A stoma is the portion of the intestine or urinary tract brought through the abdominal wall to create an opening, allowing waste to leave the body. Systematic documentation of its appearance is a foundational practice for anyone with an ostomy. Consistent, detailed documentation ensures safety and effective communication with healthcare providers. It helps in the early detection of complications, such as changes in blood supply or skin irritation, which often require prompt intervention. Precise information also guarantees that the pouching system is correctly sized and fitted, which is paramount for preventing leakage and maintaining skin health.
Documenting Key Visual Characteristics
The stoma itself is made of mucosal tissue, resembling the moist lining inside the mouth, and its visual characteristics provide immediate clues about its health. A healthy stoma is highly vascular, meaning it has a rich blood supply, and typically appears deep pink to red or beefy red in color. For a urinary stoma, a pale pink color can also be considered normal.
The tissue should also possess a shiny, moist appearance due to the continuous, natural production of mucus, which acts as a lubricant. Superficial bleeding when the stoma is rubbed or cleaned is generally not a concern, as the tissue is delicate and rich with blood vessels. However, any deviation from this normal state must be noted in detail.
A concerning change is any shift toward a pale, dusky, or dark color (purple, blue, or black), which signals a potential problem with blood flow and requires immediate medical attention. A dry or dull surface texture suggests dehydration or a lack of moisture that should be investigated. The texture should be smooth and soft, though a slightly textured or “rosebud” appearance is common. Any new presence of cuts, deep grooves, or excessive swelling (edema) should be logged.
Measuring Stoma Dimensions and Position
Documenting the physical dimensions and position of the stoma is a quantitative step that ensures the proper fit of the pouching system barrier. Stoma size and shape frequently change, especially in the first six to eight weeks after surgery, or later due to factors like weight changes or a hernia. The diameter or width of the stoma should be measured at its base where it meets the skin, typically using a specialized stoma measuring guide.
For a round stoma, one measurement of the diameter is sufficient, while an oval or irregular shape requires measuring the widest length and width. The goal is to select a pouch opening that leaves a small, consistent gap (1.5 to 3 millimeters) between the barrier edge and the stoma. This gap protects the skin without constricting the stoma. The degree of protrusion, or how far the stoma extends outward from the abdomen, is also a significant measurement.
A protruding stoma, ideally projecting 2 to 3 centimeters, helps direct effluent away from the skin and into the pouch. It is important to note if the stoma is flush (level with the skin) or retracted (pulled inward below the skin surface), as these positions may require specialized convex barrier systems. When measuring, especially if the stoma is located in a fold or is irregularly shaped, it should be measured in both lying down and standing positions to capture the size relevant for daily wear.
Evaluating and Logging Peristomal Skin Health
The skin immediately surrounding the stoma, known as the peristomal area, is the most common site for complications and must be assessed separately from the stoma tissue. Peristomal skin damage is never considered a normal finding, and careful documentation is necessary since up to 77% of ostomates may experience a skin complication. Healthy peristomal skin should look intact and match the color, texture, and temperature of the rest of the abdominal skin.
Any signs of irritation, such as redness (erythema), rashes, broken skin, or weeping (moisture), should be logged. These often indicate Peristomal Moisture Associated Skin Damage (PMASD) from stool or urine coming into contact with the skin. Other specific issues to document include small, raised bumps, which may suggest a fungal infection, or skin stripping, which leaves superficial tears after a barrier is removed too forcefully.
When logging skin issues, it is essential to define the exact boundaries of the irritation, often by noting how far the issue extends from the stoma. The “clock method” is used to pinpoint the location, with the patient’s head considered the 12 o’clock position. This allows for precise reporting, such as “moderate redness extending two centimeters from the stoma between 4 o’clock and 7 o’clock.” Precise documentation helps determine the root cause, such as an ill-fitting appliance causing leakage or an allergic reaction to the product.
Systematic Record Keeping and Reporting
Structuring the collected data into a clear log ensures that trends are easily identified and reported to a healthcare provider. A systematic record should include the date and time of the assessment, along with findings for the stoma tissue (color, moisture, texture, diameter, and protrusion). Details about the peristomal skin, including any changes in color, signs of breakdown, and the location and extent of irritation using the clock method, must also be recorded.
Documentation should occur at every pouch change, especially during the initial weeks following surgery, and then at least weekly once the stoma size stabilizes. The log should also note the type, size, and product number of the current pouching system and any accessories used. Immediate contact with a Wound, Ostomy, and Continence (WOC) nurse or physician is required for “red flags.” These include the stoma turning a dark color, persistent or excessive bleeding, or signs of a potential blockage like swelling with decreased output.