Ostomy Reversal Surgery — What It Is, Who Qualifies, and What to Expect

There's a moment I replay in my head sometimes. I was still in the hospital, barely a day or two out of surgery, and my surgeon stopped by during rounds. He mentioned — almost as an aside — that my ostomy "might be temporary." That depending on how my body healed, there could be a reversal down the road.

I want to tell you what that felt like, because I think you'll understand: it felt like a lifeline. Like a door left cracked open. I latched onto those words like they were a promise, and for months I organized my whole emotional world around the possibility of reversal. Once I get reversed, I'll feel like myself again. Once the ostomy is gone, life goes back to normal.

I want to be honest with you: clinging to reversal as my only hope made the journey harder, not easier. The possibility was real — and for many people, reversal is absolutely achievable. But hanging your entire sense of okay-ness on a future surgery you can't control? That's a heavy thing to carry.

So I want to give you the real information about ostomy reversal surgery — what it is, who qualifies, what recovery actually looks like — and also talk honestly about what it means if reversal isn't in your future. Because there is a full life on either side of that answer.

What Is Ostomy Reversal Surgery?

Ostomy reversal surgery — also called an ostomy takedown — is a procedure that reconnects the bowel after a temporary stoma has allowed a portion of the digestive tract to rest and heal. In plain language: your surgeon created a detour when you had your original surgery. Reversal surgery closes that detour and reconnects the two ends of the bowel so waste can travel normally again.

An ileostomy reversal reconnects the small intestine and closes the stoma formed from the ileum. A colostomy reversal reconnects the large intestine (colon) and closes the stoma formed from the colon. In both cases, the stoma site heals over and the body's normal exit route is restored.

It's real surgery — with real recovery — but for people who are good candidates, it's a genuine path back to life without a pouch. The key phrase there is "good candidates."

Temporary vs. Permanent Ostomies — Who Might Qualify for Reversal?

The first thing to understand is that not all ostomies are created equal when it comes to reversal potential.

A temporary ostomy is one created specifically to allow the bowel to heal — often after surgery for colorectal cancer, diverticulitis, bowel perforation, or inflammatory bowel disease. The surgeon intentionally leaves a path for reconnection later. Most temporary ostomies are ileostomies, though some are loop colostomies.

A permanent ostomy is created when the rectum or anus has been removed entirely — as in an abdominoperineal resection (APR) for rectal cancer — or when the remaining bowel simply can't be reconnected safely. If the organ that normally receives stool or urine no longer exists, there's nothing to reconnect to.

The 4 Things Your Doctor Will Look At

Even when reversal is technically possible, it's not automatic. Your surgical team will evaluate several factors before recommending the procedure. Here are the four main ones:

1. Bowel Health

The portion of bowel that was "resting" during your ostomy needs to have healed properly before it can be reconnected. Your surgeon will typically order imaging (like a contrast enema or CT scan) and sometimes a scope to examine the bowel. The anastomosis site — the place where the bowel was originally reconnected — needs to be healthy, without stricture (narrowing) or incomplete healing.

2. Your Overall Health

Reversal surgery is typically done 3–12 months after the original surgery — sometimes longer if you needed chemotherapy or radiation in between. Your body needs time to recover from the initial surgery and any adjuvant treatment before it can handle another procedure. Nutrition matters enormously here. Surgeons look for adequate weight, good nutritional status, and no active infection before scheduling a reversal.

3. The Reason for Your Original Surgery

Why you had the ostomy in the first place affects reversal candidacy significantly. Someone who had a temporary ileostomy after colorectal cancer surgery to protect a new rectal anastomosis is a different candidate than someone whose Crohn's disease is still active. If the underlying condition is under control, the likelihood of a successful reversal is higher.

4. Surgeon Judgment and Functional Capacity

Even when all other factors look good, your surgeon will assess whether the remaining bowel is long enough, functional enough, and positioned correctly for reconnection. They'll also consider whether your sphincter muscles are intact and strong enough to maintain continence after reversal. This last piece matters more than people expect — some people who get reversed struggle with urgency or frequency long-term because the muscles need time to relearn their job.

What the Reversal Surgery Actually Involves

I want to be honest here without being scary — because it's actually not as daunting as people fear once they understand what's happening.

Ostomy reversal surgery is performed under general anesthesia and typically takes 1–3 hours, depending on complexity. In many cases it can be done laparoscopically (small incisions, camera-guided), though some cases require an open approach. Your surgeon will:

• Close the stoma opening and remove the stoma from the abdominal wall
• Reconnect the two ends of the bowel (a procedure called an anastomosis)
• Close the incision at the stoma site (this leaves a small scar)

Hospital stays are typically 3–5 days, though some people go home sooner. You'll be encouraged to walk the day after surgery and will begin a liquid diet before advancing to soft foods as your bowel wakes back up.

Complications are possible — as with any surgery — including anastomotic leak, infection, and ileus (temporary bowel paralysis). The risk is real but manageable with an experienced surgical team. Talk to your surgeon specifically about their complication rates and what warning signs to watch for at home.

Recovery from Ostomy Reversal — What Nobody Tells You

Here is the part I wish someone had warned me about — and what I now tell every person I talk to who is heading into a reversal:

Your bowel does not just flip a switch and go back to normal.

After months (or longer) of being diverted, the lower portion of your bowel has to remember how to work. And in the meantime, your experience in the weeks and months after reversal can be genuinely surprising — even alarming if you weren't prepared.

Here's what's common and normal in post-reversal recovery:

• Frequency: Going to the bathroom 6, 8, even 12+ times a day is common in the first weeks. Your bowel is recalibrating. This improves over time — but "over time" might mean months, not days.
• Urgency: The urge to go can feel sudden and intense. Your sphincter muscles haven't had to hold much in a while. Pelvic floor physical therapy can genuinely help here — I wish someone had told me about this sooner.
• Clustering: Some people experience multiple bowel movements in a short window, then nothing for hours. This is normal while the bowel re-establishes its rhythm.
• Dietary sensitivity: Foods that were fine pre-ostomy might cause urgency or cramping post-reversal. A low-residue diet during early recovery helps, then a slow reintroduction of higher-fiber foods.
• Perianal soreness: Your skin hasn't had to deal with stool contact in months. Barrier cream, sitz baths, and gentle products will be your best friends.

When Reversal Isn't Possible — And Finding Peace with a Permanent Ostomy

My ostomy is permanent. My rectum was removed. Reversal was never going to be my story, and I spent a long time grieving that — even when I didn't fully acknowledge that's what I was doing.

I want to say something to the person reading this who just found out reversal isn't possible for them: that grief is real, and it's valid. You are not being dramatic. You had hope, and that hope is now taking a different shape. Let yourself feel that.

And then, when you're ready — because it takes time — I want you to know this: a permanent ostomy is not a lesser life. I travel. I speak publicly. I wrote a book. I built a nonprofit. I have relationships and joy and purpose. The bag is part of how I live, not a ceiling on how much I can live.

The shift that changed everything for me wasn't a medical procedure. It was the moment I stopped seeing my ostomy as something that happened to me and started seeing it as something I'd survived — and something I now help other people navigate. That reframe didn't happen overnight. It happened because of community, because of honest conversations, because of other ostomates who showed me what was possible.

Whether you're working toward reversal or learning to make peace with permanence, you don't have to figure this out alone.

You Can Live Fully — Whatever the Answer Is

If you're living with a temporary ostomy and hoping for reversal: keep asking questions, keep advocating for yourself, and trust the process of healing. Your timeline might not be the one you hoped for, but the destination is real.

If you're living with a permanent ostomy and wondering if this is as good as it gets: it isn't. I promise. The learning curve is real. The adjustment is hard. But on the other side of that curve, life is still big and full and yours.

The bag does not get the last word. You do.