Stoma Problems

Most patients with colorectal cancer requiring a stoma have minimal difficulties with stoma care, however, there are several common problems that can occur and treatment for these problems may range from very simple to requiring surgical revision of the the stoma.

Peristomal Skin Problems

Skin problems associated with a stoma can be caused for a number of reasons. Fungal infections are a common cause of red rash under the stoma appliance and bag because the area is often moist. Often this type of rash will extend down any skin creases. This can be treated using antifungal medications.
Some patients will develop an allergy to the appliance adhesives which causes a reaction only in the area that the adhesive touches. Changing the stomahesive often times cures this.
Poorly fitting stomas can allow leakage from the intestine onto the skin which causes skin irritation which can range from a mild redness to severe ulceration. Leakage can happen for a number of reasons. Sometimes it is because the appliance is cut to the wrong size or an inadequate amount of stoma paste is being used. Other times, anatomical problems with the stoma cause this such as the stoma being located in a skin crease or retraction of the stoma which make pouching difficult.

Stoma Retraction

If the stoma was created under some tension or the patient has gained a lot of weight following surgery, the stoma may retract. This may make pouching the stoma difficult and may require one to use a special wafer which is convex, to conform to the retraction.

Stoma Stricture

Narrowing of the opening of the stoma is called a stricture. This is recognized because the patient may have difficulty evacuating stool from the stoma or even develop intermittent abdominal distension and pain. A stricture may occur from tension on the stoma, poor blood supply to the stoma, or chronic inflammation at the stoma. Treatment may consist of dilating the stoma or may require surgical revision.

Stoma Prolapse

If the stoma begins to get larger such that more of the intestine is protruding away from the abodmen, it is likely that the stoma is prolapsing, meaning that it is telescoping on itself. Prolapse may be managed using an abdominal binder or more likely a surgical revision.

Parastomal Hernia

The stoma is created by making an opening in the abdominal wall for the bowel to pass through. If this opening widens over time, it is possible for other structures such as the small intestine to pass through the abdominal wall along side of the stoma. This is referred to as a parastomal hernia. This may produce a bulge around the stoma making the appliance fit poorly. It may also cause abdominal pain, symptoms of bowel obstruction, or it may be without symptoms. Parastomal hernias which are symptomatic should usually be repaired surgically.