Stoma problems – explanations, tips & tricks

People with a stoma know that occasionally problems can arise with their stoma. Most of them are not dramatic by any means and can be easily managed with good stoma care, a product change, a dietary review or a lifestyle adjustment. Some of these problems can be solved without additional medical professionals. Others should be closely monitored and taken seriously.

We have compiled a small overview of the most common problems for you.

Leakages

Leakages can occur for various reasons. It is important to speak to your local stoma care nurse to determine the cause of the leak. A poorly fitting pouch is often the cause of leaks.

However, the shape of your abdomen can also change after the surgery, which in turn affects the size of your stoma. It is therefore really important that the size of your stoma is checked regularly and, if necessary, the base plate is adjusted accordingly. If the pouch and base plate do not fit properly, this can lead to skin sores.

A change in discharge can also lead to problems. If your discharge becomes loose, it often finds small spots to leak out. If this discharge then touches your skin, it becomes irritated, sore and, in the worst case, inflamed.

You may also experience leaks if the curvature of your stoma has changed. In this case, please speak to your stoma care nurse. If necessary, they can suggest a different product or give you valuable tips. However, the change to a new product should also be monitored by your stoma care nurse to ensure that there are no intolerances to the skin protection material.

Tips & Tricks:

Choose a suitable ostomy pouch: Selecting the ideal stoma pouch is the first step in preventing leaks.

Ensure proper hygiene: Clean the skin around the stoma carefully with warm water. If you want to use soap, choose a mild, fragrance-free one. Do not use alcohol-based wipes as they can damage the skin. Pat the area dry with a soft towel and make sure it is completely clean and dry before applying a new pouch.

Empty your pouch regularly: Keep an eye on the capacity of it and empty when it is about a third to half full. Regular emptying helps to avoid excessive weight and pressure on the pouch and reduces the risk of leakages.

Pay attention to your activities: Certain activities can increase the risk of leakage. Be careful with activities that require strong movements, pressure on the abdomen or tight clothing. A stoma protection or belt may help to protect your stoma during physical activities.

Irritated/sore skin

Caring for your skin is the most important part of ostomy care. Occasionally the skin becomes sore, red and fragile, causing discomfort. There are a number of reasons why this can happen. For example, leakages often leads to sore areas of skin as the faeces or urine touches and irritates the skin.

Another cause may be trauma of the stoma or skin. Your stoma and the skin around the stoma are sensitive and must therefore be cared for properly. An incorrectly selected baseplate can rub and cause injuries on the side of the stoma. This in turn can cause small ulcers. So try to check the size and shape of your stoma, the baseplate and the surrounding skin regularly.

Although sensitivity to the skin protection material of certain products is rare, but it can occur - even if you have been using the products for a long time. It initially starts with a slight irritation, which can quickly worsen.

Folliculitis is an inflammation of the hair follicles - small pimples that are occasionally filled with pus and can be painful. It often occurs after shaving the hair on the skin around the stoma.

A change in discharge can also lead to skin irritation. If you are using a closed pouch and have loose stools, try switching to an ileostomy pouch. These are easier to handle and avoid the necessity of frequently changing the pouch, which can lead to skin problems.

Tips & Tricks:

Make sure that your supply fits perfectly.

Make sure that your skin does not touch the discharge, as this can lead to soreness.

Check the back of the baseplate you are using when you remove it for changing. Look for signs of faeces or urine that could have caused the irritation.

Make sure that the skin protection material (adhesive) of the baseplate is not damaged. If this is the case, the supply must be changed more frequently.

If you would like to know more about the treatment of sore skin, click here.

Diarrhoea/loose stools

If you have an ileostomy or colostomy, you may experience diarrhoea or loose stools from time to time. This situation requires a more frequent change of the pouch. When using a closed pouch, you should use a drainable pouch instead. This reduces your workload. Diarrhoea can be caused by an illness, an upset stomach or even food intoxication. The diarrhoea often subsides after a few days.

If you suspect that your lifestyle or diet is causing diarrhoea, you can try the following foods. These can thicken the stool (not recommended for diabetics):

Unripe bananas

Marshmallows

Peanut butter

White rice

Pretzel

Plain yoghurt

Pasta and potatoes

White bread

If the diarrhoea persists after 48 hours and you are concerned about a high fluid loss, please contact your stoma care nurse urgently. He/she will advise you and, if necessary, suggest taking a test sample of the discharge out of your stoma.

Ballooning

Stoma pouch ballooning can occur with a colostomy and occasionally also with an ileostomy, less frequently with urostomies. Ballooning develops when your stoma pouch overfills with gas. Typically, this happens because the filter becomes wet or blocked by the stoma output. The pressure of the wind in the pouch can then cause the pouch to detach from the body, leading to leakage.

Tips & Tricks:

If you are using a filter sticker, remove it or only cover half of the filter.

Keep an eye on your diet and try to avoid bloating foods such as fizzy drinks, onions, cabbage, peas and beans.

Limit the amount of drinks you consume with a meal.

Regular meals can reduce the development of flatulence.

Avoid chewing gum and smoking as this increases the amount of air you inhale.

Try rolling up a small piece of toilet paper and placing it inside the bag before attaching your supply. This can help weigh the pouch and prevent the inner surfaces from sticking together and creating a vacuum.

Use a few drops of olive oil/baby oil and rub it through the opening of the pouch onto the opposite side of the material before use. This allows the stool to slide better into the bottom of the pouch.

If the ballooning persists, please contact your stoma nurse. He or she will advise you to try a pouch with a different filter to improve the situation.

More detailed information about ballooning can be found here.

Hernias

Hernias occur as a result of muscular weakness. It develops around the stoma when a part of the intestine pushes through the abdominal muscle and forms a swelling under the skin. The size of a hernia can vary from the size of an "egg" to the size of a "football". Some people experience a pulling sensation, discomfort or even pain from hernias, while others have no symptoms. This can be different from person to person and usually depends on the size of the hernia. Hernias can develop at any time during or after stoma surgery and over time as the abdominal muscle stretches or weakens.

Risk factors for parastomal hernia

Age

Weight

Consumption of nicotine-containing products

Lifting heavy objects

Multiple abdominal and/or emergency surgeries

Prevention

It's important to do some form of exercise every day, even if it's just a short walk.

Try to stabilise your area around the stoma, for example by holding it while coughing. This will ensure that the muscles around this area are supported.

Wear slightly compressible clothing on the upper body. If you regularly engage in strenuous activities, supportive clothes are definitely advisable. Ask your stoma care professional for more information.

In general, hernias can also be removed surgically. This depends on whether the affected person's quality of life is severely impaired and, of course, on the evaluation of the treating surgeon.

Prolaps

Sometimes the intestine slips out further and stretches out. This can happen if the muscles that support the bowel are weakened or if the abdominal muscles are excessively strained due to heavy lifting. This usually does not cause any pain, but can be quite a shock. It is important that the stoma always keeps its pink/red colour and continues to work normally. If it darkens in colour in any way, you MUST consult a doctor immediately.

Tips & Tricks:

As the stoma enlarges due to the prolapse, it is important to check the size of your baseplate and adjust it if necessary.

You may also feel more comfortable with a larger pouch. Try it out.

Lying flat reduces the size of the stoma and can be helpful while changing the pouch.

A compression garment which can be put on while lying down is often an advantage in order to control the prolapse.

If you have any questions or insecurities, please contact your stoma care nurse. He or she can monitor, assess the prolapse and refer you to a surgeon if necessary.

Granulomas

Granulomas are small red lumps that can appear on the edges or on the stoma itself. They are caused by friction of the baseplate. Bleeding may certainly occur, which is alarming and can lead to the pouch no longer adhering properly.

Tips & Tricks:

Check the fit of the baseplate you are using.

Try to avoid enlarging the opening of your baseplate, as this can encourage the granulomas to spread.

Contact your stoma nurse, who can treat the granulomas with silver nitrate or an alternative. If the granulomas are extensive, the surgeon can remove them. However, this is rare and is only carried out if the granulomas impair the adhesion of the appliance.

Ulcus

Ulcers can occur for a variety of reasons. These can be a poorly fitting treatment, medication or a connection with your original diagnosis.

Consult your stoma care nurse for an individual assessment.

Stenosis

A stenosis is a narrowing of the stoma so that it becomes very slim and tight. It can often occur after a post-operative infection. The discharge from your stoma may become rubbery or watery.

Contact your stoma care nurse as they can proceed a dilation (= enlargement) to try to open the stoma. This procedure is uncomplicated and painless. Your stoma care nurse will show you how to do it yourself. Laxatives are also recommended to keep the stool soft enough to avoid constipation. If your stoma no longer works, you may need to undergo a surgical procedure to re-position your stoma.

Necrosis

Necrosis is rare, but occurs if the blood supply to the stoma is restricted. As a result, the stoma turns dark red/purple or even black. It may feel hard and cold. In this case, it is important to seek urgent medical attention!

Constipation with a colostomy

Constipation can occur for various reasons, e.g. reduced fluid intake, reduced mobility, a reduction in fibre or the consumption of new medication. It often leads to hard stools, which are less frequent and sometimes difficult to pass. The hard faeces are often accompanied by abdominal cramps.

Tips & Tricks:

Increase your fluid intake.

Consume more fibre.

If this does not help within 2-3 days, contact your stoma care nurse. S/he can recommend a gentle laxative which you can receive without a prescription.

Changes in urine

Any change in urine can lead to sore skin for people with a urostomy. Acidic urine can also affect the adhesion of the supply and may even be a sign of infection. Urine that is too alkaline can lead to phosphate deposits and the formation of grey, crusty residues that cause sore skin and leakages. These deposits must be treated by your stoma care device.

Urinary tract infections (UTI)

Urinary tract infections can still occur after a urostomy procedure. Your body is continuing to be susceptible to urinary tract infections. Symptoms are usually dark, turbid and strong-smelling urine and an increase in mucus production. Sometimes back pain (in the area of the kidneys), fever, nausea, vomiting and loss of appetite may occur. If you notice any of these symptoms, contact your stoma specialist. You may need to provide a sterile urine sample for your GP. This is the only way your doctor can determine whether you need antibiotics.

Tips & Tricks:

Drink at least 6-8 glasses of water every day.

Try to reduce your intake of caffeinated drinks such as coffee or tea - the caffeine dehydrates you.

If you use a drainage pouch for the night, make sure that it is properly cleaned after each use.

Empty your pouch once it is about a third to a maximum half full.

Mucocutaneous separation

During the operation, the bowel is sutured to the skin to form the stoma. Occasionally, the stitches and the skin can separate. This can look uncomfortable sometimes, but like any other wound, it will heal over time.

Speak to your stoma nurse about this. They can monitor your wound and recommend treatment options.

Rectal discharge

For all those whose rectum is still intact, rectal discharge is completely normal. It is usually a clear or viscous mucus from the anus. The bowel produces mucus as a lubricant to facilitate bowel movements through the colon. After a stoma surgery, you now have a stoma - so the stool no longer comes out of the anus, but out of your stoma. However, as the rectum is still a living organ, it will continue to produce this mucus. Basically, this consists of dead skin cells.

Mucus production varies from person to person. Some have mucus discharge several times a week, others less frequently. So if you have the feeling that you need to go to the toilet to expel mucus, this is completely normal. Follow your feelings. Try leaning forwards slightly as if you were going to the toilet as normal.

Tips & Tricks:

Wear sanitary products such as pads to prevent leakage.

Use skin protection cream to prevent irritated skin.

If the mucus is difficult to drain or is bloody, contact your stoma care nurse for advice and support. A suppository may be able to help loosen the mucus better.

Further information about it can be found here.

Closing thoughts

With a few exceptions, many of the issues mentioned are not immediately life-threatening, but they can all be quite uncomfortable. So if you feel any of the symptoms are affecting your quality of life, please speak to a doctor you trust or your stoma care professional. Having a stoma and any difficulties you may experience should not in any way define or negatively affect your life.

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