Ostomy Management

Immediately after surgery, the stoma generally appears moist and beefy red and may be about one inch across. The peristomal area should be checked frequently after the surgery for bleeding or other abnormality that would suggest a problem with wound healing. Any peristomal color changes may indicate problems, including ischemia and an ill-fitting pouching system. Input and output should be monitored along with other indicators of complications, such as hydration and electrolyte imbalances. Within one to two months, the swelling is generally reduced and the stoma shrinks to the approximate size it will stay. In some cases, stomas may continue to shrink slightly for up to a year post-surgery. Frequent measures, especially in the first two months, will allow the patient and caregivers to better match the equipment to the stoma for better management.

Stomas may protrude from the skin surface as much as a half inch. Normally the ostomy will be smooth, firm, and round or oval in shape. Once healed, the peristomal area should be free of redness, weeping, and tenderness.

Stomas may also have other appearances, such as flush with the skin, retracted, long, and mushroom shaped. These may require more careful care and specific equipment matched to the shape. For instance, a flush stoma may require a convexity wafer system to help the stoma to protrude slightly for better sealing, easier management, and to prevent waste products from seeping under the seal (convexity is a type of pouch that isn't flat. It has a raised area around the pouch opening. This encourages the stoma to stick out). For long/snout-shaped stomas, an abdominal support belt with prolapse coverlets may be used (prolapse refers to a general dropping of the stoma that can make it more difficult to manage). Surgical correction for this type of stoma may be required. For mushroom-shaped stomas a faceplate may be cut to allow the top to be enclosed, and the patient may use stoma paste to protect the skin that remains exposed under the “head” of the ostomy (a faceplate is the adhesive part of the pouch). If a seal is difficult to maintain, skin barrier films, flexible faceplates, and convexity systems may be used. If the stoma is retracted or inside of the abdomen, convexity can be used to help the stoma protrude.