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Living with two stomas after pelvic exenteration | CION Cancer Clinics
After a total pelvic exenteration you have two stomas: a colostomy for stool and a urostomy for urine, each with its own bag. Most people learn to manage both before leaving hospital, and within months are eating normally, working, praying and travelling. This page explains how the two differ, how you learn them, what daily life looks like, and the two warning signs that need the hospital the same day. 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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The short answer
What does life with two stomas actually look like?
After a total exenteration you have two openings on the abdomen: a colostomy for stool and a urostomy for urine, each covered by a bag. Most people learn to manage both within the hospital stay, and within months they are eating normally, going out, working and travelling. It is a real change, and it is a manageable one.
Why there are two, and not one
The bladder and the rectum have both been removed, and stool and urine cannot share one route without infection. So the surgeon brings the large bowel out on one side of the abdomen for stool, and builds a short tube from a piece of small bowel on the other side for urine. Each has its own bag, its own rhythm and its own routine.
What it feels like at first
Strange, and for many people upsetting. The stomas are pink, moist and have no feeling, so changing a bag does not hurt. What takes time is looking at them, trusting the seal, and stopping the fear that everyone can see or smell something. That fear fades as the routine becomes automatic.
Colostomy is usually permanent after this operation. Reversal is not something to expect, and it helps to plan on that basis.Side by side
The colostomy and the urostomy, compared
Colostomy (stool)
Urostomy (urine)
Usually on the left side of the abdomen
Usually on the right side
Works a few times a day, often after meals; can be quiet for hours
Drips constantly, so the bag has a tap at the bottom to empty it
Closed bag changed when full, or a drainable bag emptied
Emptied several times a day; connected to a larger bag at night
Output firms up over weeks as the bowel settles
Some mucus in the urine is normal, because the tube is made of bowel
Smell is contained by the bag and its filter
Leaks show as wetness; the skin needs a good seal
Not sure whether this applies to you?
Ask an oncologistBefore you go home
How you learn to manage both, step by step
The nurse does it, you watch
In the first days the stoma nurse changes both bags while you look. You see what a healthy stoma looks like, how the skin is cleaned and dried, and how the base plate is cut and fitted.
You do it, the nurse guides
Then you take over with the nurse beside you: measuring the stoma, cutting the plate, fitting it without creases, emptying and closing the tap. A family member learns at the same time, so there are two pairs of hands at home.
You do it alone
Before discharge you change each bag on your own while the nurse watches without helping. This is the test that decides whether you are ready, and it is normal to need several attempts.
Supplies and a number to call
You leave with a starter stock, a written list of the exact products and sizes you use, where to buy them near home, and a phone number for the stoma nurse when something does not look right.
!
Two things that cannot wait
If the colostomy stops working for a day or more and the abdomen becomes swollen, painful and you are vomiting, the bowel may be blocked. If the urostomy output falls sharply, or you have a fever with pain in the back or side, the kidney may be infected or blocked. Either one needs the hospital the same day. Do not wait for the morning, and do not take a laxative or a painkiller first and see.
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Commonly believed
Three things families say about two stomas
"She will never be able to leave the house again."
People with two stomas go to work, to temples, to weddings and on long train journeys. The bags sit flat under ordinary clothes, and once the routine is learned, an outing needs only a spare kit in the handbag. The first outing is the hard one.
"Everyone will be able to smell it."
Modern bags seal completely and carry a charcoal filter. Smell is released only when the bag is opened to empty it, in the toilet, the same as for anyone else. If there is a smell at other times, the seal has failed and the bag needs changing, not hiding.
"She must eat only bland food from now on."
Once the bowel has settled, most people go back to the food they always ate, including rice, dal, curd and spice. A few foods make gas or loosen the output, and you learn which by trying them one at a time. Drinking plenty of water matters more than any single food, especially with a urostomy.
Day to day
The parts of daily life people worry about most
Each of these has a practical answer. None of them is a reason to stay at home.
Clothes and bathing
Loose kurtas, saris and trousers with a soft waistband sit well over both bags. You can bathe with the bags on or off; water does not harm the stomas.
Work, prayer and travel
Desk work usually restarts within a few months. For prayer, a drainable bag emptied beforehand is enough. On long journeys carry a change kit, empty before boarding, and sit on the aisle.
Pack for travel
- Twice the supplies you expect to need
- Wipes, disposal bags and a small towel
- Your product list and the stoma nurse's number
The skin around the stomas
This is where most day-to-day trouble happens. Red, sore or weeping skin usually means the plate is cut too big or is leaking underneath. Call the stoma nurse early rather than putting up with it; a small change to the fit usually settles it.
Supplies and cost
Bags, plates and accessories are a running cost for life, and it is worth asking early what your scheme or insurer covers. Ask the nurse about lower-cost options that fit you.
Being straight with you
What this page cannot tell you
This page cannot tell you how you will feel about your body, or how quickly you will adjust. Some people are matter-of-fact within weeks. Others grieve for months, and that is a normal response to a real loss, not a weakness. A counsellor or a stoma support group can help, and asking for either is a sign of good sense.
It cannot tell you what is normal for your stomas
Every stoma is a different size and shape, and each settles into its own pattern over the first few months. What counts as normal output, how often to change, and which products fit are questions for your stoma nurse, who has seen yours.
It cannot tell you about intimacy and relationships
Sex and closeness after this operation deserve their own honest conversation, and there is a separate page on it. Many couples find their way through, and the ones who cope well usually talk about it rather than avoid it.
Questions worth asking your stoma nurse
What should my output look like at this stage. Which products are cheapest that still fit me well. What do I do if a bag leaks at night. Who do I call at the weekend. Is there a support group I can join.
If you are struggling with the stomas at home and cannot reach your nurse, call the helpline. Someone will talk it through.Questions we are asked
Common questions about living with two stomas
Can the colostomy be reversed later?
After a total exenteration, almost never, because the rectum and usually the anus have been removed and there is nothing to join the bowel back to. It is better to plan for a permanent colostomy from the start than to wait for a reversal that is unlikely. Ask your surgeon plainly if you are unsure which you have.
How often do the bags need changing?
The urostomy bag is emptied through its tap several times a day and the whole bag changed every few days. A colostomy bag is either replaced when it is about a third full, or emptied if it is the drainable kind. Your nurse will set a routine that suits your output and your skin.
Is mucus in the urostomy bag a sign of infection?
Usually not. The urine route is made from a piece of bowel, and bowel makes mucus. Some cloudiness or strands are normal. Infection is suggested by fever, pain in the back or side, urine that smells much stronger than usual or turns bloody. Those need a doctor the same day.
Can I sleep on my side?
Yes. Many people connect the urostomy to a larger night bag hung beside the bed so they are not woken to empty it, and empty the colostomy before lying down. A pillow against the abdomen can make side-lying more comfortable in the early weeks.
Can I fast for religious reasons?
Going without food for a day is usually manageable once you have recovered, but going without water is a real risk with a urostomy, because the kidneys need a steady flow to stay clear of infection. Talk to your doctor before any fast that limits fluids, and ask your religious guide what allowances exist for illness.
Will I be able to swim or exercise?
Walking and gentle exercise are encouraged from early on. Swimming is possible once the wounds have fully healed, with the bags on and sealed. Heavy lifting and hard abdominal exercise should wait for your surgeon's go-ahead, because the stomas sit in the muscle wall and a hernia can develop around them.
Where do I buy supplies in Telangana?
Larger pharmacies in Hyderabad stock the main brands, and most can order in. In the districts it is harder, so many families order online or buy a month's stock at each follow-up visit. Ask your stoma nurse for the exact product codes, because the wrong size is the commonest cause of leaks.
Does insurance or Aarogyasri cover stoma bags?
Cover for the operation and the stay is usual under Aarogyasri, CGHS, ECHS, EHS and most cashless insurers. Cover for ongoing bags and plates after discharge varies a great deal between schemes and policies. Ask before the operation what is included, and call the helpline if you want help checking.
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Sources
- NHS — Colostomy
- NHS — Urostomy
- Cancer Research UK — Pelvic exenteration for cervical cancer
- Macmillan Cancer Support — Surgery for cancer
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
Urinary Diversion After ExenterationHow the urostomy is built and the other optionsSexual Function After Pelvic ExenterationThe honest conversation about intimacyLife a Year After Pelvic ExenterationWhat settles, and what stays differentComplications and Red FlagsThe full list of what needs same-day careThe Emotional Side of Cancer SurgeryGrieving a change to your body is normal
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Struggling with a stoma at home?
Call the helpline. A stoma nurse or an oncologist will talk it through with you, and tell you whether it needs to be seen. One helpline serves every CION centre.