Life After Stoma Reversal: Recovery, Diet and Possible Complications

What happens in the first weeks after stoma reversal?

Bowel function does not settle straight away, and at first it can be irregular. In the first days and weeks there may be bloating, cramps, loose or, on the contrary, infrequent stools, and urges that are hard to put off. How it goes for you depends on which stoma was closed, what operation came before, and whether you had radiotherapy.

A protective ileostomy is usually closed through an incision around the stoma, without a large abdominal incision. Restoring bowel continuity after a Hartmann’s procedure is a bigger operation inside the abdomen. Both are described on the stoma reversal page. I perform stoma reversals myself.

Stoma reversal does not end cancer follow-up: check-ups after cancer treatment continue, and their schedule is agreed with your doctor.

What complications can occur and how to recognize them

Complications are not as rare as people tend to think, so it is worth knowing about them in advance. In a systematic review of 48 studies covering 6,107 loop ileostomy reversals, 17.3% of patients had complications^[1]. The most common were:

• small bowel obstruction (7.2%)^[1]. Any of these signs may point to it: increasing bloating, nausea or vomiting, no longer passing gas or stool;
• wound infection (5.0%)^[1]: the skin around the wound becomes red and painful, and there is discharge.

Less often, the new join in the bowel fails to heal (anastomotic leak). It may show up as increasing abdominal pain, fever, feeling generally unwell or a fast heart rate, and not necessarily all of these at once.

Later, after months, a hernia can develop at the old stoma site: a bulge that gets bigger when you cough or strain. In pooled data from 20 studies, it developed on average in 13.7% of patients after ileostomy reversal, more often in people with serious other illnesses^[6]. How to treat the hernia is decided by the surgeon. If it suddenly becomes painful, hard or cannot be pushed back, and especially if vomiting starts, urgent help is needed.

What can you eat after stoma reversal?

There is no universal diet: there are few reliable studies on eating after stoma reversal. The advice below applies mainly to people who previously had part of the rectum removed. According to an expert guideline on bowel dysfunction after such surgery, up to 96% of patients change their diet, and most find what suits them by trial and error^[5].

Things to keep in mind:

• a lot of insoluble fiber can make frequent urges, loose stools and bloating worse. Soluble fiber is usually better tolerated and may make stools more formed, but this is expert experience rather than proven fact, and the amount should be increased gradually^[5];
• patients often give up wine, cold drinks and spicy or irritating food themselves if they notice these make things worse^[5];
• eating itself can trigger a strong urge: after rectal resection this reflex is heightened^[5]. It is worth bearing in mind when planning to go out after a meal;
• if you cannot find the right diet on your own, a dietitian may help^[5].

A simple diary can also help: what you ate, when and how many times you opened your bowels, and whether you had urges that were hard to hold. It makes it easier to notice what does not agree with you and to describe it to your doctor in detail.

Frequent urges, “clusters”, leakage: low anterior resection syndrome

After rectal resection with the sphincter preserved, bowel function often changes for a long time. This condition is called low anterior resection syndrome (LARS). Its main features are leakage of gas and liquid stool, frequent bowel movements, stools in “clusters” a short time apart, and urges that are hard to put off^[3].

It is not rare. In a meta-analysis of studies that mostly assessed bowel function at least a year after surgery or stoma closure, 41% of patients had major LARS^[2]. The risk is higher after radiotherapy before surgery and when the join in the bowel is low^[2].

Over time things improve on average. In a pooled analysis of individual patient data, questionnaire scores fell noticeably up to 18 months after surgery and then stayed at about the same level for up to three years. Function recovered less well after total mesorectal excision, radiotherapy before surgery and formation of an ileostomy^[4]. In some people the problems persist for years.

A short five-question questionnaire, the LARS score, is used for assessment. The total classifies the condition as no LARS, minor or major LARS^[3]. But treatment is chosen not by the total score but by the specific symptoms and how much they affect your life^[5].

What helps if the bowel is not working well

First the doctor rules out other causes of the symptoms, then chooses treatment. Before treating LARS it is important to make sure there is no narrowing of the join, no return of the tumor and no radiation damage to the lining. This needs at least a digital rectal examination and an endoscopic look at the rectum^[5].

Evidence on treatment is still limited, and most recommendations are based on expert experience^[5]:

• diet and medication. Loperamide is one of the most widely used medicines for controlling frequent stools, but it should only be taken on a doctor’s advice, especially if you have bloating or constipation. Sitz baths and topical products ease irritation of the skin around the anus^[5];
• pelvic floor muscle training and biofeedback. There are few studies, but most showed fewer bowel movements and leakage episodes and better quality of life^[5];
• transanal irrigation: washing out the bowel with water through the anus at a convenient time. Before starting, the doctor examines the join and rules out obstructions, and the procedure should be learned under the supervision of trained staff. A rare but serious complication is bowel perforation^[5];
• if irrigation does not help, sacral nerve stimulation and other methods are possible. For severe symptoms that do not respond to treatment, a return to a stoma is discussed as a last option^[5].

When can you get back to normal life?

The timing is individual: it depends on which stoma was closed, how the wound heals and your general condition. Walking and gradually returning to everyday activities are usually encouraged early. When you can lift weights, exercise or return to physical work, the surgeon who operated on you will tell you.

Keep in mind a hernia at the old stoma site: it is one of the common late complications^[6]. If you notice a bulge there, show it to your surgeon.

What to do after stoma reversal

1. Know the warning signsSevere abdominal pain, repeated vomiting, shortness of breath, chest pain, heavy bleeding: call 103 at once. Fever, redness or discharge from the wound, bloating, nausea: contact your surgeon at once.
2. Keep a bowel diaryWhat you ate, how many times you opened your bowels, any “clusters” or leakage. It makes it easier to adjust your diet and tell your doctor what is happening.
3. Do not suffer in silenceIf frequent urges or leakage affect your life, tell your doctor. First the cause is checked, then medication, pelvic floor training or irrigation is chosen.
4. Do not skip follow-upStoma reversal does not replace cancer follow-up. If you need advice on recovery, send your discharge summaries: the online consultation is free.

Sources

1. Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis. 2009;24(6):711–723. PMID 19221766
2. Croese AD, Lonie JM, Trollope AF, et al. A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors. Int J Surg. 2018;56:234–241. PMID 29936195
3. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255(5):922–928. PMID 22504191
4. Varghese C, Wells CI, O’Grady G, et al. The Longitudinal Course of Low-anterior Resection Syndrome: An individual Patient Meta-analysis. Ann Surg. 2022;276(1):46–54. PMID 35185131
5. Christensen P, Im Baeten C, Espín-Basany E, et al. Management guidelines for low anterior resection syndrome — the MANUEL project. Colorectal Dis. 2021;23(2):461–475. PMID 33411977
6. Nasri S, Kammoun N, Trabelsi MM, et al. Prevalence and risk factors of incisional hernia after ileostomy reversal: meta-analysis with meta-regression. Hernia. 2025;29(1):204. PMID 40522527

This article is for general information and does not replace a consultation: your recovery plan is set by the surgeon who operated on you.