A stoma is a surgically created opening, typically on the abdomen, that allows for the elimination of bodily waste such as stool or urine. It connects an internal organ, like the bowel or urinary system, to the outside surface of the body. Understanding a healthy stoma’s appearance is important for proper self-care and recognizing potential issues early, helping individuals and caregivers monitor its condition and seek medical attention when necessary.
Characteristics of a Healthy Stoma
A healthy stoma typically presents a consistent appearance. Its color should be bright red or pink, often described as “beefy red,” indicating a good blood supply. The surface should also appear moist and shiny, reflecting its mucous membrane nature.
Regarding its structure, a stoma is usually round or oval in shape and often protrudes slightly from the abdominal surface. While protrusion is common, a stoma that lies flush with the skin can also be healthy, depending on the specific surgical technique used. In the initial weeks following surgery, the stoma may appear swollen, but its size typically reduces over the first six to eight weeks.
A healthy stoma lacks pain sensation; touching or cleaning it should not cause discomfort as it does not possess pain-transmitting nerve endings. The surrounding skin, known as peristomal skin, should be intact, smooth, and match the rest of the abdomen, with no signs of redness, irritation, or breakdown.
Normal Variations and Expected Occurrences
Some stoma observations are normal variations. Minor bleeding can occur when the stoma is wiped or cleaned because the tissue has a rich network of tiny blood vessels close to its surface. Such bleeding is usually minimal and stops quickly.
The size and shape of a stoma can change slightly throughout the day or with physical activity, often due to intestinal movements (peristalsis) or changes in body position. It is also normal for bowel stomas to produce mucus. This mucus, which helps with waste passage, continues to be produced by the intestinal lining and may be visible in the ostomy pouch.
The uncontrolled passage of gas or stool from the stoma is also expected. This occurs because stoma creation bypasses the sphincter muscles that normally regulate waste elimination. Consequently, there is no voluntary control over the output, which is collected by the ostomy pouching system.
Recognizing Signs of Potential Issues
While some variations are normal, certain stoma changes can signal a problem. Significant color changes, like a healthy red or pink stoma turning dark red, purple, or black, indicate a compromised blood supply (necrosis). A pale or bluish stoma also suggests inadequate blood flow.
Persistent swelling beyond the initial post-operative period warrants attention. Excessive, continuous, or spontaneous bleeding, especially from inside the stoma, can indicate a deeper issue. Foul-smelling or pus-like discharge suggests a possible infection.
Changes in the stoma’s position can also be problematic. Retraction (pulling back into the abdomen) can make pouching difficult and lead to skin irritation. Prolapse occurs if the stoma protrudes excessively. Stenosis, a narrowing of the stoma opening, can restrict output.
Complications affecting the surrounding skin, such as severe redness, persistent rash, open sores, or signs of infection (itching, burning, weeping, blisters, warts), require careful evaluation. An abnormal bulge near or around the stoma may signify a parastomal hernia.
When to Seek Professional Medical Advice
Contact a healthcare professional, such as a stoma nurse or doctor, if you observe any concerning changes in your stoma or the surrounding skin. Prompt medical advice is advised for significant color changes (dark red, purple, or black), as this could indicate a serious blood supply issue. Excessive or continuous bleeding, especially if it appears to come from inside the stoma, also requires immediate attention.
Seek medical guidance for persistent or increasing stoma swelling, or foul-smelling/pus-like discharge. Other signs warranting contact include significant stoma retraction, excessive protrusion, or narrowing. Additionally, severe pain, high fever, or no stoma output for an extended period require immediate medical evaluation.