What is an ostomy?
An ostomy is a surgical opening in the abdomen that diverts intestinal or urinary flow to the outside. It can be temporary or permanent depending on the case.
Types of ostomy
Colostomy: Diversion of the colon. Most common in low colon cancer or rectal cancer
Ileostomy: Diversion of the ileum (small bowel). Temporary in rectal surgery to protect the anastomosis
Urostomy: Urinary diversion. In extensive bladder or gynaecological surgery
When it is needed
• Low rectal cancer (5-8 cm from the anus): permanent colostomy
• Protection of the anastomosis: temporary ileostomy
• Bowel obstruction caused by a tumour
• Postoperative complications (fistulas)
• Extensive pelvic surgery with rectal resection
Adaptation and quality of life
With the right education, >90% of patients adapt well. They can work, travel, play sport and keep an active sex life.
Basic care
• Daily hygiene, changing the bag every 3-5 days
• Diet adapted to the type of ostomy
• Follow-up by a stoma care nurse
• Suitable supplies (bags, base plates, protective barriers)
Can a permanent ostomy be avoided?
This is the question we hear most often in clinic, and the answer depends less on the tumour than on who operates and how. Many ostomies presented as permanent are not necessarily so.
Low rectal cancer: sphincter-preserving surgery makes it possible to restore bowel continuity in a large proportion of tumours located 5-8 cm from the anus, provided correct oncological margins are achieved. It requires a surgeon with a high volume in rectal cancer and, often, a robotic approach to work in the narrow pelvis.
Obstruction caused by a tumour: an emergency ostomy is usually temporary. Once the obstruction has been resolved and treatment completed, reconstruction should be reconsidered.
Extensive pelvic surgery: even in pelvic exenterations, the decision on permanent diversion is made case by case, not by protocol.
If you have been told you need a permanent colostomy and nobody has explained why the alternative is not possible, that is a reasonable reason to ask for a second surgical assessment before the operation.
Ostomy reversal: when it is possible
A protective ileostomy after rectal surgery is, by definition, temporary. It is usually reversed 2 to 6 months later, once the integrity of the anastomosis has been confirmed and adjuvant chemotherapy, if indicated, has been completed.
Conditions that must be met to restore bowel continuity:
• An intact anastomosis with no leaks, confirmed by imaging
• A functioning anal sphincter
• No tumour recurrence
• Nutritional and general condition suitable for a second operation
When the ostomy has been in place for years, reversal is still technically possible in selected cases, but it is complex surgery that should be assessed by a team with experience in salvage surgery.
Have you been told you need a permanent ostomy? Before accepting it, it is worth confirming whether a preservation alternative exists or whether the diversion can be reversed later. Our team assesses these cases and tells you frankly what is possible in yours. Request an assessment.