The stoma is delicate, especially in the days and weeks following the surgery. It can be injured if mishandled or not cared for properly, or tissues can die if the stoma does not receive an adequate blood supply.
This article describes the different types of stoma a surgeon may create and what to expect immediately after surgery and during the healing process. It then lists the signs and symptoms of problems that warrant a visit either to your doctor or the nearest emergency room.
Types of Stoma
There are three main 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 (colon), and should drain a less liquid more stool-like type of waste. Urostomy: Unlike the colostomy and ileostomy, this type of stoma drains urine from the bladder rather than stool from the intestines.
What to Expect
A stoma should be a beefy red or pink color. The stoma is created using the lining of the intestine which should be moist and shiny. When completed, the tissues will be very similar in appearance to the inside of your mouth along your cheek.
In the days following the surgery, the stoma may be swollen and produce mucus. While the stoma itself should be moist, the skin around the stoma should be relatively normal in appearance.
The skin closest to the stoma may be irritated by the surgery but should otherwise be normal in color, texture, and temperature. It should not look infected or “angry” (abnormally red, swollen, or inflamed).
The stoma and skin surrounding the stoma may be tender during the healing process, and there may be some pain during normal cleaning. This should begin to ease over time. A small amount of blood from the stoma is also not unusual while it is healing.
You may need to try several different ostomy appliances to get the best fit. The same applies to appliance adhesives, some of which may be more irritating than others. Speak to your surgeon about the different options if the one you are currently using is causing discomfort or irritation.
Signs of Stoma Problems
Discuss any of these signs with your healthcare provider:
The swelling does not decrease in the weeks following surgery or increases. Your stoma is having significant changes in size—more than half an inch—in the course of a day. The stoma is no longer beefy red or pink but pale in appearance. The stoma is no longer moist in appearance but seems dry. Your stoma turns dark red, purple, or even black in color. Your stool from the stoma is always watery or diarrhea. You feel ongoing pain from the stoma. The stoma has a pus-like discharge. Your appliance doesn’t fit properly, has to be changed more frequently than expected, or is irritating your skin. The stoma seems as if it is being “strangled” by the appliance. Your stoma appears to either be pulling itself back into your abdomen or expanding outside of the abdomen.
Signs of Skin Problems Around a Stoma
Contact your healthcare provider if you see these signs of skin problem around your stoma:
The skin around the stoma appears infected and/or is red and “angry” in appearance. There is a pus-like discharge. The skin color suddenly changes. The skin is irritated by the stoma appliance, causing redness, chafing, or a raw or “burned” appearance. There is ongoing pain or an intense burning sensation. Your skin develops sores around the stoma or where the appliance rests.
When to Call 911
Major changes in the color of a stoma, including extreme paleness or extremely darkening, are signs that the tissues are not receiving enough blood. An extremely pale stoma means that the blood supply is poor. A purplish, or blackish color is an indication that tissues are dying (referred to as necrosis).
These types of color changes should be reported to your surgeon immediately, whether the surgery was recent or in the past. If you are unable to reach your surgeon, go to your nearest emergency room, particularly if the changes are sudden and rapid.
Another sign of an emergency is a severe case of cellulitis, a common bacterial infection that causes redness, swelling, and pain in an infected area of the skin. Most cases are not emergencies but can become so when:
The area of redness, swelling, heat, and pain is rapidly spreading. The affected area is hardening. The affected area is starting to go numb. The skin starts to turn purple or black. There is a high fever with chills, often accompanied by nausea and vomiting.
Summary
A stoma is a surgical opening in the abdominal wall that allows stool or urine to pass from the body when it cannot do so normally. During healing, there may be pain, redness, or swelling, but, over time, these will ease and the stoma will turn a pink to beefy red color with a moist, shiny appearance.
It is important to call your doctor if the stoma is not healing properly, changes colors, becomes dry, oozes pus, or shows others signs of infection. The same applies if the skin around the stoma becomes painful, changes color suddenly, or develops sores or chafing. Ongoing diarrhea is also a concern.
Signs of an emergency include a high fever with chills, vomiting, and rapidly spreading areas of redness, swelling, pain, hardness, and heat. Sudden changes in color—either extreme paleness or extreme purplish or blackened skin—are also signs of a medical emergency.
