Joe Manganiello Lost His Entire Large Intestine. Here’s What That Organ Does, and How People Live Without It

Joe Manganiello planned his Batman costume fitting around his digestion. Not long out of the hospital, he flew to London to be fitted as Deathstroke, the villain in the Batman film Ben Affleck was then developing, and under his sweatpants was something nobody in wardrobe knew about: an ostomy bag. Not long before, surgeons had removed his entire large intestine. So, by his account in Bloodlines: A Memoir, which goes on sale Tuesday, he stopped eating the afternoon before, giving his digestive system about eighteen hours to clear, and walked into a fitting for a costume of spandex, latex and armor. “I had to be absolutely sure nothing would come out in the bag while I wore the suit because under that degree of compression it would probably explode,” he writes. He was “appropriately empty by morning.” Nobody knew. For about a decade, almost nobody did.

We read the excerpt he published in The Hollywood Reporter, the CBS transcript of his Monday interview and the physiology papers, because that fitting room is a lesson in what the large intestine does: it is the body’s water reclaimer, its fermentation tank and its waiting room.

The book: Seven years, kept quiet, out Tuesday

Simon & Schuster’s page lists Bloodlines (Avid Reader Press, 320 pages) for October 13, 2026. Its jacket copy describes “a cascade of autoimmune-related illnesses” across a seven-year battle that “left doctors with few answers and no clear explanation.” On Monday he sat down with Gayle King on CBS Mornings, and when she noted that he still doesn’t know what the illness is, he said: “Well, it’s a host of autoimmune issues.” The Daily Beast, reporting on the People interview that broke the story on October 7, wrote that he never received a conclusive diagnosis. So we will not name one. What he has named, in print and on air, is the organ.

The night: What he says happened in 2016

He collapsed on a set in Wilmington, North Carolina, in 2016, The Hollywood Reporter says, and he told King he spent two months in hospital. Scans could not find the problem, so surgeons opened him up. “They had split me open, and my entire large intestine had turned to pus and was about to explode,” he said on Monday. “They took it out.” Had they waited, the book says, “it would have ruptured, and I would have died immediately of sepsis.” He woke, in the passage People excerpted and Extra quoted, to learn the surgery “had saved my life but had left me with an ostomy bag for an indefinite amount of time, possibly forever.” “I can’t believe I’m alive,” he told People, as The Independent reported. “For seven years I thought I was going to be dead the next week.”

The suit: An ostomy bag under a Batman fitting

The call came, he told King, “about a month out of the hospital”: the main villain in the next Batman film. The excerpt explains why the fitting took planning. “Adjusting to life without a large intestine was like waking up in someone else’s body,” he writes. “Without the storage capacity of a colon, within minutes of eating anything, my body would immediately output waste through the stoma.” That sentence is the whole fitting-room problem: a costume that squeezes everything underneath it, and a body with nowhere to hold what it makes. So he emptied the system in advance by not putting anything into it, cleared the room to change, checked that the bag was still empty and called everyone back in. There is something remarkable about a man not long out of an emergency operation timing his own digestion to the hour so that a villain’s armor would not give him away.

The organ: What the large intestine does all day

The large intestine is the last stretch of the gut, the cecum, colon and rectum, about five feet long and a fifth of the digestive tract, according to StatPearls’ physiology chapter by L. L. Azzouz and S. Sharma. By the time a meal reaches it, the small intestine has taken most of the nutrients and what arrives is liquid. The large intestine “absorbs water and changes the waste from liquid into stool,” the NIH’s digestive diseases institute (NIDDK) says, and the rectum stores that stool until a bowel movement; its bacteria also make vitamin K. Our digestion timeline has the hours.

The volume is the surprise. “The colon is an organ of conservation that salvages water, electrolytes, and energy,” P. J. Milla of Great Ormond Street Hospital’s gastroenterology unit wrote in a 2009 review in the Journal of Pediatric Gastroenterology and Nutrition: in a normal adult it absorbs about 1.5 litres of fluid a day, and under the salt-saving hormone aldosterone it can reach 5 to 6 litres. The result, in a 2002 Physiological Reviews paper by K. Kunzelmann and M. Mall, is “a feces with very little water and salt content.” Firm stool is the colon’s signature.

The second job is fermentation. The colon’s bacteria break down carbohydrate the small intestine leaves behind, much of it fiber, into short-chain fatty acids. In a 1987 study in Gut, J. H. Cummings and colleagues in Cambridge measured them in gut contents sampled at autopsy: 13 mmol per kilogram at the end of the small intestine, 131 in the cecum, the colon’s first pouch. One of those acids, butyrate, feeds the colon’s own lining. In a 1980 study in Gut, W. E. Roediger found that butyrate alone accounted for 73% of oxygen use in human colon cells from the ascending colon and 75% from the descending colon. Those were cells in a lab, and he framed the conclusion as a hypothesis: bacterial fatty acids are a major energy source for the colon wall. Our microbiome explainer has more.

Without it: How a body runs on the small intestine alone

In an ileostomy, NIDDK explains, surgeons bring the ileum, the last part of the small intestine, through the abdominal wall to form a stoma, and the entire large intestine is bypassed or removed. That is what Manganiello describes: the end of his small intestine brought out through his abdomen under a plastic bag. A stoma has no muscle, NIDDK notes, so it cannot control the timing or flow of what comes out. The United Ostomy Associations of America’s ileostomy guide (2022) tells new patients that stool may be liquid or watery after surgery and should thicken over time to about the consistency of oatmeal, with output through the day and night. “There was no real way to feel when it was going to start or stop,” Manganiello writes. That is the waiting room, gone.

The water job goes too. In a 1983 study in Gut, H. J. Kennedy and colleagues compared 39 people with a permanent ileostomy, whose colon and rectum had been removed, with 39 matched healthy people. The ileostomy group lost “excessive quantities of water and sodium” in their output compared with normal stool and had raised aldosterone, which the authors suggested drives the body’s partial compensation. Our reading, and it is ours: the hormone that can push a colon to absorb several times its usual load is the one the body turns up when the colon is gone. None of this is rare. An estimated 725,000 to 1,000,000 Americans live with an ostomy and about 100,000 ostomy surgeries are done each year, UOAA says, adding that people with ostomies live full lives that include swimming, working, sports and relationships.

The reconnection: What “reconnected” can mean

His goal, in the excerpt, was to “get my digestive system reconnected, lose the bag, and get back to my life.” His digestive tract was later reconnected with surgery, Extra reported from his People interview, and People reports he is now free of symptoms and off medication, according to The Independent. He has not said, in anything we read or watched, which operation he had, so we will not guess. Reconnecting means joining what remains, and there are two common routes. In an ileorectal anastomosis, surgeons remove the colon and join the ileum to the rectum, says a January 2025 University Hospitals Birmingham patient leaflet, which describes stool afterward as semi-formed. In ileoanal pouch surgery, or a J-pouch, surgeons build a pouch from the ileum and attach it to the anus, usually behind a temporary ileostomy; most people are continent afterward, NIDDK says, though bowel movements are “much looser and more frequent than with a healthy colon in place.” Either way, the colon stays gone; what changes is where the small intestine ends.

In the open: Why he kept it quiet, and why he is telling it now

Manganiello has explained his silence himself. “I was living in secret with this,” he told King. “Only the closest people around me knew what I was going through because I was afraid. I was afraid I wasn’t going to make it.” After the surgery, the book says, he “understood I had cheated death,” but feared “the life I had worked so long and hard to make for myself was over.” In June, announcing the book on Instagram, he said that for most of a decade “I suffered in silence, battling a deadly mystery illness.” He stopped living in secret, he told King, after 10 years, and the book, he said, is “about survival.”

Facts to carry: Bloodlines goes on sale October 13, 2026; in 2016 surgeons removed Joe Manganiello’s entire large intestine, and he hid the ostomy bag for years, Batman fitting included; he calls the illness “a host of autoimmune issues”; the colon absorbs about 1.5 litres of fluid a day, ferments leftovers into fatty acids that help fuel its lining, and stores stool; without it, output is looser and wetter; and an estimated 725,000 to 1,000,000 Americans live with an ostomy. Nothing here is a diagnosis or a guess about his health. Joe Manganiello, Avid Reader Press, Simon & Schuster, CBS Mornings, People, The Hollywood Reporter, and UOAA had no involvement in this article. It is educational, describes what the cited sources say, and is not medical advice.