Stomal Complications

Complications related to the stoma may range from a minor inconvenience to a surgical emergency. Many problems can be prevented if the stoma is correctly constructed and properly placed, which involves a combination of the skills of the surgeon and ET nurse. First will be a description of the normal stoma followed by possible stomal complications. Keep in mind that all changes in your stoma should be reported to your physician or ET nurse.

Normal: Red or pink, moist appearance. Slight bleeding is normal with cleansing. Swelling should decrease over a period of 6-8 weeks after surgery. Movement of the stoma is normal, and it may move in and out with changes in your position. Stomas are fairly hardy, but should be protected from physical blows, tight clothing, and rigid objects. The stoma has no feeling; therefore, it can be injured without pain. Always check your stoma with each pouch change, and report any change to your physician or ET nurse.

Change in Color (Ischemia/Necrosis): Caused by an inadequate blood supply to the stoma. Sometimes a stoma will "pink up" as swelling decreases. If the stoma continues to darken--turns dusky blue, dark brown or black, you should report this to your physician immediately. If the stoma does not improve, surgical revision may be needed.

Disappearing Stoma (Retraction): This is when the stoma pulls back into the abdomen which can be caused by scarring, adhesion or weight gain. Treatment may be the use of an appliance with convexity, topical products or surgical revision.

Protruding Stoma (Prolapse): This is caused by weak abdominal muscles, and the bowel appears to hang out of the abdomen. Sometimes pushing the stoma back in (by someone trained) followed by use of a binder will help. Surgical revision may be needed as the stoma may lose blood supply or stop functioning.

Bulging Around Stoma (Herniation): This is caused by protrusion of the bowel around the stoma. It is most noticed when sitting or standing. It is associated with weak muscles or obesity. Treatment may be weight control, increase of exercise slowly, exercises to strengthen abdominal muscles, supportive binder or surgical revision.

Narrowing of the Stoma (Stenosis/Stricture): This can be caused by repeated dilatations (opening the stoma with a finger), alkaline urine causing a warty growth, repeated skin breakdown resulting in scarring or a disease process. Surgical revision may be needed if narrowing is severe. If recommended, dilatations should be done correctly and gently. An ET nurse should be consulted for recommendation regarding alkaline urine, a properly fitting appliance, or products that prevent skin damage.