Living with a Stoma: A Systematic Review and Meta-Analysis of Quality-of-Life and Psychological Outcomes After Colostomy Versus Ileostomy

Background: Intestinal stomas affect an estimated 1.5 million people worldwide. The comparative psychosocial burden of colostomy versus ileostomy remains poorly synthesised, leaving clinicians without quantitative guidance for shared decision-making. Methods: PRISMA-2020-compliant systematic review and random-effects meta-analysis (DerSimonian–Laird) of studies published January 2000–March 2026 (PubMed/MEDLINE, Embase, Cochrane Library, PsycINFO). Of 47 studies in the systematic review (n = 38,612), 22 contributed extractable means ± SD to the quantitative meta-analysis. The SMD was coded as colostomy minus ileostomy on the respective scale: a positive SMD on symptom/burden scales (depression, body image disturbance) indicates greater burden in colostomy; a positive SMD on HRQoL scales (higher = better) indicates better HRQoL in colostomy. Subgroup analyses were prespecified for stoma duration (temporary vs. permanent) and indication (oncological, IBD, other). Publication bias was assessed with Egger’s test and trim-and-fill. Results: Colostomy patients had slightly better global HRQoL on disease-specific instruments than ileostomy patients (SMD = +0.12, 95% CI +0.03 to +0.21; I² = 46%), driven by output-related morbidity in ileostomy. However, colostomy patients experienced greater depressive symptoms (SMD = +0.42, 95% CI +0.10 to +0.74; I² = 8%), worse body image (SMD = +0.36, 95% CI +0.14 to +0.58; I² = 61%), and poorer sexual function, particularly after abdominoperineal resection (SMD = −0.48, 95% CI −0.71 to −0.25 on higher = better scales). Permanent stomas were associated with greater body image disturbance and poorer physical functioning than temporary stomas Conclusions: Colostomy and ileostomy produce comparable global HRQoL but distinct psychosocial signatures. Stoma type alone is a weaker determinant of HRQoL than duration, complications, sex, age, and indication. These findings should inform individualised counselling, stoma siting, and structured psychosocial follow-up programmes.