Heal Better Together�Education Series #6��Ostomy Care
February 16- March 1, 2026
Location and Drainage
Indications: Rectal Cancer, diverticulitis w/ perf, Crohn’s disease
Drainage: semisolid/solid stool and gas- usually odorous
Pouch will usually need to be emptied once or twice a day when half full
Indications: Colon perforation or obstruction due to trauma or malignancy - usually temporary
Drainage: mushy/semiformed stool with gas
Pouch will need to be emptied frequently throughout the day
https://www.hollister.com/en/ostomycare/educationaltools
Location and Drainage
Indications: Ulcerative colitis, familial adenomatous polyposis, Crohn’s disease
Drainage: dark green liquid/mushy with gas
*certain foods may change the color of the drainage ex. red jello may cause red drainage*
Pouch will usually need to be emptied frequently
Indications: Bladder cancer, neurogenic bladder
Drainage: urine with mucus, may be blood tinged initially after surgery
Pouch drains continuously
https://www.hollister.com/en/ostomycare/educationaltools
Stoma Types
https://www.ostomycanada.ca/what-is-an-ostomy/#what-is-a-stoma
Ostomy Devices
Urostomy pouching system
Ostomy Accessories
Skin barrier paste-
Used to smooth skin folds/irregularities and fill gaps between the stoma and barrier, which may reduce leaks and improve wear time.
�*ostomy paste is a caulking material - not an adhesive - and too much can reduce adherence*
Ostomy belts-
Belts wrap around the abdomen and attach to loops on certain pouches. They can help support the pouch and may help maintain a seal (especially with convex barriers) or reduce reliance on adhesives
How to use an ostomy belt - https://youtu.be/BM6hjtnB3G8
https://www.ostomy.org/types-pouching-systems/
Describing a Stoma
http://www.ccosg.org/december-2021-newletter/
Size – varies with each person and type of surgery. Initially after surgery, the stoma is swollen. It will shrink in size as it heals for up to 2 months after surgery.
Shape – round, oval, or irregular; protruding, flush, retracted, or prolapsed
Color – pink to red. The blood supply is very close to the surface of the stoma.
Sensation – no feeling in the stoma because there are no nerve endings
Describing a Stoma
Location – depends where in the bowel the stoma is created and the anatomy of the patient.
Output– depending on the type of ostomy, there will be movement of stool, gas, or urine.
Stitches – may or may not be seen around the base of the stoma.
Rod or bridge – the surgeon may use a plastic rod or tube to support a loop type stoma during the first 1 to 2 weeks
May be permanent or temporary
Applying a Device
https://www.crohnscolitisfoundation.org/patientsandcaregivers/treatment/surgery/ostomy#ostomyresources
Peristomal Skin Care
Clean the skin around the ostomy with warm water and a washcloth or soft paper towel and pat dry.
Vashe may be used to cleanse peristomal wounds.
The ostomy does not need to be cleaned like the skin around it does. When the ostomy is wiped, it is normal to see a little blood.
Dry the skin before you put on the new pouching system.
Body hair can stop the pouching system from sticking or cause pain with the pouching system removal.
WOCN Basic Ostomy Skin Care: https://cdn.ymaws.com/member.wocn.org/resource/resmgr/document_library/Basic_Ostomy_Skin_Care_docum.pdf
Documentation
Where to chart an ostomy:
Early Complications
https://www.ostomycanada.ca/blog/2025/stoma-prolapse-stenosis-retraction/
Tsujinaka S, Tan KY, Miyakura Y, Fukano R, Oshima M, Konishi F, Rikiyama T. Current Management of Intestinal Stomas and Their Complications. J Anus Rectum Colon. 2020 Jan 30;4(1):25-33. doi: 10.23922/jarc.2019-032. PMID: 32002473; PMCID: PMC6989127.
Stoma necrosis: Usually occurs between 24 horus and 5 days of stoma creation
Causes: surgical technique, edema, embolus, hypovolemia
Other associated conditions include: stoma retraction, mucocutaneous separation, stoma stenosis, and peritonitis
This is a surgical emergency. Contact treating provider immediately if suspected
Early Complications
Mucocutaneous seperation: The separation of the sutured junction between the stoma and the skin.
Causes: infection, diabetes mellitus, corticosteroids, malnutrition, excessive tension on the stoma, and stoma necrosis
Treatment: Wound care with wound fillers in the separated area
Contact treating provider immediately if noticed. Wound care requires recommendations from General Surgery and/or a WOCN practitioner.
https://www.ostomycanada.ca/blog/2025/stoma-prolapse-stenosis-retraction/
Tsujinaka S, Tan KY, Miyakura Y, Fukano R, Oshima M, Konishi F, Rikiyama T. Current Management of Intestinal Stomas and Their Complications. J Anus Rectum Colon. 2020 Jan 30;4(1):25-33. doi: 10.23922/jarc.2019-032. PMID: 32002473; PMCID: PMC6989127.
Early Complications
https://www.ostomycanada.ca/blog/2025/stoma-prolapse-stenosis-retraction/
Retraction- the stoma has receded about 0.5 cm below the skin surface. Retraction may be circumferential or in only one section. Stoma may have a concave, bowl-shaped appearance with frequent peristomal skin complications.
Causes: tension of the intestine or obesity. poor blood flow, obesity, poor nutritional status, stenosis, early removal of a supporting device with loop stomas, stoma placement in a deep skinfold, or thick abdominal walls.
Late complications usually result from weight gain or adhesions.
Stoma retraction is most common in patients with ileostomies.
Treatment: A convex pouching system and stoma belt. Surgery may be indicated
Late Complications
https://www.ostomycanada.ca/blog/2025/stoma-prolapse-stenosis-retraction/
Prolapse: The proximal segment of the bowel protrudes through the stoma site, appearing to telescope. This occurs more often in loop transverse colostomies.
Prolapse may be associated with parastomal hernias
Causes: large abdominal-wall openings, inadequate bowel fixation to the abdominal wall during surgery, increased abdominal pressure, lack of fascial support, obesity, pregnancy, and poor muscle tone.
Treatment: The stoma may require a larger pouch to accommodate the larger stoma. Cold compresses and sprinkling table sugar on the stoma may help reduce the prolapse. Prolapses may be reduced by having the patient lying supine.
Notify treating provider immediately prior to interventions.
Stoma prolapse image on the next slide
Late Complications
https://www.ostomycanada.ca/blog/2025/stoma-prolapse-stenosis-retraction
Monette MM, Harney RT, Morris MS, Chu DI. Local repair of stoma prolapse: Case report of an in vivo application of linear stapler devices. Ann Med Surg (Lond). 2016 Sep 1;11:32-5. doi: 10.1016/j.amsu.2016.08.018. PMID: 27668078; PMCID: PMC5024141./
Prolapse:
Late Complications
https://www.ostomycanada.ca/blog/2025/stoma-prolapse-stenosis-retraction/
Parastomal hernia- protrusion of abdominal contents through the abdominal wall defect created during ostomy formation
Risk factors: pregnancy, week abdominal muscles, straining/heavy lifting too soon after surgery, obesity, ascites, malnutrition, advanced age
Commonly created appliance adherence issues. Peristomal skin complications are likely.
Treatment: hernia belt and flexible pouching system
Often requires surgical intervention. Notify treating provider if noticed
Late Complications
https://www.ostomycanada.ca/blog/2025/stoma-prolapse-stenosis-retraction/
https://woundcareadvisor.com/understanding-stoma-complications_vol2-no4/�
Stoma Stenosis: Narrowing or constriction of the stoma opening
Causes: hyperplasia, adhesions, sepsis, radiation of the intestine before stoma surgery, inflammation, hyperkeratosis, weight gain
Bowel obstruction occurs frequently with stenosis
Prevention: Low residual diet, appropriate fluid intake, and use of stool softeners or laxatives
Obstruction or stenosis of the fascia requires surgery
Late Complications
https://dermnetnz.org/topics/skin-problems-from-stomas
Pyoderma Gangrinosum-
Causes: Unknown etiology. Commonly seem associated with IBS and cancer
Treatment: Steroids, Preventing further skin injury by providing proper skin care and ensuring device fits properly
*DO NOT debride these ulcers*
Peristomal Complications
Perisotmal MARSI
Pyoderma Gangrinosum
Peristomal Irritant Dermatitis-
Causes:
Treatment:
https://dermnetnz.org/topics/skin-problems-from-stomas
Peristomal Complications
Peristomal Adhesive Related Skin Injury-
Causes:
Treatment:
https://dermnetnz.org/topics/skin-problems-from-stomas
Peristomal Skin Assessment
https://psag.wocn.org/index#use-guideline
This Peristomal Skin Assessment Guide by the WOCN has been developed to help standardize assessments, identify probable reasons for the complication, and provide simple options for management.