A stoma is a surgically created opening on the abdomen that redirects waste products from the body into an external pouch. This opening, formed from the lining of the intestine or urinary tract, is a delicate piece of tissue that often causes anxiety when it exhibits an unexpected symptom like bleeding. The stoma is highly vascularized, meaning it is rich in tiny blood vessels close to the surface. This inherent structure makes minor, superficial bleeding a common and expected occurrence, though it should always be monitored.
Common and Expected Causes of Minor Bleeding
The stoma tissue resembles the delicate lining inside the mouth and can bleed easily from simple contact. This minor bleeding is typically bright red and appears as spotting or a few drops rather than a steady flow. The most frequent cause is minor friction, such as when the stoma rubs against the edge of the pouching system’s faceplate or the inner lining of clothing.
Aggressive wiping during routine stoma care is another common culprit for slight bleeding. Because the surface is well-supplied with blood, even gentle friction from a cloth or wipe can cause a temporary rupture of superficial capillaries. The bleeding stops almost immediately, often within seconds to a minute or two.
Small, raised areas called granulomas can also form around the edge of the stoma due to chronic irritation from the appliance or output. These benign growths have an excellent blood supply and may bleed readily with light touch or cleaning. If the bleeding is limited to the stoma’s outer surface and resolves quickly, it is considered a manageable, non-alarming irritation.
Warning Signs Indicating Serious Issues
While minor spotting is often normal, certain characteristics of stoma bleeding require immediate medical attention as they can signal a serious underlying issue. Bleeding that is heavy, continuous, or does not stop after several minutes of gentle pressure suggests a deeper source that needs urgent assessment by a healthcare professional.
The color of the blood is a significant indicator; dark maroon or black blood coming from inside the stoma, as opposed to bright red superficial irritation, may suggest bleeding higher up in the intestinal tract. If the pouch output is consistently mixed with a significant amount of blood, it is a warning sign of internal bleeding. Patients taking blood thinners or non-steroidal anti-inflammatory drugs (NSAIDs) should be vigilant, as these medications can increase the risk and severity of gastrointestinal bleeding.
Other associated symptoms occurring alongside the bleeding include the sudden onset of severe abdominal pain or cramping, an unexplained fever, persistent nausea, or vomiting. If the stoma changes color, becoming very pale, purple, or black, it indicates a severe compromise to the blood supply, which is a medical emergency.
Practical Steps for Managing Minor Bleeding
When a small amount of bright red blood is noticed on the surface of the stoma, the immediate intervention is to apply gentle, sustained pressure to the bleeding point. Use a clean, dry piece of gauze, a tissue, or a clean cloth and hold it against the spot for a few minutes.
The bleeding should cease within five to ten minutes, confirming it was superficial. If the bleeding persists beyond this timeframe, contact a stoma care nurse or medical provider for guidance. After a bleeding episode, examine the appliance’s fit to ensure the opening is not too tight against the stoma, which can cause chronic friction.
When cleaning the stoma, always use a dabbing or blotting motion instead of aggressive wiping to minimize the risk of surface trauma. Switching to a softer, non-woven wipe can help reduce mechanical irritation during routine changes. Regularly checking the skin around the stoma for signs of irritation or a poor appliance fit helps prevent surface bleeding.