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Life with an ileostomy: how it differs from a colostomy | CION Cancer Clinics
An ileostomy is made from the small bowel and a colostomy from the large bowel. That one difference explains almost everything else. An ileostomy produces loose, watery output through the day, needs a drainable bag and can dry you out. A colostomy passes formed stool once or twice a day into a closed bag. After rectal cancer surgery most stomas are ileostomies, and most of those are temporary. 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
- What is the actual difference between an ileostomy and a colostomy?
- Ileostomy and colostomy, compared
- How daily life differs with each type
- How you learn the routine
- Why did my surgeon choose one and not the other?
- Four things families tell us, and what is actually true
- Words you will hear, in plain language
- Common questions about ileostomies and colostomies
The short answer
What is the actual difference between an ileostomy and a colostomy?
An ileostomy brings the small bowel out through the skin of the tummy. A colostomy brings the large bowel out. Because the large bowel is the part that soaks up water, a colostomy passes formed stool, while an ileostomy passes loose, watery output that never had the chance to thicken.
Why that one difference matters so much
Almost every practical difference follows from it. How often the bag needs emptying. How careful you must be about fluids and salt. How sore the skin can get. An ileostomy is a wet stoma; a colostomy is usually a dry one.
Which one you are likely to have after rectal surgery
After a low anterior resection, the surgeon joins the bowel back together deep in the pelvis. To protect that join while it heals, most people are given a temporary loop ileostomy. A colostomy is more likely when the whole rectum and the anus have to be removed, and that one is usually permanent.
What this page cannot tell you
It cannot tell you which type you will have, or whether yours will be reversed. Those answers sit in your own scan and operation notes. Ask your surgeon for them plainly before the day.
Side by side
Ileostomy and colostomy, compared
Ileostomy
Colostomy
Made from the small bowel, usually on the right side of the tummy
Made from the large bowel, usually on the left side
Output is loose, like porridge or thinner, and flows through the day
Output is formed or soft, and often comes once or twice a day
Drainable bag, emptied several times a day, changed every day or two
Closed bag, thrown away and replaced when used
Real risk of dehydration and salt loss, especially in Hyderabad heat
Dehydration is uncommon unless you are unwell
After rectal cancer surgery, usually temporary
After removal of the anus, usually permanent
Day to day
How daily life differs with each type
Emptying and changing
With an ileostomy you empty a drainable bag when it is about a third full, which means several times a day and once at night. With a colostomy the bag is closed, and you replace the whole thing when it has been used.
Food and drink
An ileostomy needs more thought. Some foods thicken the output and some make it run, and you need more salt and more to drink than before. With a colostomy most people go back to their usual food within a few weeks.
Foods that often thicken ileostomy output
- Plain rice, curd rice, idli
- Ripe banana, boiled potato
- White bread and toast
The skin around the stoma
Ileostomy output contains digestive juices that burn the skin if the bag leaks or the hole in the baseplate is cut too large. Colostomy output is far gentler. Red, weeping or painful skin is a reason to see the stoma nurse, not something to put up with.
Wind, smell and clothing
Both bags have filters that let wind out without smell. Loose clothing hides either kind. Nobody at the temple or at a wedding will know unless you tell them.
Not sure whether this applies to you?
Ask an oncologistThe first weeks
How you learn the routine
Before the operation
A stoma nurse marks the spot on your tummy where the stoma will sit, so that you can see it and the bag does not fold when you sit down. Ask to meet the nurse before the day, and say what clothes you wear and what work you do.
In hospital
The stoma nurse changes the bag with you watching, then watches you do it. Bring the family member who will help at home, so two people learn before you leave.
The first fortnight at home
Output from an ileostomy is often at its heaviest and most watery in these weeks. Keep a simple note of how many times you empty the bag each day, and bring it to the first follow-up.
When it settles
Over the following weeks the output usually thickens and the number of emptyings falls. With a colostomy many people learn roughly what time of day the bag fills. The routine becomes ordinary sooner than families expect.
The surgeon's decision
Why did my surgeon choose one and not the other?
The type of stoma is decided by where the cancer sits and what has to be removed, not by preference. If the anus and the muscle ring that controls it can be kept, the bowel is joined back together and a temporary ileostomy protects that join. If they cannot be kept, the bowel has to end somewhere, and that end becomes a permanent colostomy.
Why the protecting stoma is an ileostomy
A loop ileostomy is quicker to make, sits well away from the pelvic join, and is easier to close again later. The more demanding stoma is chosen because it is the easier one to take away.
Who a temporary stoma does not suit
If the tumour sits very close to the anus, if the muscle ring is already weak, or if you are frail enough that a second operation would be unsafe, a permanent colostomy may be the safer plan. Your surgical team weighs these, and it is fair to ask which applied to you.
What nobody can promise on the day
Whether your ileostomy will be reversed, and when, depends on how the join heals, whether you need chemotherapy, and how fit you are for a second operation. Ask at each follow-up.
Commonly believed
Four things families tell us, and what is actually true
"A colostomy is the serious one. An ileostomy means the cancer was small."
The type of stoma says nothing about how serious the cancer is. It says only where the tumour sat and whether the anus could be kept. Some very early cancers need a permanent colostomy purely because of position.
"With a stoma she cannot eat normal food again."
With a colostomy most people return to their usual diet. With an ileostomy there is more to learn, but rice, dal, curd, chapati, cooked vegetables and most curries are all fine once you know how your own stoma responds.
"He will never be able to travel or go to work."
People with either type of stoma drive, work, fly, swim and go on pilgrimage. What changes is planning: spare bags, a known toilet, and with an ileostomy something salty to drink on a hot day.
"The stoma should be hidden from the family."
The person who will help at home needs to see it and learn to change it. Families shown the stoma in hospital cope far better than families kept away from it.
From the stoma nurse
Words you will hear, in plain language
- Stoma
- The opening on the tummy where the bowel comes to the surface. It is pink, moist and has no feeling.
- Loop ileostomy
- A temporary ileostomy made from a loop of small bowel, with two openings side by side. The usual protecting stoma after rectal surgery.
- End colostomy
- The cut end of the large bowel brought to the surface. The usual permanent stoma when the anus has been removed.
- Output
- What comes out of the stoma. The nurse asks about its amount and thickness at every visit, because both say how you are doing.
- Baseplate or flange
- The sticky ring that holds the bag to the skin. Its hole must be cut to match your stoma, which changes size in the first weeks.
Questions we are asked
Common questions about ileostomies and colostomies
How much output from an ileostomy is normal?
In the first weeks it is often high and watery, then it thickens as the small bowel adapts. Your stoma nurse will tell you what to expect for you. What matters more than the figure is the trend: output that rises sharply or turns to water needs a call the same day.
Will the ileostomy definitely be reversed?
Usually the plan is to reverse it once the join has healed and any chemotherapy has finished, but nobody can promise that on the day of surgery. The team checks the join with a scan first. A few people keep the stoma longer, or for good, because of poor healing or other illness.
Can I eat rice and curd with an ileostomy?
Yes. Plain rice, curd rice and idli thicken output, so they are often encouraged. Chew well and eat smaller meals more often. Be careful with skins, seeds and tough fibre, such as raw salad, corn and nuts, because they can block the stoma.
Which is easier to live with?
Day to day, a colostomy is closer to a normal bowel and asks less of you. An ileostomy takes more attention to fluid, salt and skin. But after rectal surgery the ileostomy is usually temporary and the colostomy is for life, so it is not a choice you make.
Can I bathe, swim and pray normally?
Yes to all three, with either type. The bag is waterproof, so bathing and swimming are fine once the wound has healed. Many people empty or change the bag before namaz or a temple visit. If ritual cleanliness worries you, say so; the stoma nurse has answered it many times.
Does the stoma hurt?
The stoma itself has no nerves for pain, so touching it does not hurt. What hurts is sore skin around it, which usually means the bag is leaking or the hole is cut too wide. The main wound is separate, and that pain fades over the first weeks.
Are the bags covered by Aarogyasri or insurance?
Sometimes. Aarogyasri, CGHS, ECHS and EHS cover the operation, and some schemes and cashless insurers cover a first supply of bags. Ongoing supplies are often paid for by the family. Ask the stoma nurse what a month of supplies costs locally.
Who do I call if the bag keeps leaking?
The stoma nurse, not the emergency department. Repeated leaks almost always mean the baseplate is the wrong size or the skin has become uneven. It is fixed by refitting, and the sooner it is looked at the less the skin suffers.
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Sources
- NHS — Ileostomy
- NHS — Colostomy
- American Cancer Society — Ostomies
- Cancer Research UK — Surgery for rectal 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
The Temporary Ileostomy After Rectal SurgeryWhy the protecting stoma is made and how long it staysHigh Output From an IleostomyWhat to do when the bag fills too fastDehydration and Salt With an IleostomyThe one risk an ileostomy carries that a colostomy does notSphincter-Saving Surgery vs Permanent StomaHow the surgeon decides whether the anus can be keptIleostomy Reversal: Timing and What to ExpectWhen and how a temporary stoma is closed
Talk to us
Been told you will need a stoma?
Send us the operation plan or call the helpline. A surgical oncologist will explain which type is likely for you and why, and put you in touch with a stoma nurse before the day.