A stoma is a surgically created opening on the abdomen that allows for the exit of waste, such as stool or urine, into an external pouching system. The sight of blood can be alarming, prompting a search for clarity on whether this is normal or a sign of a problem. Minor bleeding is often expected and not a cause for concern, but distinguishing this from more serious issues is paramount. This guidance clarifies the difference between routine, superficial bleeding and warning signs that require prompt medical attention.
Understanding Minor Stoma Bleeding
The stoma is formed by the lining of the intestine, known as the mucosa. This tissue is highly vascular, meaning it is richly supplied with tiny blood vessels close to the surface, much like the inside of the mouth or the gums. This inherent characteristic makes the stoma sensitive and prone to minor bleeding upon contact.
Because of the high concentration of blood vessels, seeing a small amount of blood on a cleansing wipe during a pouch change is not unusual. This minor bleeding is typically superficial and stops very quickly, often within seconds or a minute or two. Small streaks of blood or spotting on the appliance itself are generally considered a normal observation.
This slight oozing is a natural consequence of the tissue’s delicate structure. It should not cause panic if the stoma otherwise looks pink or red and healthy. This minor, brief bleeding falls into the category of “normal,” as the quantity of blood is minimal and its cessation is rapid and spontaneous.
Common Causes of Superficial Stoma Bleeding
Most minor bleeding is caused by simple mechanical irritation or friction against the delicate stoma tissue. The most frequent cause is cleaning the stoma during a pouch change. Wiping or rubbing the stoma too vigorously can easily disrupt surface capillaries, causing a brief trickle of blood.
Friction from the pouching system is another common culprit for localized bleeding. If the opening of the skin barrier is cut too small, the edge can rub against the stoma, causing irritation and bleeding around the perimeter. Minor trauma from clothing, such as a belt or waistband pressing against the stoma, can also cause temporary surface bleeding.
Small, benign growths called granulomas can develop on or around the stoma, often due to chronic irritation from the appliance. These raised, red areas are fragile and tend to bleed easily upon the slightest touch or friction. Bleeding from granulomas is generally not serious but may require assessment by a stoma care nurse for specialized treatment.
Warning Signs: When Stoma Bleeding is Serious
While minor surface bleeding is common, specific signs indicate a more serious problem requiring immediate medical consultation. Bleeding is a warning sign if it is heavy, fills the pouch rapidly, or is a continuous flow that does not stop after applying gentle pressure for 5 to 10 minutes. A large volume of bright red blood coming from inside the stoma opening suggests internal bleeding that must be investigated promptly.
A stoma that turns dark purple or black is a sign of necrosis (tissue death due to inadequate blood supply) and constitutes a severe medical emergency. Bleeding accompanied by systemic symptoms, such as severe abdominal pain, high fever, or persistent vomiting, suggests a serious complication like a bowel obstruction or infection.
If you are taking blood-thinning medications, your risk of significant bleeding is increased, and persistent bleeding warrants professional advice. For those with a urostomy, blood in the pouch may indicate a urinary tract infection or other issue requiring clinical attention. Uncontrolled bleeding combined with signs of dehydration, such as dizziness or light-headedness, necessitates urgent medical care.
Immediate Steps and Medical Consultation
For minor, superficial bleeding, apply gentle pressure directly to the site using a clean, dry cloth or gauze. This technique is usually sufficient to stop the flow within a few minutes. To prevent future irritation, ensure your appliance is properly sized and use a gentle, patting motion rather than vigorous scrubbing when cleaning.
If the bleeding is continuous, heavy, or accompanied by any severe warning signs, seek urgent medical advice without delay. Contact your ostomy nurse, surgeon, or primary healthcare provider immediately. In cases of very heavy, persistent bleeding or signs of a medical emergency, proceed directly to the emergency room, as professional evaluation is needed to determine the source and appropriate course of action.