The short answer: sometimes yes, sometimes no
Whether your anus is closed during colostomy surgery depends on why you need the colostomy and whether you might need your colon and rectum again later. If the surgery removes your colon and rectum entirely — usually because of cancer, familial polyposis, or inflammatory bowel disease that cannot be controlled — the surgeon will close the anus with stitches. If your colon and rectum stay in your body but are bypassed, the anus may be left open but not functional, or it may be partially closed.
The decision is made before surgery based on your diagnosis and the surgeon's assessment of whether reversal is possible. You will know going in whether your anus will be closed, left open, or partially closed, because your surgeon discusses this during pre-operative planning.
Key Takeaways
- Total removal of the colon and rectum means the anus is sewn closed permanently because there is no bowel left to connect to it.
- If your colon and rectum remain in your body but are not being used, the anus may be left open with no function, or partially closed depending on surgeon preference and your situation.
- Permanent colostomies (where removal has occurred) and temporary colostomies (where reversal is planned) have different surgical approaches to the anus.
- Complications from a closed anus are rare but can include infection or fluid buildup if the closed end is not properly managed during healing.
When the anus is sewn closed completely
The anus is sewn closed when the surgeon removes your entire colon and rectum. This happens most often with colorectal cancer, familial adenomatous polyposis (FAP), or ulcerative colitis that has not responded to medical treatment. Because there is no bowel left below the colostomy, closing the anus prevents infection and eliminates a non-functional opening.
The closure is done with absorbable stitches that dissolve over two to three weeks as the tissue heals. The surgeon may also place a drain near the closed area to prevent fluid buildup during the first week or two after surgery. Once healed, the closed anus becomes a sealed scar and requires no ongoing care.
When the anus is left open or partially closed
If your colon and rectum are still in your body but bypassed — usually because a temporary colostomy is planned or because the surgeon wants to preserve the option of reversal — the anus may be left open. An open anus that is not connected to functioning bowel will produce mucus discharge, which is normal. Some patients report a small amount of mucus in their underwear, while others have none.
Some surgeons partially close the anus to reduce mucus discharge while leaving it open enough to prevent pressure buildup. Others leave it fully open. The choice depends on the surgeon's technique and your specific situation. If mucus discharge becomes a problem, you can manage it with absorbent pads or by discussing options with your colorectal surgeon.
Permanent versus temporary colostomy and what it means for your anus
A permanent colostomy means the colon and rectum have been removed or are no longer functional, and the colostomy will be your only way of passing stool for the rest of your life. In permanent cases, the anus is almost always sewn closed because there is no reason to keep it open.
A temporary colostomy is created when the surgeon plans to reconnect your bowel later — usually after inflammation has healed, a tumor has been removed from a section that can be preserved, or trauma has repaired. In temporary cases, the anus is usually left open or partially closed because the surgeon may need to reverse the colostomy within months or years. Leaving it open preserves the option of reconnection.
Your surgeon will tell you before the operation whether your colostomy is intended to be permanent or temporary. This determines the surgical approach to your anus.
Healing and complications after anus closure
If your anus has been sewn closed, the area heals over two to four weeks. During this time, you may feel tenderness, mild swelling, or slight drainage — all normal. The surgeon may have placed a drain to prevent fluid from building up under the closed tissue. If a drain was placed, it is usually removed within a few days to a week.
Complications are uncommon but can include infection, seroma (fluid collection), or hematoma (blood collection) under the closed tissue. Signs of infection are increasing redness, warmth, pus, or fever. If you notice these, contact your surgeon. Most closures heal without incident, and once healed, the area requires no special care.
Mucus discharge from a non-functional anus
If your anus was left open or partially closed, the tissue lining your colon and rectum will continue to produce mucus even though stool no longer passes through. This mucus may drain from the anus in small amounts, especially in the first few weeks after surgery. The amount usually decreases over time as the unused bowel adjusts.
Mucus discharge is not dangerous and does not mean something is wrong. If discharge is heavy enough to be uncomfortable, you can use absorbent pads, wear protective underwear, or discuss the issue with your surgeon. Some people have almost no discharge, while others have a small amount indefinitely. This varies widely and is not predictable before surgery.
What to expect during recovery
Whether your anus is closed or left open, the area around it will be part of your surgical site and needs care during healing. Keep the area clean and dry. If you have stitches or a drain, your surgeon will give you specific instructions on cleaning and when to return for removal. Do not soak in a bathtub until your surgeon says it is safe — usually after the incision has fully closed, which takes two to four weeks.
Pain or discomfort in the area is normal for the first week or two. Your surgeon will prescribe pain medication. If pain increases after the first few days, or if you develop fever, heavy drainage, or signs of infection, contact your surgeon when ready. Most people recover without complications and can return to normal activity within four to six weeks.
Frequently Asked Questions
Will I have pain where my anus was closed?
You may feel tenderness and mild discomfort for the first one to two weeks after surgery. This is normal and managed with prescribed pain medication. Once healed, the closed area should not cause ongoing pain. If pain increases after the first week or returns later, contact your surgeon.
Can a closed anus be reopened later?
If your anus was closed because your colon and rectum were removed, it cannot be reopened because there is no bowel to reconnect to it. If your anus was left open or partially closed, your surgeon preserved the option of reversal if your colostomy was temporary.
What should I do if I have discharge from my anus after colostomy surgery?
Small amounts of mucus discharge are normal if your anus was left open or partially closed. Absorbent pads or protective underwear can manage it. If discharge is heavy, foul-smelling, or accompanied by pain or fever, contact your surgeon to rule out infection.
How long does it take for the anus to heal after being sewn closed?
The anus typically heals over two to four weeks. Absorbable stitches dissolve during this time. You will know healing is complete when the area is no longer tender, swelling has gone down, and any drain has been removed.
Is it normal to feel self-conscious about a closed anus?
Yes. Many people feel emotional about changes to their body after colostomy surgery. Speaking with a colorectal surgeon, a therapist, or a support group for ostomates can help you process these feelings and connect with others who have had the same experience.