A stoma will normally protrude slightly above the skin level. The length of the protrusion will depend on whether you have a colostomy or ileostomy (ileostomies tend to protrude further out) and the size of your bowel.
Colostomies should typically protrude 1.5 to 2.5 cm and stomas of the small bowel should evert 2.5 to 3.5 cm. Stomas that do not evert at least 1 cm above the skin surface 48 hours after surgery have a 35% chance of causing problems.
The skin around your stoma should look just like the skin on the other side of your abdomen, or anywhere else on your body. The skin around the stoma should be intact without irritation, rash, or redness. A properly fitting skin barrier protects the skin from being irritated or damaged by the stoma drainage.
Unlike a protruding stoma, a flush stoma does not protrude beyond the skin of the abdomen. A flush stoma, as the name suggests, is flush with the skin covering the abdomen. Flush stomas may be the result of a surgeon's chosen technique, or may occur over time, even though a protruding stoma was originally created.
Mucocutaneous separation, also called stoma dehiscence, is the pulling away of the stoma from the peristomal skin. The separation may involve only one or two sutures or the sutures around the entire stoma (see Figure 3).
Recap. Call your doctor immediately if the skin surrounding the stoma changes colors, develops sores or chafing, or shows signs of infection (including increasing redness, pain, swelling, heat, and a pus-like discharge).
A key aim of pouching is to protect peristomal skin. Skin can be protected with a pouch opening no larger than 1/8 inch greater than the stoma.
If your stoma is or becomes black, dusky, pale or sloughy (separating from the body), report it to your doctor or stoma nurse. You should also report any soreness, inflammation or ulceration of the skin around the stoma, and any sudden or unexplained swelling of the stoma.
A prolapsed stoma occurs when the stoma becomes longer than normal If your stoma has prolapsed it will look longer than normal and stick out further from the body. A stoma can prolapse if the muscles supporting it are weak or it may happen as a result of straining the abdominal muscles i.e. through lifting.
A healthy stoma is pinkish-red and moist. Your stoma should stick out slightly from your skin. It is normal to see a little mucus. Spots of blood or a small amount of bleeding from your stoma is also normal.
Normal Stoma Appearance
A healthy stoma will be pink or red in colour, moist and slightly shiny. Your stoma can change shape or size over time. This can mean that your bag no longer fits properly and your skin could be exposed to the contents of the stoma bag.
The skin around a stoma may become inflamed (red, swollen, painful) because the stoma is leaking, because of an underlying skin disease, or because of infection. Papules (small bumps) and nodules (large ones) can develop due to ongoing irritation, granulation tissue, viral warts, cancer or Crohn disease.
The stoma, ileostomy traditionally on the right and colostomy on the left, is placed in the center of this triangle, through the rectus muscle slightly below the umbilicus. The site should be 5 cm away from skin folds, prior scars or bony prominences, and the patient's belt line.
Ideally, the stoma should be sited below the belt line. However, there may not be sufficient space between the belt line and inguinal fold to provide an adequate pouching surface, especially in men. Stomas above the belt line often are visible through clothing and may require altering one's wardrobe.
To summarize, spontaneous closure of a stoma is a rare event. The exact mechanism leading to closure is poorly understood; further studies, perhaps animal-based, may be required to obtain insight into the probable mechanism.
Most people with stomas may have to go through a stoma infection. However, it is a possibility that anyone with a stoma should know about it. The first sign of a stoma infection may be a pus-like discharge, unusual swelling, increasing redness, or color changes.
A rash around the stoma that is red, or red with bumps – this may be due to a skin infection or sensitivity, or even leakage. Wart-like, pimple-like or blister-like bumps under the skin barrier – this type of irritation can happen any time, even if you've used the same product for months or years.
If the stoma does not protrude above the skin, the stool may get under the pouch seal and cause leakage. A convex pouching system can provide some pressure around the stoma to force output to get into the pouch and not under the skin barrier seal.
Barrier creams or sprays can be used for a short period of time. Non-sting stoma pastes to help with adhesion of to the flange to the skin. Topical steroid lotions can be used as a short course of treatment if irritation is severe, these would need to be prescribed by your stoma nurse or GP.
What are the signs of a healthy skin barrier? Here's what a happy skin barrier usually looks and feels like: Your skin is mostly smooth and flake-free. Your skin feels comfortable after using gentle cleansers and products with non-active ingredients.
To prevent the pouch from becoming too heavy, the pouch should be emptied when one-third full. If you allow it to get too full, the weight of the stool may pull the pouch away from the skin. A person with an ileostomy will need to empty the pouch about five or six times in a 24-hour period.
It's common for stomas to change in shape and size over time—especially during the first 6-8 weeks after surgery. After this period, your stoma may change due to weight gain, weight loss, pregnancy, prolapse or hernias, aging, or other changes to your physical appearance.