Signs of a Problem With Your Stoma

How to Identify Stoma Site Issues

A Stoma Requires Regular Attention After Surgery.

What is a Stoma?

A stoma is an opening created during surgery on the intestines.  The procedure reroutes part of the intestine to the surface of the abdomen, where waste can be eliminated from the body. This is done when the intestine does not function well enough to move stool out of the body through the anus.  

The stoma is delicate, especially in the days and weeks immediately after surgery.  The stoma can be injured, or tissue can die, if the stoma is not receiving an adequate blood supply and being well cared for.

Types of Stoma

Ileostomy--The ileostomy drains waste from the small intestine.  This type of stoma should be expected to produce more watery, less formed stool as the stool has less time in the digestive tract to have excess water removed.

Colostomy--This type of stoma drains waste from the large intestine, and should drain a less liquid more stool-like type of waste.

Urostomy--Unlike the colostomy and urostomy, this type of stoma drains urine rather than stool. 

The Normal Stoma After Surgery

A stoma should be a beefy red or pink color.  The tissue that makes a stoma is the lining of the intestine, and should be moist and shiny.  It is very similar in appearance to the inside of your mouth along your cheek.  A normal stoma in the days after surgery may be swollen and may also produce mucus.  

While the stoma itself should be moist, the skin around the stoma should be normal in appearance.  The skin closest to the stoma may be irritated by the surgical procedure, but it should otherwise be normal in color, texture, and temperature.

It should not look angry or infected.  The skin may be tender initially during the healing process and may feel irritated by a normal cleaning.  

The skin immediately surrounding the stoma and the stoma can be irritated the cleaning process.  A small amount of blood from the stoma itself is not unusual while it is healing.

It is normal to have to try several different appliances to get the best fit for you, some people find that appliance adhesive is irritating to the skin and have to try a different brand or type of appliance.  

Signs of Stoma Problems

  • The swelling does not decrease in the weeks following surgery or has a very large increase in size unexpectedly.
  • The stoma is no longer beefy red or pink, but pale in appearance.
  • The stoma is no longer moist in appearance, or seems dry.
  • Your stoma is very dark, and appears dark red, purple or even black in color.
  • Your stool is always watery or diarrhea, and soft or firm stool was expected in your discharge plan.
  • The stoma appears to be discharging pus.
  • Your appliance won’t fit properly, has to be changed more frequently than expected, or is irritating your skin.
  • The stoma seems as though it is being “strangled” by the appliance.
  • You feel pain from the stoma.
  • Your stoma is having significant changes in size--more than half an inch--in the course of a day.
  • Your stoma appears to be pulling itself back into your abdomen or expanding outside of your abdomen.

    Signs of Skin Problems Around a Stoma

    • The skin around the stoma appears infected and/or it is red or angry in appearance.
    • There is pus or discharge present. 
    • The skin isn’t healing well.
    • The skin around the stoma appears irritated by the stoma appliance, and may be red, chapped, flaky, scaled, raw or burn-like in appearance. This can be caused by harsh cleansers, so be sure to clean gently and with a mild soap.
    • You skin hurts, has a burning sensation or changes in color.
    • Your skin develops sores or breakdown around the stoma or where the appliance rests.

    Signs of Emergency 

    Major color changes in a stoma, with the stoma becoming pale or dark, are a sign that the tissue is not receiving the blood supply that it should. This type of change should be immediately reported to your surgeon, whether the surgery was recent or in the past.  If you cannot reach your surgeon, a stoma that is not getting an adequate blood supply is an appropriate reason to be seen at the emergency room. 

    Signs of infection in the skin surrounding the stoma or the stoma site itself, or a fever above 99.5, should be reported to your surgeon in the weeks following surgery.

    Source:

    Medline Plus. Ileostomy-Caring For Your Stoma. Accessed October 2014.  http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000071.htm 

    Continue Reading