The external colostomy appliance itself does not cause pain. A colostomy bag is a collection pouch worn on the abdomen, and any physical discomfort felt is almost always due to recent surgery or irritation of the surrounding skin. The procedure involves bringing a section of the large intestine through the abdominal wall to create a stoma, which serves as the new exit point for waste. Understanding the source of discomfort is the first step toward managing it.
Understanding the Stoma and Sensation
The stoma is the surgically created opening of the bowel on the abdomen, formed from the moist, reddish-pink mucous membrane tissue of the intestine. This tissue lacks pain-sensitive somatic nerve endings. Therefore, the stoma tissue itself cannot register pain when touched, when waste passes through it, or even if lightly injured.
The absence of pain sensation means the appliance, which adheres to the skin around the stoma, does not cause internal discomfort. Patients might still perceive non-painful sensations like pressure or movement within the abdomen. This lack of sensation is protective, but it requires the patient to visually inspect the stoma regularly, as they would not feel tissue damage.
Distinguishing Pain Sources Post-Surgery
Initial discomfort is an expected part of the healing process following the colostomy procedure. Acute pain immediately after surgery is related to the abdominal incision and internal healing of the bowel, typically subsiding over a few weeks or months. This incisional pain is managed with prescribed medication and is a temporary part of recovery, not a permanent feature of living with a stoma.
Pain that persists or develops later often signals an internal issue unrelated to the external pouch. A dull ache or dragging sensation could indicate a parastomal hernia, where abdominal tissue bulges near the stoma site. Sharp, persistent pain may be neuropathic, potentially caused by a nerve entrapped in scar tissue from the surgery.
Other internal discomforts include a phantom sensation of needing to pass stool, especially if the rectum remains in place after surgery. This feeling is caused by the muscles and nerves in the unused rectum still functioning and can be accompanied by pain from mucus buildup. Any sudden increase in pain, fever, or signs of infection should be reported to a healthcare provider immediately.
Managing Appliance-Related Discomfort
The most common source of chronic discomfort is irritation of the peristomal skin, the area immediately surrounding the stoma. This irritation, known as peristomal dermatitis, is frequently caused by leakage of effluent onto the skin, which can be corrosive. An ill-fitting appliance allows stool or urine to seep under the adhesive barrier, leading to redness, soreness, and burning.
Mechanical injury is another source of external discomfort, occurring when the adhesive barrier is removed too forcefully, stripping the top layers of skin. Cleaning the skin too aggressively can also cause trauma, presenting as weepy, red skin. Patients must gently wash the skin with warm water and avoid harsh or perfumed soaps and wipes.
Actionable steps can significantly reduce appliance-related skin issues, beginning with ensuring a proper seal. The stoma should be measured regularly, especially in the first few weeks post-surgery and after any weight change, to ensure the appliance aperture is cut to the correct size. The opening should be only slightly larger than the stoma itself to protect the sensitive skin from output.
Using barrier products like rings, pastes, or powders can help fill in uneven skin surfaces or creases, creating a flatter platform for the adhesive and preventing leaks. For persistent irritation or suspected allergic reactions, consulting a Wound Ostomy Continence Nurse (WOCN) is recommended. A WOCN can assess the fit, recommend convex appliances for recessed stomas, and suggest alternative products.