Ostomy Red Flags to Look Out for and Solutions

Part of living well with an ostomy is being proactive to spot problems early. Your stoma doesn’t have nerve endings, so you won’t feel pain if it gets injured. You may also not notice skin irritation at first. Complications can happen as soon as the first few days when necrosis and retraction are more likely, as well as months later, in the case of a hernia or prolapse. They also run the gamut from minor to serious. Since 20% to 70% of people will have a stoma setback, know the most common ones.

Necrosis is tissue death and, though rare, it can happen if the stoma doesn’t get enough blood. It will turn from bright red to dark red, purple or even black. Because this typically happens within 48 hours, you’ll still be in the hospital for care. But, sometimes it may not be obvious at first and will worsen over time. Tell your doctor about any color changes right away. Treatment depends on the extent of the tissue damage, from observation and care to surgery.

The skin around your stoma can get irritated for a variety of reasons. The adhesive that keeps the ostomy bag in place can cause redness. So can poop that comes into contact with skin because the adhesive disc, or skin barrier, that fits around the stoma isn’t properly positioned. Irritated skin can also be the reason that the barrier doesn’t lie flat. Talk to your care team about how to help skin heal.

When an ostomy bag leaks, it’s often because the skin barrier isn’t sitting correctly or because the size of its opening doesn’t match the size and shape of your stoma. The adhesive disc can move if your skin puckers when you change position. A convex shaped barrier may work better for your body type than a flat one. Another possible cause is adhesive that wears away faster than expected. Try changing it more often.

Your stoma has a lot of blood vessels, and that means it can bleed easily from minor contact, like when the opening of the bag brushes against it or during routine skin care. Apply light pressure with a cotton pad to see if it stops after a couple of minutes. Call your team about bleeding that persists. If the bleeding is very heavy, get care at the emergency room right away. This could be a sign of intestinal bleeding.

Weak spots in the tummy muscles behind the stoma can cause this specific type of hernia. You’ll likely feel a bump where the intestines bulge through. A parastomal hernia is very common and needs medical attention. If the bulge grows, it can get in the way of your stoma working properly. You might get alternate bouts of diarrhea and constipation. You might be able to reduce your chances of a parastomal hernia by wearing a stoma belt to support these muscles.

This is when your intestine pushes out, causing the stoma to look longer and protrude farther from the body. Causes include the type of surgery you had, a weakness in your belly wall, or gaining a lot of weight. Sometimes, a doctor is able to push it back in. But in other cases, it might need surgery to correct. Your doctor may have you monitor the stoma for changes in color and size and for an obstruction or blockage.

Ostomy surgery can cause adhesions or scar tissue to form. These can keep food from being digested and poop from moving along. You might feel sudden belly pain, nausea, or vomiting and notice that the output has stopped or is watery. Talk to your team about whether you should limit solid foods for a time and increase fluids. But if you’re vomiting and have extreme pain, call 911. You might need medical help to get rid of the blockage.

Stenosis means narrowing, and when this happens to the stoma opening, poop has a hard time passing through it. Scar tissue, an infection, or poor healing are common causes. Stenosis usually happens more than a month after surgery. Symptoms include cramps, swelling, and less output. For mild cases, your care team may suggest stool softeners, changes to your diet, and a procedure to make the opening wider. More serious cases may need surgery.

This is when the stoma seems to sink back so that it’s either flat with the surrounding skin or below it. It can result from weight gain, scar tissue, or weakness in the belly wall. Retraction can lead to leaks because the ostomy bag no longer fits properly. Your doctor may suggest a convex skin barrier to help move the stoma back into position. Other stoma care products like barrier paste or a stoma ring can also help create a better seal.

It's not always possible to pinpoint the exact cause of an ostomy or stoma problem without an examination. Get help right away for:

• Any unusual change in the size or color of your stoma (It should be bright red.)
• Ulcers or any long-lasting skin irritation
• Painful cramps, nausea, or vomiting that lasts more than two hours
• Excessive bleeding from your stoma or where it meets your skin
• Output that's watery or no output for more than four hours

You may be able to avoid the most common problems of skin irritation and leakage with good skin care and skin barrier placement. Try these tips:

• Make sure your skin is clean and dry before applying the barrier. Use a stoma powder if needed.
• Check that the barrier hole is snug around your stoma and the barrier itself lies flat against your skin.
• When replacing the barrier, be gentle. Pulling it off can leave skin raw. Use an adhesive remover to get rid of any residue that could prevent a good seal as well as irritate your skin.
• Use warm water and a soft cloth to clean your stoma and the surrounding skin. Don't rub or use soap.