Before a stoma, contents normally pass through the small bowel, where nutrients are absorbed, and the colon, which absorbs water. Stool is stored in the rectum until it leaves through the anus. A temporary stoma diverts contents through the abdominal wall into a pouch, often to protect a bowel join or give an injured or inflamed area time to heal.

Reversal closes the opening in the abdominal wall and reconnects bowel so contents can travel onwards towards the anus. A join is called an anastomosis. The exact route depends on what was removed in the original operation and whether a rectum or an internal pouch remains. Reversal does not put removed bowel back.

An ileostomy is made from small bowel; a colostomy is made from large bowel. A loop stoma uses an opened loop, while an end stoma uses the cut end of bowel. Both can be temporary in suitable circumstances, but their closure may require different surgery. An end stoma may require a larger operation to reconnect the bowel. Ask your surgeon to explain your own anatomy.

After reconnection, the remaining bowel and the muscles that hold stool must work together. If much of the rectum has been removed, there may be less storage space and bowel movements can be more frequent or harder to control. Your previous operation and treatment matter as much as the closure itself when considering likely function.

An intention to reverse is not a guarantee. The team considers whether you are fit enough for another operation, whether the bowel or join the stoma protected has healed, and whether the remaining bowel, rectum and anal sphincter can provide a usable route and acceptable function. Your wishes and quality of life matter alongside those clinical findings.

Depending on your original surgery, assessment may include an examination of the rectum and tests to check healing or the bowel join. Ask what each test is looking for, what its result means, and whether there are concerns about inflammation, a leak, scarring or bowel control. Not everyone needs the same tests.

Some stomas cannot be reversed because the anus has been removed or there is not enough suitable bowel to reconnect safely. Continued illness, incomplete healing, other treatment or the risks of anaesthesia and surgery may also change the plan. Ask whether a concern is temporary, whether it can be addressed and when the decision can be reviewed.

Keeping the stoma is an alternative to further surgery. A person may prefer their current routine to the risks or possible bowel function after reversal. Ask your surgeon and stoma nurse to compare both choices for your own situation, including the likely effect on work, sleep, daily life and access to toilets. You can request time and support for this decision.

Timing is individual. The first operation must have healed enough and you must be well enough for another procedure. Cancer treatment such as chemotherapy, complications or ongoing illness can delay closure. Ask who reviews readiness and what happens while you wait, rather than assuming a date given early in recovery is a promise.

Pre-assessment reviews your health, medications, allergies, previous operations and anaesthetic. Some people need blood tests or other checks. Tell the team if your health changes, and follow its instructions on eating, drinking, bowel preparation and medicines. Do not stop prescribed medicines independently. Ask about help with nutrition, fitness and support at home.

Reversal is performed under general anaesthetic. The surgeon may make a cut around the stoma, release the bowel from the abdominal wall, join it and return it to the abdomen, then close the abdominal wall and skin. An end stoma or scar tissue can mean a more extensive approach. Ask whether open or keyhole access is planned and what might change it.

A closure can be shorter than the original operation but remains significant surgery. After the anaesthetic you are monitored in recovery and then on the ward. Ask afterwards what was done, whether a new join was made, how the wound will be cared for and whether anything differed from the plan. Sometimes further surgery or a new stoma may be needed if a serious complication develops.

The aim is to restore a route for stool through the bowel without the stoma pouch. This may remove the daily task of managing that pouch. It does not ensure the bowel habit you had before illness or the first operation. Discuss the likely outcome for your particular operation and what matters most to you.

As with other abdominal operations, complications can include bleeding, wound or chest infection, urinary infection, blood clots and anaesthetic problems. A clot in the leg can travel to the lung. Prevention and treatment depend on your circumstances; ask about movement, breathing exercises and any medicines or stockings recommended for you.

A leak at the new bowel join can cause infection inside the abdomen and may require antibiotics, drainage or another operation. An abdominal collection can cause worsening pain, bloating and fever. A fistula is an abnormal connection that can develop between bowel and skin. Symptoms require assessment, since a serious problem cannot be identified reliably from a symptom list alone.

Bowel movement can temporarily slow after surgery, known as ileus. A mechanical obstruction is different and can occur when bowel is kinked or affected by adhesions, which are bands of scar tissue. Both can cause swelling, pain, nausea or vomiting. Treatment is decided in hospital and sometimes further intervention is needed. A hernia can develop at the former stoma site later.

A 2025 systematic review combined five randomised trials comparing earlier and later closure of diverting ileostomies after rectal cancer surgery. It reported more surgical complications with early closure, with uncertainty for other outcomes. Those trials involve a particular operation and selected patients; they do not establish the best timing for every stoma or for Crohn’s disease. Your surgeon can explain how your health and healing affect timing.

You may have a drip until you can drink enough. The team monitors pain, wounds, urine, eating and bowel function. Walking and breathing exercises are often encouraged with support. The hospital stay varies with the operation, your progress and complications. Before discharge, ask for instructions, medicines, wound supplies and a day and out-of-hours contact.

Stool may initially be loose and bowel movements frequent or urgent. Some people experience clustering, when several movements happen close together, or leakage. The pattern often changes as recovery progresses, but the amount of remaining bowel, a low join, pelvic radiotherapy or weaker sphincter muscles can affect longer-term function. Ask what is realistic for your operation.

Keep a simple record of bowel frequency, urgency, leakage, foods and the effect on sleep or activities if useful. Share it with your colorectal or stoma nurse. They can assess persistent symptoms and discuss diet, skin protection, bowel management or referral for pelvic floor support. Do not assume that persistent difficulties must simply be endured.

Sore skin around the anus can occur with frequent loose stools. Ask your team about gentle cleaning and a suitable barrier product. Dietary changes or bowel-slowing medicines may help some people, but they should be tailored to your symptoms and health. Seek advice rather than treating severe pain, vomiting, worsening bloating or dehydration yourself.

At home, build up walking and everyday activity gradually. You may tire more easily than expected. Ask about returning to driving, work, lifting, exercise and sex for the operation you had; work that involves lifting may need a different plan from desk work. Check that you can safely control the car and perform an emergency stop, and check your insurance.

Recovery can also bring mixed feelings. Some people feel relieved to be without a pouch, while others find new bowel habits difficult or miss the predictability of their stoma. Ask about specialist nursing, dietitian or continence support, and consider a support organisation such as Colostomy UK. Follow-up for cancer, inflammatory bowel disease or another original diagnosis remains important.