Caring For Your Stoma

After your ostomy, you have a new body part to care for: your stoma. The stoma is the opening created by your ostomy surgery, in which a piece of the bowel is brought through the abdominal wall to serve as a conduit for urine (in a urostomy) or stool (in an ileostomy or colostomy).

A stoma is round or oval, and can be flat or protruding. It should be shiny, pink or red, and moist, like the inside of your mouth. After surgery, it will be large and swollen, but should shrink over the following 6 to 8 weeks.

Routine Stoma Care

A stoma is delicate, so you need to treat it with care. However, it has no nerve endings and so it should not be painful when touched.

The stoma itself doesn’t need much hands-on care. You can gently clean it with toilet tissue or water, if needed. You can safely bathe or shower with a stoma, as normal exposure to air or water won’t harm it.

Because the stoma has many tiny blood vessels, it’s normal to see a small amount of blood when you’re cleaning it, or if the stoma is rubbed or scraped. Avoid wearing a belt or tight waistband directly over the stoma, but otherwise you can wear your normal wardrobe.

Problems with Your Stoma

Every time you bathe or change your ostomy pouching system, you should take a close look at your stoma and the skin around it to check its condition. If you have trouble seeing your stoma, you can use a mirror or ask a loved one to help. If anything looks unusual or has changed suddenly, contact your healthcare provider.

People sometimes experience the following problems with their stoma:

Irritation of the peristomal skin: Often, leakage from your ostomy pouching system can damage the skin around the stoma. If you notice that the peristomal skin is developing a rash or sores, or is itchy or painful, contact your wound, ostomy, and continence (WOC) nurse for help.

Read more: How To Care For Your Peristomal Skin

Leakage: If stomal output is leaking around your skin barrier, there’s nothing wrong with the stoma itself. Rather, it means you’ll have to adjust your ostomy pouching system. Use a stoma measuring guide to ensure a precise fit, apply a barrier ring or stoma paste, or try a different brand or type of pouching system.

Bleeding: While a small amount of bleeding is normal when cleaning your stoma, ongoing or significant bleeding can be a problem. If you see blood in your ostomy bag and/or stoma output, contact your healthcare provider. If the bleeding is heavy, or coming from inside your stoma, contact your healthcare provider right away.

Laceration: The stoma can get cut or torn by the edge of the pouching system, by clothing, or by accident (such as getting nicked with a razor, or getting poked with something sharp). Typically, a lacerated stoma doesn’t hurt. Your WOC nurse can advise you on how to help it heal and prevent future injury.

Mucocutaneous separation: After ostomy surgery, the sutured connection between the stoma and the skin can separate, creating a wound. Contact your WOC nurse, who can advise you on what to do to help it heal.

Granulomas: Sometimes, small red lumps appear around the edge of the stoma. These bumps, called granulomas, can be caused by the skin barrier rubbing against the stoma, and they can prevent the ostomy pouching system from adhering well. Contact your WOC nurse if you notice granulomas.

Parastomal hernia: If you notice a bulging under or around your stoma, it could be a parastomal hernia. This means the intestine is pushing outward, through the abdominal muscle. Sometimes, a parastomal hernia will go away on its own. Sometimes, surgery may be required. Contact your healthcare provider if you notice a hernia developing.

To prevent a parastomal hernia, you can wear a support garment. Stick to a gentle exercise routine, support your stomal area with your hands when coughing or sneezing, and avoid lifting anything heavy.

Prolapse: If you notice that your stoma has elongated, this may be due to prolapse. A prolapsed stoma “telescopes” outward, which can be caused by abdominal muscle weakness, coughing, weight gain, pregnancy or other pressure/strain on the area.

Sometimes, a prolapsed stoma is temporary, or goes away when you change position (e.g. lying down). Sometimes the stoma remains prolapsed and may need special care, such as a larger ostomy pouching system. Contact your healthcare provider if you have a prolapsed stoma.

Retraction: Sometimes, the stoma retracts so that it sinks below skin level. This can be caused by weight gain or by the shape of the abdomen. A retracted stoma can make it more difficult to attach your ostomy pouching system and prevent leaks. Ostomy accessories can help, such as a convex barrier ring.

Stenosis: Stenosis is the narrowing of the stoma, which restricts output and may cause it to become thin and ribbon-like or watery. If you notice stenosis, contact your healthcare provider.

Obstruction: It’s possible for the stoma or the intestines to become blocked by internal scarring/adhesion, by fiber-rich foods, or by food that hasn’t been chewed completely. Signs of an obstruction include spurts of very watery stool; stool with a strong odor; swollen skin around the stoma; abdominal pain; a hard, bloated or swollen abdomen; the cessation of stoma output; nausea or vomiting. Contact your healthcare provider, or go to the emergency room if symptoms are severe.

Necrosis: Necrosis (tissue death) is a rare but serious complication that typically occurs soon after ostomy surgery. If you notice that the stoma is no longer red or pink, but is instead dark red, purplish, blue, gray, brown, or black, you need to seek emergency medical care right away. Other signs of necrosis can include a stoma that’s hard and dry, cold to the touch, or soft and flaccid.