Understanding Colostomy Reversal and What the Process Involves

Woman wearing a HIRO ostomy belt facing the ocean in Hawaii | Colostomy reversal guide

One of the first questions many people ask after ostomy surgery is, "Can this be reversed?" Sometimes the answer is yes. I've lived with an ostomy since 2008 and have talked with thousands of people about their surgery and life afterward, and I know how much this question weighs on people. There's a lot of information on social media, TikTok and Instagram, and not all of it is accurate, so here I've brought together clear, trusted medical sources. My goal isn't to push you one way or the other. It's to help you understand the process so you can have a better conversation with your surgeon and make the best decision for your health and your life.

Quick answer: A colostomy reversal is surgery to close a temporary colostomy and reconnect the bowel so stool passes through the rectum again (Mayo Clinic). It's usually done at least 3 months after the first surgery, once you've fully recovered (NHS). Not every colostomy can be reversed, and not everyone chooses to.

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What is a colostomy reversal?

When a colostomy is made, part of the colon is brought through the abdominal wall to form a stoma, often to let the bowel heal after illness or surgery. A reversal closes that temporary colostomy and reconnects the bowel (Mayo Clinic Care Network). You may also hear it called a colostomy takedown.

There are two main types (Mayo Clinic Care Network):

Type What it means How big a surgery
Loop colostomy reversal The surgeon detaches the loop from the abdominal wall and reconnects the bowel Generally shorter, less invasive, quicker recovery
End colostomy reversal (Hartmann reversal) The surgeon must find the colon or rectal stump inside the abdomen and reconnect it More complex, often a larger incision and longer recovery

Can every colostomy be reversed? No. A surgeon may advise against it if the bowel hasn't healed well or is too short to reconnect safely (Mayo Clinic Care Network). Before a Hartmann reversal, the surgeon will check how much rectum remains and how much scar tissue there is (University Hospitals Sussex NHS).

It's also your choice. One NHS hospital puts it simply: you can keep your colostomy, the decision is yours together with your surgeon, and not everyone chooses reversal (University Hospitals Birmingham NHS). In one UK study of people who had a Hartmann's procedure, 30% declined reversal, many because they were satisfied with their stoma or didn't want more surgery (published study, via PMC).

The process, step by step

  1. Waiting to heal. A reversal is only done once you're in good health and fully recovered, usually at least 3 months after the first surgery. There's no time limit, and some people live with a colostomy for years before reversal (NHS). Mayo Clinic notes most reversals are planned six weeks to six months after the first surgery, depending on your health and the reason for the colostomy (Mayo Clinic Care Network). For a Hartmann reversal, the right timing is still debated among surgeons (Sherman & Wexner, Clinics in Colon and Rectal Surgery).
  2. Check-ups and tests. Your team will make sure the bowel has healed before reconnecting it (Sherman & Wexner).
  3. The surgery. It can be done laparoscopically (keyhole, with a camera) or as open surgery through a longer incision. Open surgery usually means a longer stay and recovery (Mayo Clinic). At one NHS hospital, a stoma reversal usually takes around 90 minutes (North Bristol NHS).
  4. Hospital stay. Mayo Clinic says one day to about a week, depending on the procedure (Mayo Clinic Care Network); the NHS says most people go home 3 to 10 days after surgery (NHS). You'll go home once you can eat, drink and manage pain.

Recovery and bowel changes

Even though a reversal is usually a smaller operation than the first one, it still takes several weeks to recover and return to normal activities (NHS).

  • Your bowel needs time to adjust. Many people have frequent, loose or urgent stools afterward, and some have temporary leakage (Mayo Clinic Care Network).
  • Eat gently at first. A low-fiber diet is often recommended to start (Mayo Clinic Care Network).
  • Rest and avoid heavy lifting. You may feel tired for a few weeks. Plan time off work and avoid heavy lifting early on to lower the risk of a hernia (Mayo Clinic Care Network). See my post Do I Have a Hernia? for more.
  • Be patient. People interviewed in an Oxford University study were often surprised by how long their bowel took to start working again after surgery (Healthtalk, University of Oxford).

Risks and when to call your doctor

Colostomy reversal is generally safe, but like any abdominal surgery it carries risks (Mayo Clinic). A Hartmann reversal in particular is a bigger operation. Dr. Steven Wexner and colleagues note its most frequent complications are infection, wound infection and a slow-to-wake bowel (ileus), and that doing it laparoscopically is linked to fewer complications and a shorter stay (Sherman & Wexner). Other risks in hospital include blood clots, chest infection and urinary infection, which is why you may get daily anti-clotting injections and support socks (North Bristol NHS).

Ask your surgeon about your own risks, and call your care team after you go home if something doesn't feel right.

This article is for general information and isn't medical advice. Your surgeon and ostomy nurse know your case best.

If reversal isn't right for you

Keeping your colostomy is a valid choice, and plenty of people live full, active lives with one. I've lived with my ostomy since 2008, and I surf, teach martial arts and perform fire arts. If you're living with a stoma for now or for good, these may help:

HIRO ostomy belt, vertical style, worn at the beach

Frequently asked questions

What is a colostomy reversal?

Surgery to close a temporary colostomy and reconnect the bowel so stool passes through the rectum again (Mayo Clinic).

How long after a colostomy can it be reversed?

Usually at least 3 months after the first surgery, once you've fully recovered. There's no upper time limit (NHS).

Can every colostomy be reversed?

No. It depends on how well the bowel has healed, whether there's enough bowel to reconnect safely, and your overall health (Mayo Clinic Care Network).

How long is the hospital stay?

Anywhere from one day to about 10 days, depending on the type of surgery and how quickly your bowel starts working (Mayo Clinic Care Network; NHS).

How long does recovery take?

Several weeks before you're back to normal activities (NHS).

What are bowel movements like after a reversal?

Many people have frequent, loose or urgent stools at first while the bowel adjusts (Mayo Clinic Care Network).

Do I have to have my colostomy reversed?

No. The decision is yours together with your surgeon, and not everyone chooses reversal (University Hospitals Birmingham NHS).

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