Types of Ostomy: Colostomy, Ileostomy and Urostomy Explained by an Ostomy Belt Inventor

Smiling doctor ready to explain colostomy, ileostomy and urostomy types | HIRO Ostomy Belts blog by O'Hamill Inc.

Every ostomy is a little different. Knowing which type you have makes everything else easier, from choosing supplies to knowing what's normal.

I've lived with an ostomy since 2008, and I've worked in the ostomy industry since 2009. Over those years I've talked with thousands of people about their surgery, and one thing comes up again and again: a lot of people aren't completely sure what type of ostomy they have, or what makes it different from someone else's. That's understandable. When you're recovering from surgery, there's a lot to take in.

This guide breaks down the main types of ostomy in plain language. I've backed it with trusted medical sources from the United States, Canada and the United Kingdom. It isn't medical advice, so always ask your surgeon or ostomy nurse about your own situation.

Quick answer: The three main types of ostomy are a colostomy (made from the large intestine), an ileostomy (made from the end of the small intestine) and a urostomy (which carries urine). Each is named for the part of the body it comes from (Cleveland Clinic). An ostomy can be temporary or permanent, and the stoma can be an end stoma or a loop stoma.

Contents

Ostomy vs Stoma: What's the Difference?

You'll hear both words a lot. The ostomy is the surgery that creates a new opening, and the stoma is the opening itself on your belly. Health professionals often use the two words interchangeably (NIDDK). If you're brand new to this, start with my guide on what a stoma is and what to expect early on.

You're far from alone. About 100,000 people in the United States have ostomy surgery of the bowel each year (NIDDK), and more than 165,000 Canadians live with an ostomy (Ostomy Canada Society).

Colostomy

A colostomy is made from part of the colon, or large intestine, and brought to the surface of your belly (Ostomy Canada Society). Because the colon absorbs water as stool moves through it, where your colostomy sits makes a big difference in what your output is like. The further along the colon, the firmer the stool (Crohn's and Colitis Canada).

The American Cancer Society describes four types by location:

Type Where it sits Typical output
Ascending Right side of the belly Liquid, rich in digestive enzymes. Less common, since an ileostomy is often preferred
Transverse Upper belly Soft, loose or paste like. Often temporary
Descending Left side of the belly Firmer and more regular. Often permanent
Sigmoid Lower left side of the belly Firmer and more regular. Often permanent

The American Cancer Society notes that people with a descending or sigmoid colostomy have more predictable output, and some use timing strategies or irrigation to manage it. Want to learn more about wearing a belt with a colostomy? See my guide on how to wear a colostomy bag belt.

Ileostomy

An ileostomy is made from the ileum, the end of the small intestine (Cleveland Clinic). Since the stool hasn't passed through the colon, where water is reabsorbed, output is liquid to pasty, and it can come out soon after eating (Crohn's and Colitis Canada).

A few things worth knowing:

  • It's usually on the right side of the belly (Crohn's and Colitis Canada).
  • Protect your skin. Ileostomy output contains digestive enzymes that can irritate your skin (Ostomy Canada Society). That's why a well fitted barrier matters so much. My stoma care tips cover how I keep my skin healthy.
  • Check your medications. Crohn's and Colitis Canada suggests telling your pharmacist you have an ileostomy, since some medications are coated to dissolve in the large intestine.
  • Stay hydrated. You lose more fluid with an ileostomy. My ostomy diet guide covers hydration in detail.

For more on belts made for ileostomy wear, see finding an ileostomy belt built for comfort and security.

Urostomy

A urostomy, also called a urinary diversion, redirects urine away from the bladder to a stoma (Ostomy Canada Society). Ostomy Canada describes the most common type as an ileal conduit, where a short piece of the ileum is used to carry urine from the kidneys out through the stoma. Output is urine, which drains continuously and may contain some mucus.

Cleveland Clinic lists bladder cancer as one reason someone may need a urostomy. A full guide to urostomies is coming soon on the blog.

Continent Ostomies and Internal Pouches

Not every ostomy means wearing a pouch on the outside. Ostomy Canada Society describes a few "continent" options, where an internal pouch is made from your own intestine:

  • Ileoanal reservoir (J pouch). After the colon is removed, a pouch made from the end of the small intestine is connected to the anus, so you keep control of when you go. Crohn's and Colitis Canada notes it's used for ulcerative colitis, and surgeons often create a temporary ileostomy while it heals.
  • Continent ileostomy (Kock pouch). An internal pouch with a valve, drained with a small tube several times a day.
  • Continent urostomy. An internal pouch for urine.

Whether one of these is an option depends on your condition and your surgeon. A detailed J pouch guide is also on its way to the blog.

End Stoma vs Loop Stoma

Beyond the type of ostomy, the way the stoma is made matters too. The NHS and the American Cancer Society describe these main styles:

  • End stoma. The bowel is divided, and one end is brought through your belly and stitched to the skin, making a single opening. According to the NHS, an end ileostomy can be temporary or permanent. The American Cancer Society says an end colostomy is usually permanent.
  • Loop stoma. A loop of bowel is brought through the belly and opened, making one stoma with two openings. The NHS explains that one opening is "active" and passes stool, while the other leads to the resting bowel and may pass mucus. A loop stoma is usually temporary.
  • Double barrel colostomy. The bowel is fully divided into two separate stomas, one for stool and one for mucus. The American Cancer Society notes this is usually temporary.

From my conversations over the years, loop stomas are often a bit larger and can be more oval than round. I've also found that some people with loop ostomies need a completely specialized belt, and some even wear more than one appliance or a specialized appliance to get a secure fit. That's one reason measuring your stoma and working with your ostomy nurse to find the right setup matters so much. If you have a loop ostomy and aren't sure what will work for you, reach out to me and I'll do my best to point you in the right direction.

Temporary vs Permanent

An ostomy can be temporary or permanent (Cleveland Clinic).

  • Temporary. Gives part of the bowel or urinary tract time to heal. Crohn's and Colitis Canada notes a temporary ostomy may last weeks, months or even years. A temporary colostomy is usually kept about three to six months before it's reversed, according to the American Cancer Society.
  • Permanent. Used when part of the bowel or urinary tract is permanently damaged or has to be removed, or when the bowel can't be reconnected, such as when the rectum is removed.

A personal note: Technically, my own surgery is considered temporary. But with my Crohn's disease, things have never fully healed 100%, so a reversal doesn't necessarily make sense for me. A reversal would also mean considering having a J pouch created, and I've heard a lot of pros and cons from people who have one. That's a topic I'll save for another article.

If you have a temporary colostomy, my guide to colostomy reversal walks through the process.

Why People Need an Ostomy

Cleveland Clinic lists several common reasons for ostomy surgery:

  • Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis
  • Colorectal cancer
  • Bladder cancer
  • Diverticulitis
  • Intestinal obstruction
  • Chronic bowel or urinary incontinence

For me, it was Crohn's disease. Surgery gave me my life back, and I share that story in How Ostomy Surgery Saved My Life. If you're facing surgery and feeling nervous, Should You Be Afraid of Ostomy Surgery? may help too.

Choosing an Ostomy Belt for Your Type

No matter which type of ostomy you have, your pouch carries weight that pulls on your barrier, especially as it fills. An ostomy belt supports that weight without compressing the pouch, so it can still fill and work normally. Over the years, I've designed belts for people with every type of ostomy, and a few things depend on your type:

  • Which side your stoma is on. Every HIRO belt comes with a Left or Right wear side option. An ileostomy is usually on the right side, while a descending or sigmoid colostomy usually sits on the left.
  • Your opening size. HIRO belts come in different opening sizes to fit around your barrier and pouch. Our sizing guide walks you through it.
  • Horizontal or vertical. With more frequent, liquid output, some people prefer a vertical setup that's easy to drain, while others like horizontal for sports and sleep. Our horizontal vs vertical comparison explains both.

For everyday wear and active days, I use the HIRO Performance belt. For sleeping and lighter days, there's the slim HIRO Ostomy Support Belt™ Ultralight Sleek Fit. Our colostomy and ileostomy support belt page and my guide on how to choose an ostomy belt can help you decide.

Where to Find Help

Types of Ostomy FAQ

What are the three main types of ostomy?
A colostomy, made from the large intestine; an ileostomy, made from the end of the small intestine; and a urostomy, which carries urine. Each is named for the part of the body it comes from, according to Cleveland Clinic.

What's the difference between a colostomy and an ileostomy?
A colostomy comes from the colon, so output is usually firmer, especially lower down the colon. An ileostomy comes from the small intestine, so output is liquid to pasty and contains digestive enzymes that can irritate skin, according to Crohn's and Colitis Canada and Ostomy Canada Society.

Which side is an ileostomy or colostomy on?
An ileostomy is usually on the right side, according to Crohn's and Colitis Canada. A descending or sigmoid colostomy usually sits on the left, according to the American Cancer Society.

What's the difference between an end stoma and a loop stoma?
An end stoma has one opening, made from the end of the divided bowel. A loop stoma has two openings in one stoma: one passes stool and the other leads to the resting bowel. The NHS notes a loop stoma is usually temporary. In my experience, some people with a loop ostomy need a specialized belt or appliance.

Can an ostomy be reversed?
Sometimes. A temporary ostomy is meant to be reversed once the bowel heals, while a permanent ostomy is for life, according to Cleveland Clinic. Your surgeon can tell you which you have.

Keep Reading

Sources

Richard O'Hamill has lived with an ostomy since 2008. He's the inventor of the performance ostomy support belt and founder of O'Hamill Inc., maker of HIRO ostomy support belts.

This article shares my personal experience and general information from trusted medical sources. It is not medical advice. Please talk with your surgeon or ostomy nurse about your own care.