Exercise guide
Exercise with a stoma is safe and recommended: the UK stoma nurses' recommendations call it safe and essential, and most sports are possible once you've rebuilt your strength. Gentle breathing and core exercises can usually start about a day after surgery if you're able, then build up in levels over weeks and months. Teams vary, and your stoma nurse or surgical team decides when you start.
This guide follows those recommendations (EXPASS, Exercise and Physical Activity after Stoma Surgery) alongside NHS and charity advice: when to start, how to progress your core exercises, lifting and the gym, swimming and sport, support belts, fluids with an ileostomy, and exercising with a parastomal hernia. Advice on lifting differs between hospitals, so follow your own team at first. It applies to colostomies, ileostomies and urostomies.
The UK stoma nurses' 2025 recommendations (EXPASS) say exercise with a stoma is safe and essential, and that core rehabilitation should be standard for everyone. Yet in a UK survey of 2,631 people with a stoma, 9 in 10 weren't meeting activity guidelines, and most had never been given advice on tummy exercises.
EXPASS and its quick guide say gentle core exercises, such as breathing, pelvic tilts and knee rolls, can start about a day after surgery if you're able, in bed or a chair. Teams vary, so your stoma nurse or surgical team decides, and it's never too late to start.
Work up through the levels over weeks and months, guided by how your tummy responds. Ease off or go back a level for doming or bulging, pressure, pulling, or soreness that lasts more than 24 hours.
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The NHS says avoid strenuous activities or heavy lifting for 8 weeks after a colostomy and 3 months after an ileostomy. EXPASS says the evidence doesn't support a fixed limit, and recommends learning to lift well instead. Follow your own team at first.
Up to 1 in 3 people with a stoma get a hernia next to it (a parastomal hernia). In observational studies, exercise is linked with fewer hernias, but those studies can't show cause and effect.
After rehabilitation, most sports are possible, including swimming once your wounds have healed and contact sport with a flat protector. After removal of the rectum or pelvic floor surgery, wait about 3 to 6 months before running and jumping.
A stoma is an opening made by a surgeon that connects an internal organ, such as the bowel, to the skin of your tummy; poo, or urine with a urostomy, collects in a bag stuck over it. A colostomy uses the large bowel (colon). An ileostomy uses the end of the small bowel (ileum) and makes looser output that's usually emptied several times a day. Stomas can be temporary or permanent.
Reasons include bowel cancer, inflammatory bowel disease (Crohn's disease or ulcerative colitis), diverticulitis, a blocked bowel and injury. Surgery that removes the rectum, or the whole large bowel and rectum, also affects the pelvic floor.
As many as 13,500 people have stoma surgery each year in the UK, and around 1 in 350 people live with a stoma (Crohn's & Colitis UK says 1 in 335). Around 60% of stoma operations are planned, so most people have time to prepare.
The NHS says it takes around 8 weeks to recover from a colostomy and 6 to 8 weeks from an ileostomy. Healing carries on for longer: York's NHS hospital physiotherapists say the tummy wall takes about 2 years to regain its strength.
A parastomal hernia is where part of the bowel pushes through the gap in the tummy muscles beside the stoma, making a bulge under the skin. How often it happens depends on how it's counted: up to 1 in 3 people (Crohn's & Colitis UK); 29.7% in a survey of 443 people (40% with a colostomy, 24% with an ileostomy); 54.3% on scans in a Spanish hospital series. An end colostomy carries the highest risk. Most hernias are managed without an operation, with help from the stoma nurse, a different bag, support wear or exercise.
A stoma can push out further than usual (a prolapse), sink in, or get blocked, when output slows or stops with cramps, swelling and being sick. High output, more than about 1 to 1.5 litres a day, can dehydrate you and is more common with an ileostomy.
EXPASS is the agreed view of a 15-member panel of stoma and colorectal nurses, physiotherapists, surgeons, researchers and people living with a stoma, reached by formal voting. Its authors call the research behind it sparse and of varied quality, and say these are recommendations, not formal guidelines. The work was funded by grants from stoma product and support wear companies.
EXPASS's timelines depend on how complex your surgery was and how fit you were before it. After simpler surgery, if you were fit, the first phase may take 2 to 4 weeks; after complex surgery, or if you were frail or unwell, 12 to 14 weeks. The timings on this page are its standard pathway, in between.
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EXPASS encourages getting up and moving soon after surgery. Gentle core exercises can start about a day after surgery if you're able, but teams vary: your stoma nurse or surgical team decides when you start. Roll onto your side to get out of bed, and breathe out as you stand up from a chair.
An international roundtable convened by the American College of Sports Medicine (ACSM) advises a medical check and clearance before starting exercise after tummy surgery or with a stoma.
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If you have time, EXPASS suggests learning the breathing and level 1 exercises and how to get out of bed and up from a chair. If you're able, aim for 150 minutes of moderate exercise a week, strength training at least twice a week, and core or Pilates exercises 2 to 3 times a week for 20 to 30 minutes.
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The NHS suggests a short walk when you feel ready. EXPASS says walk little and often, balanced with rest, building up to 60 minutes or more if you can; York's leaflet aims for 30 minutes a day by 2 to 3 months.
EXPASS's levels, with examples. Move up only when the level you're on feels controlled, with no doming or bulging.
Breathing, knee rolls, single leg slides, pelvic tilts, overhead reaches and knee drops. York's leaflet suggests 3 to 5 repetitions with 5 to 10 second holds, twice a day; the Ileostomy and Internal Pouch Association suggests starting with 4 and never going beyond 10.
Breathing on hands and knees, single knee lifts, bridges, cat-cow, seated knee lifts, calf raises and mini squats.
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Tabletop with your knees bent at right angles, dead bug, small curl-ups, and planks and side planks on your knees.
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Half roll-backs, hover planks, side planks on your feet, then longer planks, roll-ups, the hundred, bicycling and the farmer's walk. Advanced moves, such as Russian twists, V-sits, sit-ups, hanging leg raises, crunch machines and rollouts, come last and may not suit everyone.
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On EXPASS's standard pathway: up to 6 weeks, master breathing and work through levels 1 to 3, daily, little and often; from 6 to 16 weeks, levels 3 to 5, with 2 to 3 sessions a week of 20 to 30 minutes; after that, 2 to 3 sessions a week of specific core training (30 to 60 minutes) for life, if you can. Some advanced exercises may need changing for more than a year.
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If you didn't start early, or had your surgery years ago, start at level 1 anyway: EXPASS says you'll probably move up faster.
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There are no trials of the levels: they're an expert consensus framework. But they're the UK stoma nurses' own, and they agree with the NHS and charity leaflets we read.
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Leave out sit-ups and double leg raises while your tummy heals: UK leaflets agree on this, though no trial has tested it. Planks come later, starting on your knees.
3 to 5 repetitions with 5 to 10 second holds, twice a day (York), building to no more than 10 (Ileostomy and Internal Pouch Association). With an internal pouch, leave out pelvic floor squeezes unless your consultant recommends them.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoSide-lying tummy draw-inBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoBent-knee fall-outBeginner · No equipment
3D demoPelvic floor exercise (Kegel)Beginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoGlute bridgeBeginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoSeated marchBeginner · A bench or box
3D demoSlow calf raiseBeginner · A wall
3D demoSit squat (partial squat)Beginner · No equipment2 to 3 sessions a week of 20 to 30 minutes (EXPASS), checking each move with the self-check below. The repetitions in our levels 3 and 4 workout are our editorial starting points.
3D demoDead bug heel tapsBeginner · No equipment
3D demoDead bugBeginner · No equipment
3D demoChest lift (Pilates curl-up)Beginner · No equipment
3D demoKnee plankBeginner · No equipment
3D demoKnee side plankBeginner · No equipment
3D demoKnee hover (Pilates tabletop hover)Beginner · No equipment
3D demoHalf roll back (Pilates C-curve roll back)Beginner · No equipment
3D demoStraight-arm plank (high plank)Intermediate · No equipment
3D demoSide plankIntermediate · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoRoll-up (Pilates)Intermediate · No equipment
3D demoBicycle crunchIntermediate · No equipment
3D demoFarmer's carryBeginner · A dumbbell + A kettlebellEXPASS's self-check. Emptying the bag first is the ACSM roundtable's advice.
Advice on lifting varies between hospitals and charities, from a few weeks to 3 months, and it's expert opinion rather than trial evidence. Follow your own team at first:
EXPASS says it's especially important not to stop lifting your children, and that avoiding even a kettle or pots and pans creates fear. In the first 6 weeks, it suggests lifting light to moderate things, babies included, with good technique, and light housework, while taking care with awkward heavy lifts, heavier housework, gardening and DIY.
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On EXPASS's standard pathway, moderate lifting and more active work come back from about 6 to 16 weeks. Very heavy repetitive lifting and the most physical jobs wait until about 4 to 6 months, and getting back to full strength for a demanding job can take 6 to 12 months.
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From EXPASS's lifting advice and the Ileostomy and Internal Pouch Association's leaflet.
In the first 6 weeks, EXPASS suggests walking, light cardio such as a treadmill walk or an exercise bike, swimming once your wounds have healed, and light strength exercises. From 6 to 16 weeks, build up time and effort, with strength work at high repetitions and low weights. In the long term most activities are possible, though demanding ones such as rowing, heavy weights or competition need good core strength first.
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Start with weights you can lift 12 to 15 times, for 2 to 5 sets, without straining; if you trained before, start at no more than half your old weights, repetitions and sets. Keep weights close to your body, and begin with shorter, controlled moves such as curls, shoulder presses, lateral raises and leg extensions before squats, lat pulldowns and leg presses; later, build to 6 to 8 heavier repetitions. Breathe out on the effort and never hold your breath (EXPASS and the ACSM roundtable).
EXPASS says no sport is completely off limits after the right rehabilitation, though after complex surgery getting back to a high level can take 1 to 2 years or more. Colostomy UK says there's no reason you shouldn't take part in competitive sport once you've recovered and your doctor or stoma nurse agrees.
After removal of the rectum or surgery involving the pelvic floor, EXPASS suggests waiting about 3 to 6 months before running and jumping, to let the area heal and lower the risk of a hernia there. Seated exercise may need a cushion, and a pelvic health physiotherapist can help.
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You can swim once all your wounds have fully healed. Bag adhesive stays effective in water, flange extenders add security, filter covers keep water out, and smaller bags may suit.
Colostomy UK suggests keeping up your core exercises alongside running, walking further than you plan to run before you start, and run-walking if you need to. Secure your bag, think about flange extenders, and stop if it hurts. EXPASS places couch to 5K at its lowest level of demand on the core.
A stoma is generally resilient to knocks, and a protector is a personal choice for confidence. Avoid hard, plastic, dome-shaped protectors, which could damage the tummy wall in a fall or impact; flatter guards, padding or foam may suit. Your stoma nurse can tell you when to go back to contact sport.
EXPASS calls Pilates an excellent choice for anyone with a stoma; start with a clinical or physiotherapist-led class, or a teacher who understands stomas, because classes vary. York's leaflet suggests a Pilates or yoga class to progress. Lying on your front is safe with any stoma: it's a matter of comfort.
12 to 15 repetitions, 2 to 5 sets, without straining, and no more than half your old weights if you trained before (EXPASS). Start with the first four, then add the squat, pulldown and leg press.
3D demoDumbbell biceps curlBeginner · A dumbbell
3D demoStanding overhead pressIntermediate · A barbell + A dumbbell
3D demoDumbbell lateral raiseBeginner · A dumbbell
3D demoLeg extensionBeginner · Strength machine
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoLat pulldownBeginner · A cable machine
3D demoLeg pressBeginner · Strength machineWalk little and often, building towards 60 minutes or more (EXPASS). An exercise bike suits the first weeks; running comes after rehabilitation, and about 3 to 6 months after rectal or pelvic floor surgery.
In a survey of 443 people with a permanent stoma, those with a hernia did about a third as much physical activity as those without, but being overweight, or the hernia itself, may explain that. In a Spanish hospital, people who did supervised tummy exercises from at least 6 weeks before surgery to a year after had fewer hernias than earlier patients (64 people after matching). Both studies are observational, so they can't show cause and effect, and no trial has tested whether exercise lowers the risk.
EXPASS says the risk should be respected but not feared, and that stronger, more active people with good core function are probably less likely to get a hernia, and more likely to manage one without surgery. Crohn's & Colitis UK suggests tummy-strengthening exercises, keeping a healthy weight and not smoking to lower the risk.
EXPASS says it's vital not to become less active because of a hernia: keep up your core exercises, probably 2 to 3 sessions a week of 20 to 30 minutes for life, and levels 4 and 5 needn't be avoided if you can do them well without extra doming. In a small study (HALT), 19 of 28 people with a hernia or bulge completed a Pilates-based programme, and some said their hernia felt smaller and they felt more confident. It tested only whether the programme was workable.
Repairs and mesh are your surgeon's decisions. The European Hernia Society recommends placing a mesh when an end colostomy is made, to lower the risk of a hernia, for people at high risk or with a fair life expectancy.
There's no strong evidence that support wear stops hernias forming. EXPASS says it shouldn't be standard after surgery and isn't needed for all exercise, though wearing it for comfort and confidence is a personal choice; with a large or uncomfortable hernia, a garment fitted by a specialist probably helps. Crohn's & Colitis UK suggests a belt or girdle for heavier activities, and Colostomy UK's 2019 article said one might be advisable when exercising, but a 2024 review found no studies of whether garments work. EXPASS advises against garments with a hole for the stoma, which give less support.
Crohn's & Colitis UK suggests around 2 litres of fluid a day with an ileostomy, and about a teaspoon of salt a day, more in hot weather when you also lose salt and water in sweat. The ACSM roundtable says ask for advice on fluids around exercise, as an ileostomy raises the risk of dehydration. Thirst, tummy cramps, feeling dizzy or faint, and dark wee are signs of dehydration.
High output is defined differently, as more than 1, 1.2 or 1.5 litres a day. Your team may limit plain drinks and suggest a rehydration solution instead, so ask them what to drink rather than drinking more water. Sources differ on sports drinks: Crohn's & Colitis UK says sports or rehydration drinks are better than water, tea and coffee, while a Colostomy UK dietitian says sports drinks don't contain enough salt to replace a rehydration solution.
Empty your bag before you start (ACSM roundtable) and check it's secure (Colostomy UK). Take a drink with you, and plan fluids and salt around longer or hotter sessions (our suggestion).
Our pelvic floor guide has the full routine.
Pelvic floor squeezes are part of EXPASS's core levels and of the York and Ileostomy and Internal Pouch Association programmes. After removal of the rectum or pelvic floor surgery, most people benefit from pelvic floor rehabilitation, and a pelvic health physiotherapist can help.
The Ileostomy and Internal Pouch Association advises people with an internal (J) pouch not to do pelvic floor squeezes unless their consultant recommends them.
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A reversal is another tummy operation, so start again with gentle breathing, core and pelvic floor exercises and build up (our suggestion). In a trial of 53 people whose stoma was closed after rectal cancer surgery, pelvic floor exercises helped bowel control improve sooner but made no difference by 9 months, and a review of 12 trials of pelvic floor rehabilitation after rectal cancer surgery rated the evidence low to very low certainty.
Start with the core routine after bowel surgery (levels 1 and 2), move on to levels 3 and 4 when it feels easy with no doming, then the beginner Pilates workout. Add the band workout from the 6 to 16 week phase, with EXPASS's weights tips.
A gentle 20-minute core routine for the weeks after bowel or stoma surgery: breathing, tummy and pelvic floor work lying down, then chair and standing moves.
20 minBeginner14 movesA bench or box, A wallThe next step after the first core routine: 20 to 30 minutes of level 3 and 4 core work, 2 to 3 times a week, from the UK stoma nurses' recommendations.
25 minIntermediate14 movesNo equipmentA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA gentle 15-minute Pilates-based routine for ongoing low back pain, built from neutral-spine moves with options for backs that dislike bending or arching.
15 minBeginner10 movesNo equipmentA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA full-body resistance band workout: squats, presses, pull-aparts, band walks, good mornings and flyes.
25 minBeginner7 movesA band, An anchor pointEXPASS puts walking and couch to 5K at its lowest level of demand on the core. After rectal or pelvic floor surgery, wait about 3 to 6 months before running.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginner3 days a weekA 9-week beginner plan with the same walk-to-run shape as Couch to 5K: three run-walk sessions a week, from 1-minute jogs to 30 minutes of running.
3 training days35 minBeginnerThis is general information, not a diagnosis: your stoma nurse and surgical team know your operation, so use the numbers they gave you. A&E means accident and emergency, and GP means general practitioner. In the US, call 911 where this page says 999.
Call 999, and don't drive yourself to A&E, if you have a hernia and:
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If you have a hernia and:
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These can be signs of an infection or a blocked bowel. With a stoma, ask for an urgent GP appointment or call 111 if you have:
Get urgent help from your GP, stoma nurse or 111 if cramps get worse, there's been no output for 12 hours, you're showing signs of dehydration, or you're being sick. Crohn's & Colitis UK says go to A&E if your tummy pain gets worse or you're sick. Colostomy UK says a short walk, if it isn't too painful, may help a partial blockage.
Thirst, tummy cramps, feeling dizzy or faint, or dark wee: contact your stoma nurse. Contact your hospital urgently if your ileostomy output is more than 2 litres a day for 3 days or more.
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Over the next 24 hours, watch for a blockage, a change in output (more watery, on and off, none at all, or with feeling or being sick), a swollen or pale stoma, a stoma that pushes out, a bigger bulge, or pain around your stoma or scars that lasts 24 hours. Take it easier and get advice if they don't settle. Severe or long-lasting pain around the stoma, or a big change in output, needs medical advice straight away.
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Speak to your stoma nurse urgently for cramps, feeling sick, or swelling around your stoma. See them for a new bulge or swelling around the stoma, a stoma that's changing shape, sore skin or leaks during exercise, or before starting a support garment.
Surgery, a stoma and worries about leaks can affect your mood. If you're thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988. Colostomy UK's stoma helpline is 0800 328 4257, and Crohn's & Colitis UK's helpline is 0300 222 5700.
EXPASS says the evidence doesn't support a no-lifting rule or a fixed limit, which can do more harm than good: learn to lift well, take care with awkward or heavy loads for a few weeks, and don't stop lifting your children. NHS pages still give 8 weeks or 3 months for heavy lifting, so follow your team at first.
EXPASS recommends specific core exercises for everyone with a stoma, from soon after surgery and for life. In observational studies, exercise is linked with fewer hernias, though that doesn't prove exercise is the reason. What to leave out early is sit-ups and double leg raises.
There's no strong evidence that support wear stops hernias forming, and you don't need it for all exercise. It's a personal choice for comfort, and may help with a large hernia.
Bags are waterproof and the adhesive stays effective in water. Swim once all your wounds have healed.
EXPASS says lying face down is safe with any stoma; it's a matter of comfort.
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EXPASS says keep active and keep your core exercises going. A small study found a Pilates-based programme workable and acceptable for people with a hernia or bulge.
EXPASS says no activity is completely off limits after the right rehabilitation. A flat protector, not a hard dome, can add confidence.
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Yes. The UK stoma nurses' recommendations say exercise is safe and essential, and once you've recovered and your doctor or stoma nurse agrees, you can play sport, even competitively.
Gentle breathing and core exercises can usually start about a day after surgery if you're able, in bed or a chair, along with short walks. Teams vary, so your stoma nurse or surgical team decides. The NHS says recovery takes around 8 weeks after a colostomy and 6 to 8 weeks after an ileostomy, and core work and walking carry on through that time.
Start with breathing, pelvic tilts, knee rolls and leg slides, then build up in levels over weeks and months. Leave out sit-ups and double leg raises while you heal; planks come later, starting on your knees. Ease off if you notice doming or bulging.
Advice varies: the NHS says avoid heavy lifting for 8 weeks after a colostomy and 3 months after an ileostomy, while the UK stoma nurses say a fixed limit isn't needed if you learn to lift with good technique. Follow your own team at first, keep loads close, breathe out as you lift, and split heavy shopping.
Yes, built up gradually: start with a weight you can lift 12 to 15 times, for 2 to 5 sets, without straining. If you trained before, start at no more than half your old weights and repetitions. Begin with moves like curls and shoulder presses before squats and leg presses, and breathe out on the effort.
There's no evidence that the right exercise causes one. In observational studies, people who are more active have fewer hernias, which links exercise with fewer hernias but doesn't prove cause and effect. Core exercises are recommended for everyone with a stoma, and you should tell your stoma nurse about any new bulge.
Yes. Keep active and keep doing your core exercises, probably 2 to 3 sessions a week of 20 to 30 minutes, as long as you don't notice extra doming. A fitted support garment may help if the hernia is large or uncomfortable. Call 999 if it becomes very painful or changes colour, or you're being sick or can't pass anything.
Not necessarily. There's no strong evidence that support wear stops hernias forming; wear it if it makes you more comfortable or confident, and ask your stoma nurse for a fitted one if you have a hernia. Garments with a hole for the stoma aren't recommended.
You can swim once all your wounds have fully healed. Running and other sports come back after rehabilitation; if your rectum was removed or you had pelvic floor surgery, wait about 3 to 6 months before running and jumping. For contact sport, a flat protector is fine, but avoid hard, dome-shaped ones.
Aim for around 2 litres a day and about a teaspoon of salt, more in hot weather. If your output is high, ask your team what to drink rather than just drinking more water, and contact the hospital urgently if it's more than 2 litres a day for 3 days or more.
Yes: lying face down is safe with any stoma. The stoma nurses call Pilates an excellent choice; start with a clinical or physiotherapist-led class, or a teacher who understands stomas.
A reversal is another tummy operation, so our suggestion is to start again with gentle breathing, core and pelvic floor exercises and build up, as after other bowel surgery. Pelvic floor exercises may help bowel control improve sooner, though the evidence is weak. Ask your team about lifting limits for the new wound.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
