it was. The stoma nurse then visits early and starts teaching you and one family member how to care for it.
On the consent form
Words you will see on the consent form, in plain language
- Anastomosis
- The join between the two cut ends of the bowel. When the form says "resection and anastomosis", it means remove a piece and join the rest back together.
- Colostomy
- A stoma made from the colon. Output is usually formed or soft, and the bag needs changing less often than with an ileostomy.
- Ileostomy
- A stoma made from the last part of the small bowel. Output is looser and more frequent. It is the usual choice for a temporary stoma that protects a low join.
- Loop stoma
- A loop of bowel brought to the surface with two openings side by side. Made when the plan is to close it later.
- Possible stoma
- Wording that gives the surgeon permission to make a stoma if the join cannot be made safely. Signing it does not mean one is expected.
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Commonly believed
Three things families tell us about stomas, and what is true
"A stoma means the cancer is very advanced."
It does not. A stoma is about where the tumour sits and how safe the join is. Someone with a small, early tumour low in the rectum may need one, while someone with a larger tumour higher up may not. The pathology report tells you about the stage.
"He will never be able to leave the house again."
People with stomas go to work, travel, pray, farm, swim and attend weddings. The bag sits flat under ordinary clothes and holds in smell. The first weeks are an adjustment, and a stoma nurse is there for exactly that.
"We should refuse the stoma and ask the surgeon to just join it."
A join that leaks causes a serious infection inside the belly, a longer stay and often an emergency operation that ends in a stoma anyway. A temporary stoma is suggested to protect you from that. Ask why, and when it can be closed, rather than asking for it to be skipped.
Being straight with you
What to ask before you sign, and what this page cannot tell you
This page cannot tell you whether you personally will have a stoma. Only the surgeon who has seen your scans and, on the day, your bowel can say that. What it can do is give you the questions that get a straight answer.
Five questions worth asking
Where exactly is the tumour, and how low will the join be? Is a stoma unlikely, possible or planned? If it is made, will it be temporary or permanent? If temporary, roughly how long before it could be closed? And will a stoma nurse mark my skin and teach me before I go home? Write the answers down.
Who this decision does not belong to
It does not belong to the family, and it does not belong to you alone. It belongs to your treating team, made with you. Your job is to understand why a stoma might be needed and to say what matters to you, whether that is work, faith, travel or caring for someone else. Those things can change how the operation is planned.
If you were told a stoma is planned and the reason was not clear, ask for a second conversation. It is a normal request.Questions we are asked
Common questions about stomas after colectomy
What are the chances I will need a stoma?
For a tumour in the right or middle part of the colon, a stoma is uncommon. For a tumour low in the sigmoid colon or in the rectum, a temporary stoma is common. In an emergency operation for a blocked or burst bowel, a stoma is likely. Your surgeon can be far more precise.
If a stoma is temporary, when is it closed?
Usually some months after the first operation, once the join has been checked and any chemotherapy after surgery is complete. Closure is a smaller operation with a shorter stay. The timing depends on how you recover and on the treatment plan, so ask your surgeon for a rough window.
Can I refuse a stoma?
You can refuse any operation, but you cannot choose the inside of it. If the join is unsafe, a stoma is the safe alternative to a leak. The more useful question is why the surgeon thinks it may be needed and what would change that.
Will I feel the stoma or will it hurt?
The stoma has no nerve endings for pain, so it does not hurt to touch or when stool passes. The skin around it can become sore if the bag leaks or is cut too large, and the belly wall aches like any wound at first. Pain from the stoma itself is unusual and should be reported.
Will the family have to look after the bag?
Most people learn to manage their own bag before leaving hospital. It helps for one family member to learn alongside, in case of illness or a weak spell. The stoma nurse teaches both of you.
Can I still eat normal food with a stoma?
Yes, with a few adjustments in the early weeks while the bowel settles. Rice, dal, curd, well-cooked vegetables and soft rotis are all fine. Foods with skins, seeds and tough fibres come back slowly. An ileostomy needs closer attention to fluids and salt.
Does a stoma mean I will need chemotherapy?
No. Chemotherapy after surgery is decided by the pathology report, mainly the stage and whether lymph nodes were involved. The stoma has no bearing on that. Someone with a stoma may need none, and someone without one may need it.
Is a stoma covered by Aarogyasri or insurance?
The operation that makes a stoma is usually covered under the same package as the colectomy. The bags and supplies you use at home are a separate cost, and cover for them varies by scheme and policy. Call the helpline with your card details and we will check.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- NHS — Colostomy
- NHS — Ileostomy
- Cancer Research UK — Surgery for bowel cancer
- American Cancer Society — Colostomy guide
- National Cancer Institute — Colon Cancer Treatment (PDQ) - Patient Version
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
Temporary vs Permanent Stoma After Bowel SurgeryWhat decides whether a stoma is closed laterWhat an Anastomosis IsThe join that a stoma protects, explainedStoma Reversal: When and HowThe second operation that closes a temporary stomaLife With a Colostomy BagWork, food, travel and prayer with a bagColectomy: What the Operation InvolvesThe operation this page sits inside
Talk to us
Not sure whether a stoma is on your plan?
Send us your colonoscopy report and scans, or call the helpline. A surgical oncologist will tell you what the plan is likely to involve and what to ask. One helpline serves every CION centre.