What is a Colostomy? A Guide for Ovarian Cancer Patients

A colostomy is a surgical procedure that creates an opening in your abdomen, allowing waste to leave your body through a new route when your bowel can’t function normally. If you’re facing ovarian cancer surgery, understanding what a colostomy involves can help you feel more prepared and less anxious about what lies ahead.

Understanding Colostomy Surgery

When ovarian cancer spreads to your bowel (which happens in more advanced cases) your surgical team may need to remove the affected section. Sometimes, they can reconnect the healthy portions of your bowel right away. But in other cases, your body needs a temporary bypass to heal properly.

That’s where a colostomy comes in.

During the procedure, your surgeon brings part of your colon (large intestine) through an opening in your abdominal wall. This opening is called a stoma. Your stool then exits through this stoma into a pouch that attaches to your skin. The pouch, often called a colostomy bag, collects everything and can be emptied as needed.

What is a Colostomy Bag?

A colostomy bag is a medical pouch that adheres to your abdomen over the stoma. Think of it as a discreet collection system that you control and manage yourself.

Modern colostomy bags are designed with everyday life in mind. They’re made from odor-proof materials, come in different sizes, and can be either opaque or clear. You’ll work with a specialized stoma nurse or ostomy nurse (sometimes called a WOC nurse — Wound, Ostomy, and Continence nurse) to find the system that works best for your body and lifestyle.

The bag typically needs emptying when it’s about one-third full. Most people change their complete pouching system about once or twice a week, though this varies by individual needs.

What is the Difference Between a Colostomy and Ileostomy?

Both colostomy and ileostomy are types of ostomy surgery, but they involve different parts of your digestive system.

A colostomy uses your large intestine (colon). Because waste has traveled further through your digestive tract, the output is typically more solid and formed. The stoma is usually positioned on the left side of your abdomen.

An ileostomy uses your small intestine (ileum). The output here is looser, more like the consistency of toothpaste or thick liquid, because less water has been absorbed from the waste. The stoma typically sits on the right side of your abdomen. Because of where it’s located in your digestive system, an ileostomy requires more frequent emptying, usually 3 to 4 times daily.

Ileostomies are more commonly used as temporary protective diversions during healing. They come with some advantages: lower rates of stoma prolapse (when the stoma extends further out), retraction (when it pulls inward), and parastomal hernia (when abdominal contents push through near the stoma) compared to colostomies. 

However, because the output is more liquid, ileostomies carry a higher risk of dehydration, making it especially important to stay well-hydrated.

Which type you might need depends entirely on your specific situation and what your surgeon finds during ovarian cancer treatment. Your medical team will explain their recommendations based on where the cancer has spread and which approach gives you the best outcome.

Types of Colostomies in Ovarian Cancer Surgery

Not all colostomies work the same way. Understanding the different types can help you know what questions to ask your surgical team.

By Location in Your Colon

Sigmoid colostomy is the most common type. It’s created in the last section of your colon before the rectum, and because waste has traveled through most of your digestive system, the stool is firmer and more formed.

Descending colostomy sits on the lower left side of your abdomen. The output is still fairly solid since it’s not far from the sigmoid colon.

Transverse colostomy is positioned horizontally across your upper abdomen. Here, stool tends to be softer and less formed because it hasn’t traveled as far through your colon.

Ascending colostomy is rare and usually temporary. Located on the right side of your abdomen, it produces liquid or semi-liquid stool.

By Surgical Technique

End colostomy brings one end of your colon through your abdominal wall to create a single opening. This is typically permanent, though sometimes it can be temporary to allow healing before reconnection.

Loop colostomy involves pulling a loop of colon through your abdomen and partially cutting it to create one large stoma with two openings. This type is usually temporary and often used when part of your bowel needs time to heal.

Double-barrel colostomy (also called an end colostomy with a mucous fistula) creates two separate stomas: one for waste and one for mucus. This is typically a temporary solution used in emergency situations.

When Might You Need a Colostomy?

Bowel resection during ovarian cancer surgery isn’t uncommon when the disease has spread. The good news is that in most cases, your surgeon can reconnect the healthy portions of your bowel right away — a procedure called an anastomosis — and an ostomy isn’t needed at all.

However, you might need a colostomy if certain conditions make immediate reconnection risky or impossible:

• The tissue quality at the reconnection site isn’t healthy enough for proper healing
• The location of the anastomosis makes it particularly vulnerable
• You’ve had an extensive anastomosis created that needs time to heal without the stress of passing stool
• Your bowel needs a period of rest after extensive surgery

Research has identified specific risk factors that increase the likelihood of needing an ostomy during ovarian cancer surgery. These include large volume ascites (fluid buildup in the abdomen), low protein levels in your blood, high peritoneal cancer index (widespread disease in the abdominal cavity), multiple intestinal resections, anastomoses located below the peritoneal reflection (lower in the pelvis), and suboptimal cytoreduction (when not all visible cancer can be removed).

In many cases — and this is important to know — the colostomy is temporary. Your surgeon creates it to protect healing tissue and give your body time to recover. Once everything has healed properly and you’ve completed any necessary chemotherapy for ovarian cancer, you may be able to have reversal surgery.

But some colostomies are permanent. This happens when too much of the bowel needs to be removed or when reconnection isn’t surgically possible. Your surgical team will be honest with you about which situation applies to you.

Preparing for Colostomy Surgery

Finding out you might need a colostomy can feel overwhelming. That’s completely normal. But preparation can help ease some of that anxiety.

In most cases, you’ll be consented for the possibility of a colostomy before any debulking surgery for ovarian cancer. It’s a standard part of preparing for advanced disease. 

However, whether you’ll actually need one often isn’t known until your surgeon is operating and can see the full extent of disease involvement.

Some hospitals offer preoperative ostomy education, where you’ll meet with a stoma nurse before surgery. Research shows this preparation makes a real difference: it can reduce hospital length of stay (8 days versus 10 days without education), decrease patient anxiety, reduce complications around the stoma site, help you become proficient in ostomy care faster (5.5 days versus 9 days), improve quality of life, and result in significant cost savings.

If your hospital offers this service, the stoma nurse will talk you through what to expect and may even mark potential spots on your abdomen where the stoma could be placed. They’ll consider things like:

• Your natural skin folds
• Where you wear your waistband
• Your hip bones and belly button location
• How you move and sit

The goal is choosing a spot you can easily reach and see, both sitting and standing.

Your surgical team will also discuss your diet leading up to surgery. You might need to follow specific eating guidelines or take bowel preparation solutions. These steps help ensure the cleanest surgical field possible.

What to Expect During Recovery

In the hospital, you’ll wake up with a clear pouch over your stoma. This transparent bag lets nurses monitor output while you recover. Don’t be alarmed if your stoma looks swollen or dark red right after surgery. This is normal and the swelling will go down over the following weeks.

You’ll probably spend anywhere from three days to a week in the hospital, depending on how extensive your surgery was. During this time, your stoma nurse becomes your new best friend. They’ll teach you:

• How to empty your pouch
• When to change your complete pouching system
• How to clean around your stoma
• What healthy stoma tissue looks like
• How to protect the skin around your stoma

Here’s something important to know: you’ll need to demonstrate that you can care for your ostomy independently before you’re discharged. This hands-on learning is a key part of your recovery timeline. 

The faster you feel comfortable managing your own care, the sooner you can go home. Don’t feel pressured, but do engage fully with your stoma nurse’s teaching. Ask questions, practice the techniques, and speak up if something doesn’t make sense. Some patients need a bit more time to gain confidence with ostomy care, and that’s okay. Your team will work with you at your own pace.

At first, you’ll only pass gas through your stoma. Within two or three days, you’ll start passing stool, which will probably be quite liquid initially. As your bowel function returns to normal, things will firm up.

At home, recovery continues. You won’t be able to do heavy lifting or strenuous activities for several weeks. You’ll feel tired, sometimes profoundly so. This is your body’s way of telling you it’s working hard to heal.

During this time, having support matters. Whether it’s a partner, family member, or friend who can help with daily activities like cooking, cleaning, and managing your stoma care, don’t hesitate to ask for help. Many patients also find comfort in connecting with ovarian cancer support groups where others understand exactly what you’re going through.

Living with a Colostomy: Practical Guidance

Once you’re home and healing, you’ll develop your own rhythm for managing your colostomy. These practical tips can help you navigate the day-to-day realities with more confidence.

Managing Your Pouching System

Your pouching system includes both the bag (to collect waste) and a wafer or skin barrier (to protect your skin and attach the bag). All systems have these two components, but they come in different styles and configurations to suit different needs.

There are two main types of systems:

• One-piece pouches combine the pouch and skin barrier together in a single unit. When you remove the pouch, the barrier comes off with it, and you apply an entirely new system each time.
• Two-piece systems keep the pouch and barrier separate. The barrier stays adhered to your skin while you can remove and replace just the pouch. This allows you to change the bag without disturbing the skin barrier.

Beyond these basic systems, you’ll find other helpful accessories. Some people use belts to help secure the ostomy system more firmly in place. If your stool output becomes predictable and occurs at regular times, you might even be able to use a cap instead of wearing a full pouch all the time.

The opening in your skin barrier needs to fit snugly around your stoma, no more than 1/8 inch larger than the stoma itself. Getting the right fit matters. Too small, and it could cut or injure your stoma. Too large, and stool could irritate your skin.

Your stoma will change size as swelling goes down after surgery. During your recovery period, measure your stoma once a week to ensure you’re using the right fit and size. As healing progresses and the swelling fully resolves, your stoma will settle into its permanent size, but those early weeks require regular monitoring.

Emptying Your Bag

Empty your colostomy bag when it’s one-third to one-half full. This prevents it from getting too heavy (which could loosen the seal) and keeps it discreet under clothing.

The process is straightforward:

• Sit on the toilet or on a chair facing the toilet
• Place toilet paper in the bowl to reduce splashing
• Open the clip or closure at the bottom of the bag
• Gently empty the contents
• Clean the inside and outside of the pouch tail
• Close and secure the clip

Protecting Your Skin

The skin around your stoma should look like the skin anywhere else on your abdomen. But exposure to stool (especially if it’s loose) can cause irritation.

Keep your skin healthy by:

• Ensuring your barrier opening is the right size
• Changing your pouching system regularly (typically twice a week)
• Removing the system gently and pushing your skin away rather than pulling the barrier off
• Cleaning with warm water only and drying completely before applying a new system
• Watching for any signs of irritation, redness, or itching

If your skin does become irritated, don’t ignore it. Contact your stoma nurse or healthcare team right away. Skin problems can prevent proper sealing and lead to bigger issues.

Diet and Nutrition After Colostomy

Here’s some good news: having a colostomy doesn’t require a special diet. Your body still digests food normally. It just exits through a different route.

That said, some guidelines can help:

• Eat on a regular schedule with three or more small meals daily
• Chew your food thoroughly
• Drink 8 to 10 glasses of water each day to prevent dehydration and constipation
• Try new foods one at a time so you can identify what affects your stool
• For the first two weeks after surgery, limit gas-producing foods like beans, broccoli, cabbage, and carbonated drinks

Keep track of how different foods affect you. Some may cause more gas, looser stool, or odor. This knowledge helps you make informed choices, especially before social situations or travel.

Bathing and Swimming

You can absolutely shower or bathe with your colostomy. Water won’t enter your stoma, and soap won’t harm it. Just rinse thoroughly and make sure no soap film remains before applying your new pouching system.

Many people shower with their bag off, especially in the morning when bowel activity is typically lower. Others prefer keeping it on. Do what feels comfortable for you.

Swimming is also completely possible. Consider swimwear with patterns or darker colors if you’d prefer more concealment, though many modern pouching systems are quite discreet.

Intimacy and Your Colostomy

Ovarian cancer and sex can be complicated enough without adding concerns about a colostomy. But intimacy can still remain fulfilling.

Many people worry about leaks or odor during intimate moments. Some solutions that help:

• Empty or change your bag beforehand
• Use a smaller pouch or a stoma cap designed for intimacy
• Cover the bag with special wraps or a soft camisole
• Communicate openly with your partner about any concerns

Give yourself time to adjust. Your confidence will grow as you become more comfortable managing your colostomy in daily life.

When Colostomy Reversal Might Happen

If your colostomy was temporary, you’re probably wondering: when can it be reversed?

According to multiple studies, between 70-80% of patients with temporary ostomies have them successfully reversed, typically between 2 and 50 weeks after the initial surgery. The timing depends on several factors:

• How well you’ve healed from your initial surgery
• Whether you needed chemotherapy for ovarian cancer and how you responded
• Your overall health and any complications that may have occurred
• Results from tests showing your bowel has healed properly

Your surgical team will monitor your progress during follow-up visits and let you know when reversal might be possible. Keep in mind that even after reversal, your bowel habits likely won’t return exactly to how they were before your ovarian cancer diagnosis. The surgery, treatment, and period of bowel rest all have lasting effects.

Managing Challenges and Complications

Even with excellent care, challenges can arise. Knowing what to watch for helps you address problems quickly. Contact your healthcare team immediately if you notice:

• Severe cramps lasting more than 2 to 3 hours
• Continuous nausea or vomiting
• Very watery stool lasting more than 5 to 6 hours
• A lot of bleeding from your stoma
• Your stoma changing color significantly (very dark or pale)
• Deep cuts or injuries to your stoma
• Severe skin irritation that won’t improve
• Your pouching system leaking repeatedly despite proper application
• Signs of infection around your stoma, including purulent (pus-like) drainage, warmth, tenderness, redness, or fever
• Signs of serious infection (sepsis), such as high heart rate, low blood pressure, or altered mental status (these require emergency medical attention)

Common Concerns

Gas and odor are often worries, especially in social situations. Modern pouching systems are designed to be odor-proof when sealed. If you notice odor, check that your skin barrier is secure. Certain foods — eggs, cabbage, fish, onions — can increase odor, so you might choose to avoid them before important events.

Finding pills in your pouch can indicate you’re not absorbing your medications properly. Talk to your doctor or pharmacist about whether liquid formulations might work better for you.

Constipation or diarrhea both need attention. Stay hydrated, eat adequate fiber, and stay as active as your recovery allows. If problems persist, your healthcare team can recommend or prescribe medication to help.

Phantom rectum is another experience some patients face after perineal or rectal resection. Even though your rectum has been removed or bypassed, you may still feel the urge to have a bowel movement. This sensation can occur at any time after surgery and can be disconcerting. If this happens, try sitting on the toilet and going through the motions as if you were having a bowel movement. This often helps the feeling pass. Know that phantom rectum is a recognized phenomenon, and your healthcare team can offer additional strategies if it becomes bothersome.

Moving Forward

A colostomy doesn’t define you. It’s a medical intervention that allows you to heal, receive necessary treatment, and, most importantly, survive.

Yes, it requires adjustment and learning. Yes, it changes some aspects of daily life. But thousands of people live full, active, joyful lives with colostomies. They travel, swim, exercise, maintain careers, enjoy relationships, and pursue their passions.

Your stoma nurse, surgical team, and the broader ovarian cancer community are here to support you through every step. Take advantage of their expertise. Ask questions, even the ones that feel embarrassing. Advocate for yourself when something doesn’t feel right.

Some additional resources that could be helpful for you:

• Osto Group is an organization that takes donations of unused ostomy products and gives to uninsured people.
• The United Ostomy Associations of America promotes quality of life for people with ostomies and continent diversions through information, support, advocacy and collaboration.
• Meet an Ostomate hosts a unique community of 40,000+ members where people talk openly, receive support, make friends, and even find relationships while navigating life with an ostomy.
• Convatec’s me+ program provides free support, advice, tools, and ostomy supplies to financially eligible patients.