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CION Cancer Clinics
Ileostomy reversal: timing and what to expect | CION Cancer Clinics
A temporary ileostomy is usually reversed a few months after the rectal operation, once the join deep in the pelvis has healed and any chemotherapy has finished. Before the date is fixed, a dye test checks the join and the anaesthetist checks your fitness. The reversal is a shorter operation, but the weeks after it, when the bowel learns to work again, are often the hardest part. 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
- When is a temporary ileostomy reversed?
- From the stoma to the reversal, step by step
- What actually happens during the reversal?
- What is bowel function like afterwards?
- Words you will meet, in plain language
- Common reasons a reversal is delayed
- Four things families tell us, and what is actually true
- Common questions about ileostomy reversal
The short answer
When is a temporary ileostomy reversed?
A temporary ileostomy is usually reversed a few months after the rectal operation, once the join deep in the pelvis has healed and any chemotherapy has finished. For many people that means somewhere between three months and a year. The date is set by healing and treatment, not by the calendar.
Why the wait is as long as it is
The stoma was made to keep stool away from the new join while it heals. Reversing it too early risks a leak at that join, which is the most serious complication of rectal surgery. If you need chemotherapy after the operation, most surgeons prefer to finish it first, because chemotherapy slows healing and a second operation would interrupt the course.
What has to be true before the date is fixed
Three things. A dye study has shown the join is sealed and not narrowed. You are fit enough for another anaesthetic. And any treatment that would get in the way has finished. Your surgeon will also check how well the muscle ring at the anus is working.
What this page cannot tell you
It cannot tell you your date, or promise that your stoma will be reversed at all. A few people keep it longer, or for good, because the join has not healed, because of other illness, or by choice. Ask your surgeon at every follow-up where things stand.
The pathway
From the stoma to the reversal, step by step
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Healing from the first operation
The first weeks are about the main wound, the new stoma and getting eating and drinking right. Nobody is thinking about reversal yet.
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The pathology report and any chemotherapy
What was found in the removed tissue decides whether chemotherapy is advised. If it is, the stoma usually stays until the course is complete, and the reversal is planned for a few weeks after.
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Checking the join
A dye is passed through the back passage and pictures are taken to show the join is sealed and not narrowed. Some surgeons also look directly with a small camera. It is uncomfortable rather than painful.
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The fitness check
Blood tests, a chest check and a review by the anaesthetist. If you lost weight or strength during chemotherapy, you may be asked to build up for a few weeks first.
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The reversal itself
A shorter operation than the first, usually through the stoma site alone. The two ends of small bowel are joined and the skin is closed. Most people go home within days.
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Learning the bowel again
The first weeks after reversal are the hardest part, with frequent, loose and urgent motions. This is expected and it improves. Our page on low anterior resection syndrome explains why.
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What actually happens during the reversal?
The cut
The surgeon cuts around the stoma, frees the loop of bowel, joins the two ends and returns them inside. Usually no other cut is needed. Occasionally the tummy has to be opened more widely if there is a lot of scar tissue.
The anaesthetic
A general anaesthetic, so you are asleep. Because the operation is shorter than the first, most people feel less knocked about afterwards. Tell the anaesthetist about any problem last time.
The stay
Usually a few days. You are encouraged to walk and drink early. The team waits for the bowel to start working, which shows as wind and then a motion, before you go home.
Reasons the stay runs longer
- The bowel is slow to wake up
- A wound infection at the stoma site
- Vomiting or a bloated tummy
The wound
The old stoma site is often left partly open or closed loosely, because it is a wound that was in contact with bowel contents. It heals from the inside over a few weeks and leaves a puckered scar.
Being straight with you
What is bowel function like afterwards?
Expect the first weeks to be difficult. The rectum that stored stool has been partly or fully removed, and the bowel above it has been resting for months. Frequent motions, urgency, several motions in a cluster and some leakage are all common at first, and most people find they improve over the following months.
What helps early on
Eating small, regular meals. Thickening foods such as rice, banana and toast. Barrier cream around the anus. A medicine to slow the bowel or bulk the stool if your team prescribes one. And a plan for where the toilets are, so the fear of urgency does not keep you at home.
Who a reversal may not suit
Someone whose muscle ring at the anus was weak before surgery, or who had radiotherapy to the pelvis, may be warned that function after reversal could be poor, and offered the choice of keeping the stoma. Someone too frail for another anaesthetic, or whose cancer has returned, may be advised against it. This is a discussion, not a verdict.
The question to ask
"What do you expect my bowel to be like a year after reversal, and how would that compare with keeping the stoma?" A good surgeon will answer both halves honestly. If the answer is "we cannot be sure", that is an honest answer too.
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On your notes
Words you will meet, in plain language
- Anastomosis
- The join between two ends of bowel. The reversal makes a new one in the small bowel; the first operation made one in the pelvis.
- Contrast enema or leak test
- The dye study that checks the pelvic join is sealed before the stoma is closed.
- Stricture
- A narrowing at the join. If found, it may need stretching before reversal, which delays the date.
- LARS
- Low anterior resection syndrome: the frequent, urgent, clustered motions many people have after the rectum is removed and the stoma is closed.
- Parastomal hernia
- A bulge beside the stoma where bowel pushes through the muscle wall. Reversal usually removes the problem.
Why the date moves
Common reasons a reversal is delayed
- Chemotherapy has not finished, or was extended
- The dye study shows the join is not yet sealed
- A narrowing at the join that needs stretching first
- Weight or strength lost during treatment
- Your own choice to wait for a family event or harvest
Commonly believed
Four things families tell us, and what is actually true
"After the reversal, everything goes back to how it was."
The stoma goes, but the rectum does not come back. Most people have frequent and urgent motions at first, and many have some change for good. It improves and can be managed, but expect a new normal rather than the old one.
"The reversal is a small operation, so there is nothing to worry about."
It is smaller than the first, and most people recover faster. It is still an operation under a general anaesthetic, with a wound, a new join and a real chance of a slow bowel or a wound infection. Prepare for it properly.
"If they delay it, something must be wrong."
Delays are usually about chemotherapy, fitness or a join that needs more time, not about the cancer. Ask the reason directly. A surgeon who is waiting for a good reason will tell you what it is.
"We should get it reversed quickly so he can stop the special diet."
Reversing before the join has healed risks a leak, which is far worse than months more with a bag. The wait is a safety margin, not a queue.
Questions we are asked
Common questions about ileostomy reversal
How long after the first operation is the stoma usually closed?
Commonly a few months, and for people who have chemotherapy afterwards, a few weeks after the last cycle. Some units close it earlier when no chemotherapy is planned and the join has healed well. Your own date depends on the dye study, your fitness and your treatment, so ask your surgeon.
Is the reversal done through the same big cut?
Usually not. Most reversals are done through a cut around the stoma itself, and the old scar is left alone. If there is a lot of scar tissue inside, or the surgeon cannot reach safely, the tummy may need to be opened more widely. Ask which is likely for you.
How long will I be in hospital?
Usually a few days, until the bowel has started working and you are eating and passing motions. It runs longer if the bowel is slow to wake up or the wound becomes infected. Have someone at home for the first days.
Will I be able to control my bowels straight away?
Not fully, and it is important to know that beforehand. Urgency, frequent motions and some leakage are common in the first weeks. Barrier cream, small regular meals and, if prescribed, a bowel-slowing medicine all help. Most people see steady improvement over months.
Can I choose to keep the stoma instead?
Yes. Some people, particularly those warned that bowel function may be poor, decide a well-managed stoma suits them better. It is a legitimate choice and your surgeon should discuss it with you openly, without pressure either way.
What is the dye test like?
A soft tube is placed in the back passage and a liquid that shows on X-ray is run in while pictures are taken. It takes a few minutes and feels like pressure and a strong urge to go. You go home straight after.
Does the reversal cost extra, and is it covered?
It is a separate operation and is billed separately. Aarogyasri, CGHS, ECHS and EHS cover stoma reversal as part of cancer treatment, and most cashless insurers do too, but approval has to be sought again. Call the helpline with your scheme details before the date is fixed.
What if the cancer comes back before the reversal?
The plan changes, and the reversal is usually put on hold while the team decides on treatment. This is one reason the scans before reversal matter. It does not mean the stoma will never be closed; the order of events is being rethought with you.
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Dr. C. Raghavendra Reddy
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MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- NHS — Ileostomy
- Cancer Research UK — Surgery for rectal cancer
- American Cancer Society — Surgery for rectal cancer
- NICE — Colorectal cancer (NG151)
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
The Temporary Ileostomy After Rectal SurgeryWhy the stoma was made in the first placeLow Anterior Resection SyndromeThe bowel changes most people meet after reversalBowel Retraining After Rectal SurgeryPractical steps for the weeks after the stoma is closedFitness, Tests and PrehabilitationGetting ready for a second anaestheticCost, Insurance and Schemes for Cancer SurgeryHow a second operation is covered
Talk to us
Waiting for a reversal date?
Send us your discharge summary and any scan reports, or call the helpline. A surgical oncologist will explain where you are on the pathway and what still has to happen before the stoma can be closed.