A stoma is a surgically created opening on the abdomen that allows waste, such as urine or stool, to exit the body. While adapting to life with a stoma, experiencing bleeding can be unsettling. The tissue is quite delicate, so not all instances of bleeding are cause for alarm.
Understanding Stoma Bleeding
The tissue that forms a stoma, known as mucosa, is highly vascular and rich in blood vessels, similar to the lining inside the mouth or gums. This means the stoma can bleed easily from minor irritation or friction. Minor bleeding often appears as small spots on the ostomy pouch or faint streaks when cleaning the stoma. Such slight bleeding is typical and often stops quickly with gentle pressure.
In contrast, concerning bleeding involves continuous flow, large blood clots, or dark blood emerging from inside the stoma itself. While some minor bleeding is common, it should decrease as the stoma heals.
Common Reasons for Bleeding
Several factors can contribute to stoma bleeding. Mechanical irritation is a frequent cause, occurring when clothing, a belt, or the edge of the pouching system rubs against the stoma. This friction can lead to slight surface bleeding.
Cleaning techniques also play a role, as applying too much pressure or using vigorous motions when wiping the stoma can cause minor trauma. Small amounts of bleeding can occur during routine pouch changes, particularly when removing or applying the adhesive wafer. The stoma tissue can be easily disturbed, resulting in a few spots of blood that resolve quickly.
Underlying skin issues around the stoma, known as peristomal skin irritation, can also manifest with bleeding. This irritation might stem from leakage of output onto the skin or an ill-fitting pouch, leading to inflammation and making the skin more prone to bleeding. Granulomas, small, benign, raised areas on or near the stoma, are another common cause of easy bleeding. These growths often develop from chronic irritation and can bleed with minimal contact. Certain medications, such as blood thinners or aspirin, can also increase the likelihood of bleeding from the stoma.
When to Seek Medical Help
While minor stoma bleeding is often not serious, certain signs indicate a need for prompt medical attention. Heavy, continuous bleeding that does not stop after several minutes of gentle pressure is a significant warning sign. The passage of large blood clots from the stoma or bleeding that appears to originate from deeper inside the stoma lumen, rather than just the surface, warrants immediate medical evaluation.
Bleeding accompanied by other concerning symptoms, such as severe abdominal pain, fever, nausea, or vomiting, suggests a more serious underlying issue. Any sudden changes in stoma color, like becoming dusky, pale, or dark purple or black, are serious indicators of compromised blood supply and require urgent care. If bleeding causes symptoms such as dizziness, weakness, or lightheadedness, or if it occurs after a fall or injury, medical help should be sought without delay. Persistent minor bleeding that does not resolve with gentle care over a day or two should also be discussed with a healthcare provider.
Tips for Stoma Care
Gentle cleaning practices are important for preventing stoma bleeding. Use soft wipes and pat the stoma gently rather than rubbing vigorously. Proper pouching techniques are equally important, ensuring the barrier opening fits snugly around the stoma to prevent friction and protect the surrounding skin. Using barrier rings or pastes can further enhance the seal and minimize irritation.
Regularly inspecting the stoma and the skin around it helps in early detection of any irritation or changes. Maintaining good hydration and a balanced diet supports overall intestinal health, which can positively influence stoma well-being. Avoid harsh soaps or adhesives that might irritate the peristomal skin. Consulting a Wound, Ostomy, and Continence Nurse (WOCN) is recommended, as these specialists provide valuable guidance on appropriate products and care techniques.