Living with a colostomy

Some people that went on surgery due to colon cancer are living with a colostomy. Colostomy is a hole that joins large bowel with outside, where a bag collects fecal waste. What patients are most worried about is whether people around will notice they have the bag. This article explains how to take care of the colostomy and solves some questions to help making life as normal as possible.

Post updated on 17. December 2025.

The most usual treatment for a patient with colon cancer is surgery. Other strategies like chemotherapy or radiotherapy commonly added to surgery, in order to eliminate those cancer cells that can’t be seen during the operation. Sometimes removing rectum or anus, or a part of the colon is also needed. This is done through a procedure called colectomy. But the colon is a tube, and if part of it is removed, an alternative for the body to be able to eliminate fecal waste and gases must be found.

What is a colostomy?

A colostomy is the operation to join the large bowel with the outside of the body, through a hole called stoma. The stoma is protected by an adhesive seal, a tube and a bag, which is what collects fecal waste. Colostomy can be temporary or permanent, depending on the case, and the person who has it must learn to take care of it.

If this colostomy is temporary, a few months later another surgery can be conducted to join again large bowel, so the bag won’t be necessary anymore and the patient will be able to use the toilet again as they used to do before cancer.

The stoma can be done in many parts of the bowel, according to the location of the tumor and medical indications. Surgeon will always try to preserve as much as possible the normal functioning of the body.

What kinds of colostomy exist

The most common kinds of colostomy are:

• Transverse colostomy: It is done at the transverse bowel, which is the part that crosses abdomen horizontally. It may have two holes: one for eliminating fecal waste and another for eliminating the mucus that the bowel produces naturally.
• Ascending colostomy: It is done at the ascending bowel (the first section of the large intestine), at the right side of the abdomen. Ascending colostomy is unusual because in these cases, an ileostomy is preferred. Ileostomy is a similar procedure, but it’s done at the end of the small intestine. With it, fecal waste collected by the bag is more liquid.
• Descending colostomy: It’s done at the descending colon, at the left side of the abdomen. After a descending colostomy, fecal waste has more solid consistency.
• Sigmoid colostomy: It’s located at the sigmoid colon, at the end of the large bowel before rectum. It’s the most frequent kind of colostomy and it eliminates solid fecal waste in a more regular pace.

Care and hygiene of the colostomy

As you can see in this picture, colostomy bag is joined to the stoma. It attaches thanks to a sticker that attaches on the skin to ensure it is well sealed.

Colostomy bags are the only intended to do this; no other sort of bag can replace them. You can find them at the drug store.

Empty colostomy bag

Some bags are reusable and can be drained without having to detach them. It must be drained not later than having it half full. If you wait longer, the bag can detach itself. In general, for a colostomy, emptying occurs 2 to 3 times per day; for an ileostomy it must be more often because fecal waste is more liquid.

Although the bag is drainable, it must be changed and recplaced by a new one every 3 to 4 days.

Emptying of the bag can be seen in this video:

How to change the ostomy pouch

The first time you attach or change your ostomy pouch, a nurse will be there to help you. It may seem complicated, but you will find it easier every day.

• During the first weeks the stoma is bigger; later it gets smaller and smaller until it gets its final size. It’s usually pink or a bit red.
• The bag attaches to the skin with a sticker, to avoid leaking. To clean the stoma you need to detach the pouch from up and downwards, holding the skin around to keep it smooth.
• The hole can be cleaned with caution using toilet paper, water and mild soap with balanced PH. If you don’t have water and soap you can use a cleaning wipe, but never use alcohol.
• The stoma can bleed a little bit, and it’s fine. If this happens, keep it covered with a clean sponge and cold water for a while.
• To attach the sticker bond, dry the area without pressing. Cut the flange to fit the stoma following the instructions included.
• Put the sticker on your skin, leaving the stoma in the flange and ensuring a crease-free seal. Jojn the bag if it’s not attached by default.

This video explains how to change the ostomy bag:

Special water-proof stickers exist. With them you will be able to take a shower with your bag attached. If you notce an irritation, you can use a moisturizer.

Ask the doctor if the stoma bleeds significantly, if it changes its color or if you notice that the surrounding area seems to get inside the body or, on the contrary, it stands out. You should also ask for medical advice if you feel abdominal pain or fever, and if fecal waste releasing pace changes suddenly.

“Quality of life in people with cancer“. PDF handbook for patients and family members.

Accepting physical change when living with a colostomy

The stoma and the bag entail a meaningful change in physical appearance and self-image. You need th get used to it and accept this change, which is not always easy. It’s normal to experience emotions like ange or, sadness and, sometimes, míld anxiety or depression symptoms. These negative emotions are part of the acceptance process.

Only you know what it really means living with a colostomy. Some people can try to help you with expressions like “You should be happy, as you have a second chance“. These expressions have a good intention, but they are usually useless because they can insinuate that you are overreacting with your concern.

But getting used to it and stop feeling bad is viable, as it happens to the vast majority of patients. A method which can help you achieving it is progressive self-observation. It consists of showing yourself in front of a mirror, step by step, for some days:

1. The first day, show yourself for 5 minutes in front of the mirror, alone and dressed.
2. The day after, show yourself for 5 minutes in front of the mirror, alone and wearing only underwear.
3. The day after, show yourself for 5 minutes in front of the mirror, alone and naked.
4. The day after, you can repeat the last step, but staying in front of the mirror as long as you need until discomfort vanishes itself.
5. Finally, you can repeat each step (dressed, in underwear and naked) having close to you somebody you trust, for example, your spouse.

It’s considered normal that, during the first weeks after surgery, your social life becomes restricted. After some time it’s recommendable to bring it back and keep it as much as possibe, instead of staying home. You can feel like you take two steps forward and one backwards, like if you lose what you had achieved. It happens to lots of people, and it’s normal.

Lifestyle when living with a colostomy

Unlike anus, which has a sphincter (a muscle that closes to hold fecal waste until the person arrives to the toilet), the stoma doesn’t have this sphincter. Fecal waste can go out anytime and, therefore, the bag must be attached 24 hours a day.

The bag can also accumulate gas, usually produced during digestion. To reduce gas you can reduce the amount of some kinds of food like banana, sparkling drinks, dairy products, asparagus or cauliflower. It’s key to maintain a balanced and varied diet, knowing that fruit is really healthy but it produces more gas when eaten abundantly. Further this, no other special diet is needed, unless the doctor gives you a different advice.

There are no special preventive measures needed for travelling. If you have to take a plane, you will want to carry some colostomy bags with your carry-on luggage instead of your checked lugage: if your suitcase was lost, it is important not to be short on bags.

Likewise there are no special preventive measures for getting dressed. You can wear any kind of clothes except those that are tight in your abdomen. You can use a swimmingpool or go to the beach and you can work as usual. What’s more, working can help you to recover you normal life.

You can get back to physical exercise, or begin with it if you didn’t do it before. At the beginning you can start walking and, progressively, get involved in more strong activities like running, swimming or playing tennis. Bag sticker is sweat-proof. Ask your doctor for advice on what kind of sport is more suitable to you, specially if you like contact sports like boxing or fighting.

Sexual activity doesn’t need to end when someone is living with a colostomy. Of course it’s normal to worry about your physical appearance or about how your partner will look at you. It’s crucial to talk openly about that. Remember that sex doesn’t need to be restricted to penetration, but there are many other ways of physical contact (kisses, caressing, etc). The most important thing is to enjoy it. Being flexible and accepting all these changes will help you to improve, as well, your sexual life.

I am afraid of others to notice I use the bag. Do I have to tell them?

Please, consult laws in your country about whether disclosure is compulsory at work. Nevertheless, even if it’s not, you might see yourself in the need of doing so (for example, if you need to justify that you cannot lift heavy things). In general, it’s a personal decision. It should be you the one who decides who you tell it to and who you don’t. If you believe that somebody can make awkward questions with morbid curiosity you can choose not to tell them. But at the end of the day, living with a colostomy i’s going to be easier to you is there is someone you trust who knows.

The fear of other people to notice you use the bag is common. Some patients are afraid of a visible bulge under the clothes or at the bag will give off an odor. However, experience shows that people around won’t notice that you use the bag: they will only know if you tell them. Sticker, used correctly, is powerful enough to block any leak. And if you eat out, you can drain or change the bag in the toilet discreetly.

Some people with a colostomy say they feel the bag smelling, but at the same time they admit it’s just their imagination.

In any case, talking with the loved ones about this experience can be really helpful, as well as asking health professionals for help (doctors, nurses, therapists, etc). It makes easier to cope with all the changes related to living with a colostomy, to accept the new appearance and to go back to normal life.

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