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Stoma bleeding – what is cause for concern and what isn’t?

It is always worrying when your stoma or the skin around it bleeds. Stomas are incredibly vascular with a lot of blood vessels near the surface, which means it can bleed easily due to the extremely good blood supply. Therefore, it is not unusual to find a small amount of blood on the cloth when cleaning your stoma. Knowing what to do next and when to get help is important, so here are some tips to help guide you:

What to do if you notice blood on your stoma:

If you spot any bleeding, it is important to take the time to examine your stoma. Have a good look whilst changing your stoma appliance and to try to determine where the blood is coming from. Keep an eye on the contents of your pouch throughout the day/night and check whether the bleeding is in the pouch or simply around your stoma. Usually, the bleeding comes from one of three sources:

  1. From the stoma itself
  2. The skin around your stoma (peristomal skin)
  3. Or internally via your stoma and into your stoma pouch

What are the reasons for bleeding?

  • If the bleeding is minor and you notice spots on the wipes as you clean, the bleeding may be coming from the edges of the stoma. The stoma is incredibly vascular and can easily bleed if knocked or caught by the edges of the stoma appliance. This is usually nothing to worry about and happens to most ostomates at some time or another. Try pressing gently with a wipe to the area which is bleeding and this will usually stop. If it continues for more than 10 minutes without stopping, it is a good idea to discuss with your Stoma Care Nurse.
  • Bleeding from the surrounding skin is very common and is usually caused by skin irritation of your stool touching the skin. This can be caused by an ill-fitting stoma pouch which may lead to leaks or the pouch may rub against the stoma, either way it is not likely to be a reason for concern. Speak to your Stoma Care Nurse and she can help you with ensuring your stoma pouch fits correctly.
  • Granulomas are another cause of bleeding from around your stoma. They are benign red, raised areas on or around the stoma. They are usually small in size but can vary. They develop usually from friction of the stoma bag rubbing on the stoma itself, causing over healing of the damaged skin. Some granulomas cause bleeding and discomfort. Speak to your Stoma Care Nurse if you notice granulomas on or around the edges of your stoma as there are stoma pastes available to protect the skin and other treatments such as silver nitrate which can be used by your stoma care nurse to help treat and control any troublesome bleeding.
  • Ulcers can occur for a variety of reasons. Causes can be an ill-fitting appliance, medications, or linked to your original diagnosis. Contact you Stoma Care Nurse for assessment.
  • If you see blood inside your stoma pouch or mixed amongst your stool/urine, contact your Stoma Care Nurse or GP. For those with a colostomy or ileostomy it could indicate intestinal bleeding and for people with a urostomy it may be due to an infection such as a Urinary Tract Infection (UTI). If you take anticoagulants such as aspirin or warfarin this may increase you risk of bleeding. If the bleeding is heavy and continuous you should seek urgent advice from your GP, NHS 111 or visit A&E should it persist.

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