A stoma is a surgically created opening on the abdomen through which faeces or urine leave the body into a pouch (appliance). Stomas are created for bowel cancer, inflammatory bowel disease, trauma, bowel obstruction or perforation (including from typhoid in some regions), and bladder conditions. Some are temporary; others are permanent. Adjusting to a stoma is a big physical and emotional change, and nurses are central to helping patients manage it confidently.
Types of stoma
| Type | Usual site | Output |
|---|---|---|
| Colostomy (large bowel) | Usually left lower abdomen | Formed to semi-formed stool |
| Ileostomy (small bowel) | Usually right lower abdomen | Liquid to porridge-like, often large volumes; more risk of dehydration and skin damage |
| Urostomy (ileal conduit) | Usually right abdomen | Urine, continuous; may contain mucus |
What a healthy stoma looks like
- Moist, pink or red, like the inside of the mouth.
- It has no nerve endings, so it isn’t painful to touch, but it can bleed slightly when cleaned.
- Swelling is normal in the first weeks after surgery; the stoma shrinks over 6–8 weeks, so the appliance size needs re-measuring.
Warning signs (report promptly)
- Dark red, purple, brown or black stoma: possible ischaemia (poor blood supply). Urgent.
- Retraction (sinking below the skin) or prolapse (protruding more).
- Separation of the stoma from the skin.
- No output for a prolonged period with abdominal pain and vomiting (possible obstruction).
- High output from an ileostomy (commonly over 1.5–2 litres a day): risk of dehydration and kidney injury.
- Sore, broken or infected skin around the stoma.
Changing an appliance: step by step
- Explain, ensure privacy, gather equipment: new appliance, measuring guide, scissors, warm water, soft wipes, disposal bag, any accessories (adhesive remover, barrier film).
- Wash hands, put on gloves.
- Remove the old appliance gently from top to bottom, supporting the skin (an adhesive remover helps).
- Clean the stoma and skin with warm water; dry thoroughly. Avoid soaps, oils and antiseptics that affect adhesion.
- Inspect the stoma and skin.
- Measure the stoma and cut the flange so it fits snugly, about 2–3 mm larger than the stoma, so skin is protected without pressing on the stoma.
- Apply the new appliance, smoothing from the stoma outwards; hold for a minute so the warmth helps it stick.
- Dispose of waste properly; document output, appearance and any concerns.
Emptying and output
Empty drainable pouches when about one-third to half full, to prevent leaks. Record output accurately, especially for ileostomies, and watch fluid balance and electrolytes.
Diet and lifestyle advice
- Most people can return to a normal diet gradually. Chew food well.
- People with ileostomies should drink enough fluids and may need extra salt; some high-fibre foods (e.g. nuts, sweetcorn, fruit skins) can cause blockage early on.
- Gas-producing foods may increase wind.
- Most people can return to work, exercise, travel, swimming and intimacy after recovery, with the right appliance.
Emotional support
Many patients worry about body image, smell, leaks, relationships and religious practices (such as prayer and ritual cleanliness). Respond with sensitivity; involve a stoma care nurse specialist where available; connect patients with support groups. Teach patients to manage their own appliance before discharge, and make sure they know where to get supplies, which can be costly and hard to find in some countries.
Related: Post-operative nursing care · The acute abdomen
Based on Association of Stoma Care Nurses UK guidance and standard stoma nursing practice. Educational content: follow local policy and specialist advice.