Symptoms
of Stoma Complications:
Skin Irritation: Redness, itching, soreness, or broken skin around the stoma.
Leakage: Stool or urine leaking from under the ostomy appliance.
Stoma Retraction: The stoma pulling inward or sinking below the skin level.
Stoma Prolapse: The stoma telescoping outward and becoming longer than usual.
Stoma Stenosis: Narrowing of the stoma opening.
Stoma Necrosis: Darkening or blackening of the stoma, indicating tissue death.
Parastomal Hernia: A bulge or swelling around the stoma.
Bleeding: Excessive bleeding from the stoma or peristomal skin.
Changes in Output: Significant changes in the amount, consistency, or color of stoma output.
Pain: Abdominal pain or pain at the stoma site.
Causes
of Stoma Complications:
Surgical Technique: Improper stoma construction during the initial surgery.
Poor Stoma Care: Inadequate cleaning, incorrect appliance fitting, or aggressive removal of adhesive.
Weight Fluctuations: Significant weight gain or loss can alter the abdominal contour and affect appliance fit.
Underlying Medical Conditions: Conditions like inflammatory bowel disease (IBD), diabetes, or immunosuppression can increase the risk of complications.
Infection: Bacterial or fungal infections of the peristomal skin.
Trauma: Injury to the stoma or surrounding area.
Steroid Use: Prolonged steroid use can delay wound healing and increase infection risk.
Dehydration: Dehydration can cause changes in stool consistency.
Dietary Factors: Certain foods can cause diarrhea or constipation, affecting stoma output and increasing leakage risk.
Age: Elderly individuals may have reduced skin elasticity and healing capacity.
Medicine Used
for Stoma Complications:
Topical Steroids: Creams or ointments to reduce inflammation and itching around the stoma.
Antifungal Creams: To treat fungal infections of the peristomal skin.
Antibiotic Creams or Oral Antibiotics: To treat bacterial infections.
Pain Relievers: Over-the-counter or prescription pain medications to manage pain.
Anti-diarrheal Medications: To control diarrhea and reduce leakage.
Stool Softeners or Laxatives: To manage constipation.
Wound Care Products: Specialized dressings to promote healing of peristomal skin wounds.
Adhesive Removers: To gently remove ostomy appliances and prevent skin damage.
Precautions
for Stoma Complications:
Proper Stoma Care: Clean the stoma and peristomal skin regularly with warm water and mild soap.
Correct Appliance Fit: Ensure the ostomy appliance fits properly to prevent leakage and skin irritation.
Gentle Appliance Removal: Use adhesive removers and gentle techniques to remove the appliance.
Skin Protection: Apply a skin barrier film or wafer to protect the peristomal skin from irritation.
Hydration: Drink plenty of fluids to prevent dehydration and maintain stool consistency.
Dietary Management: Follow dietary recommendations provided by your healthcare provider or ostomy nurse.
Regular Monitoring: Examine the stoma and peristomal skin regularly for any signs of complications.
Avoid Heavy Lifting: Avoid heavy lifting or straining, which can increase the risk of parastomal hernia.
Maintain a Healthy Weight: Maintain a healthy weight to prevent changes in abdominal contour.
Report Changes: Report any changes in stoma appearance, output, or peristomal skin condition to your healthcare provider or ostomy nurse.
How long does an outbreak last?
The duration of a stoma complication varies depending on the type and severity of the problem, as well as the treatment approach.
Skin Irritation: Mild skin irritation may resolve within a few days with proper skin care.
Infections: Infections may take several days to weeks to clear with appropriate antibiotic or antifungal treatment.
Stoma Retraction/Prolapse/Stenosis/Hernia: These conditions typically require medical or surgical intervention and may take weeks or months to resolve fully. Some might require ongoing management.
Necrosis: Stoma necrosis requires immediate medical attention and potentially surgery. The healing process can take several weeks or months.
How is it diagnosed?
Visual Examination: A healthcare professional, typically an ostomy nurse or surgeon, will visually examine the stoma and surrounding skin.
Patient History: They will ask about symptoms, stoma care routine, diet, and any underlying medical conditions.
Palpation: The area around the stoma may be palpated to check for hernias or other abnormalities.
Stoma Output Assessment: The amount, consistency, and color of the stoma output will be assessed.
Skin Swabs/Cultures: If infection is suspected, skin swabs or cultures may be taken to identify the causative organism.
Imaging Studies: In some cases, imaging studies such as X-rays, CT scans, or ultrasounds may be necessary to evaluate internal structures.
Stomaoscopy: Direct visualization of the stoma and a small portion of the bowel with a scope.
Timeline of Symptoms
The timeline of symptoms varies depending on the specific complication.
Immediate Post-operative: Stoma necrosis may occur within the first few days after surgery.
Early Post-operative (Weeks): Stoma retraction, prolapse, or stenosis may develop within the first few weeks or months after surgery.
Long-Term: Parastomal hernias and peristomal skin irritation can develop months or years after surgery.
Acute: Skin infections or leakage can develop suddenly due to various factors.
Important Considerations
Early Detection: Early detection and treatment of stoma complications are crucial to prevent them from worsening.
Ostomy Nurse Consultation: Regular follow-up with an ostomy nurse is essential for ongoing support and education.
Appliance Selection: Choosing the right ostomy appliance is important for comfort and preventing leakage.
Lifestyle Adjustments: Making lifestyle adjustments, such as dietary modifications and avoiding heavy lifting, can help prevent complications.
Psychological Support: Living with an ostomy can be challenging, and psychological support may be beneficial.
Surgical Revision: In some cases, surgical revision of the stoma may be necessary to correct certain complications.
Patient Education: Patient education is critical for successful stoma management.
Seek Professional Help: Always consult with a healthcare professional or ostomy nurse for any concerns or questions about your stoma.