This topic is about someone who has been living with a colostomy due to a history of ulcerative colitis and cancer. They are considering a surgical reversal of the colostomy but are worried about losing bowel control if the colitis returns. Here are some insights and advice shared by others who have faced similar situations:

- The person has dealt with ulcerative colitis since 2011, experiencing many embarrassing accidents due to loss of bowel control.
- In 2017, ovarian cancer spread to the sigmoid colon, necessitating emergency surgery and resulting in a colostomy.
- After undergoing a hysterectomy and chemotherapy, all cancer follow-ups have been clear since 2017.
- Although a surgical reversal is technically possible, doctors have warned that the colitis could return, potentially leading to a loss of bowel control again.
- The main concern is whether to keep the reliable control provided by the ostomy or risk renewed incontinence after a reversal.
- The person is seeking advice from others who have experienced a similar situation with colitis and an ostomy.

Additional considerations include:

- Previous colitis medications were ineffective before the ostomy.
- There is uncertainty about how much bowel was removed beyond the sigmoid colon, and the person plans to review their medical records.
- The ostomy is currently well tolerated, and a reversal would only be considered if continence could be reasonably assured.

Advice and insights from others include:

1. Carefully consider quality of life. Some people have chosen not to reverse their ostomy because pre-stoma symptoms like incontinence and urgency might return, while the ostomy provides better day-to-day control.
2. Be aware that additional surgery can bring its own trauma and potential complications. Only proceed if the benefits clearly outweigh the risks.
3. Explore colostomy irrigation. If you have a true colostomy, regular irrigation might allow you to wear a small cap or patch instead of a pouch, offering more freedom without a full reversal. Consult an ostomy nurse or surgeon for guidance.
4. Re-evaluate modern medical therapy for colitis before making a decision:
- Confirm how much of the colon and rectum remain, as active colitis can only occur in the remaining large-bowel tissue.
- Seek opinions from up-to-date gastroenterologists on current drug options.
- Specific biologics like Stelara (ustekinumab) and Humira (adalimumab) have been suggested, with one person reporting 100% control of symptoms with Stelara.
5. If medical therapy can reliably control inflammation, a reversal might be sensible. If not, keeping the ostomy could spare you from additional major surgeries.
6. Consider postponing the decision. Keep the ostomy while you are symptom-free, monitor for any recurrence, and preserve the option of reversal for later if circumstances change.
7. Listen to your body and maintain regular follow-ups with both surgical and GI teams. Only you can balance the surgical risk against continence and lifestyle priorities.