The ostomy conversation happens before you're ready. Here's what I wish I'd known.

The ostomy conversation almost never happens at the right time.

It happens when things are urgent. When your surgeon is moving fast and you're still trying to catch up. When the person you love is lying in a hospital bed, scared, and you're standing beside them trying to hold it together. That's when the diagram comes out. That's when the word stoma enters the room. And that's when most families — including mine — go completely silent.

If you're in that place right now, or you're afraid you might be soon, I want you to know: you are not alone, and this conversation — as hard as it is — does not mean what you think it means.

What an ostomy actually is (and why surgeons bring it up when they do)

An ostomy is a surgical opening — called a stoma — created in the abdomen that allows waste to exit the body into an external pouch, bypassing a section of the bowel that is too diseased, damaged, or inflamed to function safely. In Crohn's disease, the most common type is an ileostomy, where the end of the small intestine is brought through the abdominal wall.

Surgeons raise the possibility of an ostomy when the bowel can no longer be managed medically, when there is a perforation or abscess, when strictures are causing dangerous blockages, or when previous surgical repairs have failed. According to the Crohn's & Colitis Foundation, up to 75% of people with Crohn's disease will require surgery at some point in their lifetime. Of those, a significant number will face a temporary or permanent ostomy as part of their surgical plan.

Key takeaway: An ostomy is a tool surgeons use to protect the bowel and give it time to heal — it is not a sign that treatment has failed.

Why the timing always feels wrong

Here is what I've observed — as a naturopath, and as someone who has sat in those hospital rooms. The ostomy conversation almost never happens when you feel emotionally ready for it. It happens in the middle of a crisis, or at the tail end of an appointment where you've already absorbed too much, or in a pre-op meeting the night before surgery.

That's not a failure of your surgeon's communication. It's the nature of Crohn's disease. This condition escalates fast. Decisions have to be made quickly. And surgeons are trained to give you information, not always to give you time.

My husband had three surgeries. The first conversation about the possibility of a stoma came when he was already in serious trouble — complications from earlier surgery, inflammation that wasn't responding, a body that had been pushed to its limit. I remember the feeling in that room. It was like the floor shifted.

What I didn't know then — and what I want you to know now — is that the fear of what an ostomy means is almost always bigger than the reality of living with one. Not because it isn't hard. It is. But because people adapt, and they find their footing, and life continues in ways that surprise you.

Key takeaway: The shock you feel in that conversation is normal — and it is not a reliable guide to what life will actually look like on the other side.

What to ask before you leave that appointment

One of the most practical things I've learned — both from my naturopathic training and from lived experience — is that the families who navigate surgical conversations best are the ones who come in with questions. Not because they know more, but because questions slow the conversation down enough to actually hear the answers.

Here are the questions I'd encourage you to ask:

- Is this ostomy temporary or permanent? Many ostomies created during Crohn's surgery are temporary — the bowel is given time to rest and heal, and a reversal surgery is planned for later. This is not always possible, but it is more common than people realise.

- What does recovery look like in the first six weeks? Understanding the physical timeline helps you prepare practically — at home, at work, with your family.

- Will I see a stomal therapy nurse before surgery? A stomal therapy nurse (also called a WOC nurse in the US) is a specialist who can help with placement of the stoma, fitting of the pouch, and practical education before and after surgery. Asking for this referral is entirely reasonable and often makes an enormous difference.

- What are the risks of NOT having this surgery right now? This question helps you understand the urgency and puts the ostomy conversation in its proper context.

- Are there naturopathic or nutritional supports I can put in place before surgery to optimise my recovery? As a naturopath, I always encourage families to ask this — not to delay surgery, but to walk into it as prepared as possible.

Key takeaway: Asking questions is not the same as resisting the recommendation — it is how you become an active participant in your own care.

What life looks like on the other side

My husband is now more than 20 years in deep remission. Zero flares. He travels, he works, he is present for our family in ways that simply weren't possible when he was in the grip of active disease. Surgery — including everything that came with it — gave him that.

I am not telling you this to minimise what you're facing. I'm telling you because when we were in those hospital rooms, nobody told us this part. Nobody said: people get through this, and more than that — they thrive.

The Crohn's & Colitis Foundation has documented that many people with ostomies report improved quality of life compared to life with severe, uncontrolled Crohn's disease. That doesn't mean the adjustment is easy. It means the adjustment is worth making.

If you're supporting someone through this conversation right now, the most important thing you can do is stay in the room. Ask the questions. Write things down. And remind them — and yourself — that this is not the end of the story. It is, for many people, the beginning of a better chapter.

Common questions

Can a Crohn's ostomy be reversed?

Sometimes, yes. Many ostomies created during Crohn's surgery are temporary, with reversal planned once the bowel has healed. Whether reversal is possible depends on the extent of disease, the type of surgery, and the individual's overall health. Your surgical team is the right person to discuss this with.

How long does it take to adjust to life with an ostomy?

Most people begin to feel physically confident with their ostomy within 6–12 weeks of surgery, though emotional adjustment takes longer. Stomal therapy nurses and peer support communities (including ostomy associations in most countries) are invaluable during this period.

Does an ostomy mean Crohn's has 'won'?

No. An ostomy is a medical tool — one that protects the bowel and, in many cases, enables remission. For many people with Crohn's, surgery including an ostomy is what finally brings disease under control after years of failed medical management.

What can a naturopath do to support someone preparing for ostomy surgery?

As a naturopath, I focus on nutritional preparation before surgery (supporting immune function and reducing inflammation where possible), and on recovery support afterward — including gut-healing nutrition, fatigue management, and emotional wellbeing. This always works alongside, never instead of, the surgical and gastroenterology team.