There are several potential complications related to the stoma itself. Not all stoma complications will be addressed. Examples of the more common stoma complications include retracted stoma, peristomal hernia, prolapsed and cut stoma
The retracted stoma functions at or below skin level. It may develop around the stoma or the supporting structures at the fascia layer which may shrink causing the stoma to be pulled inward. It may also be due to a surgical problem in which not enough bowel is available to create a protruding stoma. A retracted stoma can prove problematic because the stool has the tendency to pass underneath the appliance resulting in stool leakage and skin soreness.
The goal is to increase the degree to which the stoma protrudes. This can be accomplished in two ways. The first method is to add convexity to the pouching system which will help to “bud” the stoma. If convexity does not resolve the problem then the second method used is to add flexibility to the pouching system which may help to conform and adhere to uneven skin surfaces.
A peristomal hernia is characterized by a bulging of the area around the stoma. It can result in a blockage or obstruction.
A hernia can occur due to weak abdominal muscles, inadequate healing or difficulties at the time of surgery. Peristomal hernias are more commonly found when the stoma is sited outside the rectus muscle.
Peristomal hernias can be supported by hernia belt purchased at surgical
supply stores, a wide tensor bandage or light-weight panty girdle. A flexible pouching system might adhere better to the bulging skin surface. Surgical repair may be necessary if pain or obstructive symptoms become an issue of concern.
A prolapsed stoma is an increase in size of the stoma, usually in the length of the stoma. The possible causes of a prolapse include obesity, too large an abdominal opening for the bowel which may prevent the mesentery from remaining secured to the abdominal wall, increased intra-abdominal pressure that may occur with coughing, sneezing, or vigorous peristalsis, multiple previous incisions, or the stoma sited outside the rectus muscle.
In the event of a prolapse, it is recommended that the patient lie down and the stoma covered with a warm damp cloth. The bowel can then be gently
manipulated back in place. A patient can be taught this technique. An abdominal binder or prolapse guard can be used to prevent the prolapse from reoccurring. If the prolapse is not resolved by the above measures, surgical repair and/or relocation of the stoma site may be necessary.
The signs of a cut stoma would include a noticeable break in the integument of the stoma which may be accompanied by bleeding. A stoma can be traumatized due to: the movement of a flange which is not properly fixed to the peristomal skin, a sharp blow, or an inadvertent cut by scissors or nails. Bleeding may be stopped through use of a silver nitrate stick, a stitch, or use of a haemostatic dressing. Surgical intervention may be necessary if bleeding persists.
Patients need to be taught preventive measures in terms of properly sizing the opening of their appliance, and avoiding rough, contact sports without proper protection to the stoma site. Patients also need to be reminded that once a stoma is cut, scarring will occur and the mucosa will appear white.