What Does an Ostomy and Stoma Look Like?

A stoma looks like a small, round or oval mound of moist, pink-to-red tissue sitting flush with or slightly raised above the surface of the abdomen. It resembles the inside of your cheek or lip: glistening, soft, and without skin covering it. The opening is typically around two centimeters across for a colostomy, though size varies with the type of surgery and the section of bowel or urinary tract involved. A clear or skin-toned pouch is usually attached over the stoma with an adhesive wafer, so in everyday life, the stoma itself is hidden under clothing and the pouching system.

The Appearance of a Healthy Stoma Up Close

Because a stoma is made of intestinal or urinary tract lining brought through the abdominal wall, it has the wet, slightly shiny look of mucous membrane rather than normal skin. The color in a well-perfused stoma ranges from a beefy red to a softer pink, somewhat like the tissue you see when you pull down your lower eyelid. It has no nerve endings for sharp pain, so touching it feels like pressure rather than a sting, though it can bleed lightly when cleaned or rubbed, which is normal. An end colostomy, for example, typically has the bowel brought to the surface through an opening roughly two centimeters in diameter.¹

Shape varies. Some stomas are perfectly round; others are more oval or slightly irregular. The tissue may sit a centimeter or so above the surrounding skin like a small bud, or it may sit almost level with the skin surface, which is described as a flush stoma. A stoma that protrudes a little is generally easier to manage because output drains more cleanly into the pouch. A flush or retracted stoma, by contrast, can make getting a good seal with the adhesive wafer trickier.

The surrounding skin, called the peristomal area, should ideally look just like the rest of your abdominal skin: the same color, texture, and moisture level. When you see redness, raw patches, or weepy skin around a stoma, that is a sign of irritation or a complication, not the normal picture.

How Different Types of Stomas Look

Not every stoma looks the same, because the tissue that forms it comes from different parts of the digestive or urinary system. The three main categories each have their own visual quirks.

• Colostomy: Made from the large intestine, usually on the left side of the abdomen. The stoma tends to be relatively round and flat or slightly budded. Because the colon is wider than the small intestine, a colostomy opening can be a bit larger, sometimes up to three or four centimeters across. Output ranges from semi-formed to fully formed stool, depending on how much colon remains upstream.
• Ileostomy: Made from the end of the small intestine, typically on the right side. Ileostomies are often fashioned with a deliberate spout, a small protrusion of a couple of centimeters, because the output is much more liquid and caustic. That spout helps direct waste into the pouch and away from the skin. The tissue color is the same pink-to-red mucosa, but the stoma diameter tends to be slightly smaller than a colostomy.
• Urostomy: Made by rerouting urine through a short piece of intestine that opens onto the abdomen. Visually it looks similar to an ileostomy, a pink budded spout, but the output is urine rather than stool. You may notice clear or slightly yellow liquid collecting in the pouch rather than anything resembling bowel content.

There are also loop stomas, where the surgeon brings a loop of bowel to the surface and opens one side, creating two visible openings side by side on a shared base. A loop stoma looks wider and flatter than a single-opening end stoma, and you can sometimes see two distinct lumens if you look closely. Loop stomas are more common when the plan is to reverse the ostomy later.

What the Output Looks Like

If you are preparing for ostomy surgery, or you are a caregiver, knowing what to expect in the pouch can reduce a lot of anxiety. The appearance and consistency of stoma output depend heavily on which part of the digestive tract the stoma comes from.

A colostomy from the descending or sigmoid colon produces output that looks much like ordinary stool: brown, semi-formed to formed, and relatively solid. A colostomy placed higher up, such as in the transverse colon, produces softer, pastier output because less water has been absorbed. An ileostomy, by contrast, produces green-to-brown liquid or porridge-like output because the small intestine’s job of absorbing water and nutrients is only partly complete. Researchers have proposed a formal consistency scale that spans the full range, from separated firm pieces all the way down to thin, clear liquid.² In daily life, most people with an ileostomy describe their output as something between applesauce and oatmeal, while most people with a sigmoid colostomy describe theirs as soft-formed stool.

Color also shifts. It is normal for stoma output to change shades depending on what you eat and drink. Beets and tomato-heavy meals can tinge things red, which can be alarming if you are not expecting it. Green vegetables can produce greenish output. These color changes are harmless. What is not normal is black, tarry output or bright red blood mixed in, both of which warrant prompt medical attention.

The Pouching System and What It Looks Like on the Body

Most people who encounter someone with an ostomy never see the stoma itself because it is covered by a pouching system at all times. The system has two main parts: a skin barrier (also called a wafer or baseplate) and the pouch. The wafer is a flat, flexible adhesive piece that sticks to the peristomal skin and has a hole cut to fit snugly around the stoma. The pouch attaches to the wafer and collects output.

Pouches come in one-piece systems, where the wafer and pouch are a single unit, and two-piece systems, where the wafer stays on the skin and the pouch clicks or snaps onto a flange. They are available in opaque or transparent options. Transparent pouches are often used in the early days after surgery so nurses can monitor the stoma without removing the system. Once things settle down, many people switch to opaque pouches that blend more with skin tone and feel less conspicuous.

Some people need a convex wafer rather than a flat one. A convex wafer has a gentle dome shape that presses into the peristomal area and helps push a flush or retracted stoma out just enough for a better seal. These products vary in how firm or flexible they are and where the pressure is concentrated, with some focusing pressure near the stoma’s edge and others spreading it across the wafer.³ Getting the right fit matters, because a poor seal is one of the main causes of leakage. In surveys from the United Kingdom, the majority of ostomy patients reported at least one leakage episode in a given month, and more than half experienced both daytime and nighttime leaks.⁴ While leakage is common enough to be considered part of life with an ostomy, a well-fitted system and routine wafer changes go a long way toward preventing it.

How the Stoma Changes Over Time

Right after surgery, the stoma typically looks swollen, dark red, and larger than it will eventually be. This is normal postoperative edema. Over the first six to eight weeks, the stoma gradually shrinks as swelling subsides, and the color lightens from a deep red to a more moderate pink-red. During this period, you will likely need to resize the hole in your wafer more than once as the stoma settles into its final dimensions.

In the weeks immediately after creation, the stoma may also appear glossy and produce a thin layer of mucus, which is the intestinal lining doing what it does naturally. Small amounts of blood when you clean the stoma are normal because the mucosal tissue has an excellent blood supply. What you do not want to see during healing is a stoma turning pale, dusky blue, or black, any of those colors suggest compromised blood flow and need urgent medical evaluation.

Over months and years, the stoma usually maintains a stable appearance, but gradual changes in your body can alter how it sits. Weight gain may cause the stoma to sink or become flush; weight loss may cause it to protrude more. Aging and loss of abdominal muscle tone can shift the skin contours around the stoma, sometimes creating creases or folds that make pouching harder.

When the Skin Around the Stoma Looks Wrong

Healthy peristomal skin matches the rest of the abdomen in color, moisture, and smoothness. But irritation is extremely common. The most frequently reported issue is moisture-associated skin damage, where the skin becomes inflamed, sore, itchy, and red from contact with effluent, affecting roughly half of ostomy patients. Maceration, where the skin turns white, soggy, and wrinkled from prolonged moisture, affects about one in five. Mechanical trauma from adhesive removal, such as skin stripping or tape blisters, is also common. Skin infections like fungal overgrowth or folliculitis occur less frequently, at around one to two percent in studied populations.⁵

A rarer but more serious condition is parastomal pyoderma gangrenosum, a painful skin disorder marked by deepening, necrotic ulcerations in the skin surrounding the stoma. It tends to affect young to middle-aged adults, occurs slightly more often in women, and is associated with autoimmune conditions, obesity, and local complications like hernia.⁶ The ulcers can look alarming, with undermined edges and a wet, raw base, and they often get misdiagnosed as infection. Anyone developing deep, rapidly worsening ulcers around a stoma should see a specialist, because pyoderma gangrenosum requires specific treatment and can worsen if treated with standard wound care alone.

Ileostomy patients tend to have more skin problems than colostomy patients because the small-bowel output contains active digestive enzymes that are harsh on skin. That is also why ileostomies are intentionally fashioned with a spout: the more the output clears the skin and falls directly into the pouch, the less chemical exposure the peristomal area gets.

Parastomal Hernias and Other Structural Changes

Over time, a visible bulge may develop around a stoma. This is a parastomal hernia, where a loop of intestine pushes through the abdominal wall alongside the stoma, creating a dome-shaped swelling under the skin. It is one of the most common long-term complications, and it changes the visual profile of the stoma significantly. A mild hernia may look like gentle puffiness around the stoma when standing or straining, while a large one can create a prominent mound several centimeters high that shifts when you change position.

Where the surgeon places the stoma plays a role in hernia risk. In a classic study, patients whose stoma was brought through the rectus abdominis muscle, the paired muscle running down the center of the abdomen, had a hernia rate of about three percent. Patients whose stoma was placed lateral to that muscle had a rate above twenty percent.⁷ This dramatic difference is why stoma placement through the rectus muscle is now standard practice. When hernias do develop, imaging shows that the bowel typically slides through on the inner side of the original opening rather than the outer side.⁸

Prolapse is another structural change worth knowing about visually. A prolapsed stoma looks like a length of dark red, glistening intestine protruding several centimeters beyond where it normally sits, sometimes telescoping out when you cough or bear down. It can be startling to see but is not always an emergency. Mild prolapse that reduces when you lie down may just need a different pouching approach. Severe or irreducible prolapse, especially if the tissue turns dark or dusky, needs surgical evaluation.

Where on the Abdomen a Stoma Is Placed

Before surgery, a stoma care nurse typically marks the ideal position on the abdomen. This preoperative assessment takes into account the shape of the abdomen, skin folds, belt lines, scars, and whether the patient can see and reach the site while standing, sitting, and bending over.⁹ The goal is to land the stoma on a relatively flat area of skin within the rectus muscle, away from creases, bony prominences, and the waistline.

In practice, colostomies tend to land on the lower left abdomen, ileostomies on the lower right, and urostomies on the right as well, though exact placement varies with anatomy and surgical need. When emergency surgery is involved and no preoperative marking has been done, the stoma sometimes ends up in a less-than-ideal spot, such as within a skin fold or too close to the hip bone, which can make pouching difficult. Poor placement does not change what the stoma tissue itself looks like, but it can change the contour of the peristomal area and increase the risk of leakage and skin breakdown.

Body Image and What People Feel When They See Their Stoma

Knowing what a stoma looks like on paper is different from seeing one on your own body for the first time. Many people describe feeling shock, grief, or revulsion in the early days, not because the stoma is medically alarming but because it is a visible, permanent-seeming change to a part of the body that was previously unmarked.

Research on psychological adaptation shows that body image disturbance is real but uneven. Younger patients tend to report more distress about their changed appearance than older patients, and people who are overweight report higher levels of body image disruption. Men, on average, scored higher on body image disturbance questionnaires than women. Interestingly, people who knew their stoma was temporary reported more disturbance than those with a permanent stoma, possibly because the awareness of “I should not have to look like this” made the alteration harder to accept. People who felt a sense of self-efficacy, a confidence that they could manage their stoma care, had significantly less body image distress.¹⁰

This is one reason why stoma nurses encourage patients to look at and touch their stoma early in recovery, even when the instinct is to avoid it. Familiarity tends to reduce distress. The stoma does not have the aesthetic horror that people often imagine before surgery. It looks like living tissue, because it is. It does not smell when it is covered by a properly sealed pouch. And once the postoperative swelling resolves, most people find it easier to manage and less visually confronting than they feared.

Stomas in Infants and Children

Neonatal and pediatric stomas are created for conditions like congenital bowel abnormalities, necrotizing enterocolitis, and Hirschsprung disease. They function the same way as adult stomas but are much smaller, sometimes barely a centimeter across in a newborn. The tissue looks the same: moist, pink-to-red mucosa. But the proportions are different. A stoma that would be unremarkable on an adult abdomen can look startlingly large relative to a newborn’s belly.

Pediatric pouching systems are scaled down to match, with smaller wafers and softer adhesives designed for delicate skin. Because babies grow quickly, stoma size changes more rapidly than in adults, and the pouching system needs frequent adjustments. The peristomal skin of infants is also more fragile and more susceptible to irritation from adhesive and effluent. Parents who are seeing their child’s stoma for the first time may be reassured to know that the tissue is supposed to be red, moist, and slightly raised. Pale or dark tissue is the concern, not the normal rosy color.

When a Stoma Is Reversed

Not all ostomies are permanent. Loop ileostomies and loop colostomies are frequently created with the plan to reverse them once the downstream bowel has healed, often after three to six months. After reversal surgery, the stoma site is closed, and a scar replaces the opening. The scar is typically small, roughly the size of the original stoma opening, and fades over time like any abdominal surgical scar.

In the weeks after reversal, the former stoma site may look slightly indented or puckered as the tissue remodels. Some people develop a small hernia at the closure site because the abdominal wall was already weakened by the original surgery. Visually, a healed reversal site a year out looks like a faint circular or oval mark, unremarkable to anyone who does not know its history.

For people whose ostomy is permanent, the stoma becomes a long-term part of the body. Many long-term ostomates describe reaching a point where the stoma simply looks like their stoma: not beautiful, not alarming, just a feature they manage like anything else. Clothing covers it entirely, pouching technology has become discreet enough that even swimwear and fitted clothes work, and the initial shock of appearance gives way to a practical relationship with a piece of anatomy that, in the end, is keeping them alive.