From time to time ostomates may experience problems with their stoma. Some common stoma issues can be easily identified and resolved before causing too much discomfort or pain. The most common stoma complications which can cause stoma pain are listed below. If you are experiencing any of these it is best to speak with your stoma care nurse to get support and advice.
Stoma leakage is usually a result of the stoma appliance not fitting correctly. At some point, many ostomates will experience a dreaded leak from their appliance. It is worth making sure the aperture (hole)of the bag fits correctly around your stoma. There should be no gaps around your stoma, nor should it be tight when applying your appliance. If you experience a leak, the effluent from your pouch leaks under the flange and onto your skin. Then it quickly starts to cause an irritated sensation which can then lead to sore skin which is very uncomfortable.
Granulomas are benign growths which may develop around the stoma. They appear as small, raised, red bumps. They are common and are deemed a nuisance by ostomates who experience them. Granulomas can be painful when touched and can bleed very easily particularly when the skin around the stoma is being cleaned. The bleeding can loosen the adhesive of the stoma appliance and can cause leaks. Although they are problematic, they are usually harmless but it is a good idea to get them checked out by your stoma nurse.
Ulcers can develop around your stoma and underneath your stoma appliance. They can occur for a variety of reasons and can be linked to original diagnosis/underlying medical condition, medications or even the appliance you are using. They can often cause pain and discomfort. Contact your Stoma care nurse and he/she will advise you on how to manage these.
Retracted stoma and stenosis:
A retracted stoma occurs when the stoma is below skin level. It can occur with a urostomy, ileostomy or colostomy. The reasons are usually due to difficulties with the stoma formation, weight and the shape of your abdomen. Retracted stomas can cause a few issues with leaks and will need careful assessment from your stoma nurse to decide which stoma appliance will work best for you. Often a convex product will be used, but this must be initiated and monitored by your nurse.
Stenosis results in the stoma becoming very tight and small. The output from your stoma will become ribbon like or even liquid. Again let your stoma nurse monitor this, as your stoma may need to be gently dilated. You may also be advised to take laxatives to keep your output soft, so it is passed easily without any discomfort.
Constipation may be an issue if you have a colostomy. It can cause abdominal cramping and if you are constipated you will pass a very hard and dry stool which can be very uncomfortable.
Eating a high fibre diet and drinking plenty of fluids will help with constipation. Try to increase the amount of fibre which helps soften the stools, by choosing wholemeal rather than white bread/pasta, wholegrain cereals such as Weetabix/porridge and more fruit and vegetables. Constipation may also be due to not drinking enough fluids, try to drink 6-8 cups per day.
Medication could also be the cause of constipation – so check any painkillers or anti-depressants you may be taking. If your constipation lasts for more than 2-3 days without any signs of improving, speak to your stoma care nurse or GP as you may benefit from starting a course of laxatives.
Stoma obstruction and blockage:
Partial or complete blockages can be experienced by ostomates, due to the type of surgery you may have had. These blockages can be caused by certain foods which the bowel may find difficult to digest or could be caused by adhesions and scar tissue within the bowel which are stopping the stool from passing through.
You will know if your stoma is blocked as your stoma pouch will be empty when it should be filling up. Or in some cases the output may become watery. Another symptom in addition to your output slowing down is stomach ache/abdominal pain. You may start to feel waves of cramping and pain, which may worsen if the problem is not resolved. Some self-help tips include stopping eating solids but increase your fluid intake. Drinking warm drinks can also help stimulate the bowel. Having a bath may ease the abdominal pain. Drawing your knees up to your chest and rocking from side to side can also help move the food blockage.
You will find your abdomen becomes swollen and hard, eventually if left unresolved, a blockage can cause intense pain, nausea and vomiting. If this happens, please seek emergency medical attention to resolve the obstruction and avoid perforation of the bowel.
A parastomal hernia is when loops of the intestine bulge through weakened abdominal muscles behind the stoma. You will usually be able to tell if a hernia is present by the obvious bulge or lump which forms behind or around your stoma. As the hernia develops and grows, it can cause the stoma to become retracted which can cause issues with the adherence of your stoma bag. If your hernia is large, you may experience a dull ache or dragging sensation, particularly after the stoma has been active or towards the end of the day. Contact your stoma nurse for a review of your stoma. Your stoma nurse may measure you for a support garment which will help provide some support for the hernia and will ease any discomfort.
A prolapsed stoma is when the stoma extends to an abnormal length. Prolapses are more common in loop ileostomies. They may occur due to a weak abdominal wall which is common after abdominal surgeries such as stoma formation, weight gain, pregnancy, or sudden pressure in the abdomen such as when lifting heavy objects. It is important to contact your stoma care nurse if you develop a prolapse as it will need to be monitored to check it is not becoming obstructed (blocking), it is still functioning well and remains a good colour. You will also need to change your stoma appliance to a larger size to incorporate the new stoma size.