Complications Of A Colostomy

Overview

A colostomy is an operation that creates a new way for poo (stool) to leave your body. A small part of your large bowel (colon) is brought out through an opening in your tummy. This opening is called a stoma. Poo then collects in a bag that sticks over the stoma. 'Complications' simply means problems that can happen with the stoma, the skin around it, or the bowel behind it. Most of these problems are small, treatable and very common — and your stoma nurse can usually help.

Yes. Skin irritation and bag leaks are the most common problems, and many people have them at some point. More serious issues, such as a blockage, a hernia or a prolapse, are less common but still happen to some people.

Anyone who has a colostomy, at any age. How often problems happen depends on your body shape, your general health, the type and position of your stoma, and how well your bags fit.

Symptoms

Common symptoms

• Red, itchy, sore or broken skin around the stoma
• The bag leaking, lifting at the edges, or not sticking well
• A small amount of bleeding when you clean the stoma (a little is normal — heavy bleeding is not)
• The stoma getting longer or sticking out more than usual (called a prolapse)
• The stoma sinking back towards the skin (called retraction)
• A bulge beside the stoma that gets bigger when you cough or lift (called a parastomal hernia)
• Changes in how much poo comes out — very loose, very watery, or none at all
• Wind, smell or noisy gurgling that bothers you
• Blockage signs: crampy tummy pain, a swollen tummy, vomiting, and little or no poo or wind

Symptoms in children

• Babies and children may show problems by crying more, feeding less, or having a bag that keeps leaking
• Watery poo and vomiting can cause dehydration faster in children than in adults
• Contact your child's stoma nurse or doctor the same day if their output stops or they seem unwell

Symptoms in older adults

• Skin becomes thinner and more fragile with age, so irritation and tears are more likely
• Losing too much fluid from high output can cause confusion, dizziness and falls
• Poor eyesight, shaky hands or memory problems can make bag changes harder — ask for extra help and aids
• Other health conditions and their treatments can affect how the bowel behaves

Causes

Main causes

• Bag and skin problems: a bag that does not fit well, or is changed too roughly or too often
• Skin reactions to adhesives, wipes or cleaning products
• Poo leaking onto the skin, which irritates it
• Pressure inside the tummy from coughing, lifting or straining, which can cause a hernia
• The stoma tissue moving outwards (prolapse) or sinking inwards (retraction)
• Blockage from scar tissue (adhesions) or from food that is hard to break down
• Infection of the skin or the wound
• High output — a lot of watery poo — caused by infection, some foods, or another illness

Risk factors

• Being overweight, or gaining weight around the middle
• Lifting heavy things, or having a long-lasting cough
• A sudden change in weight
• The type and position of your stoma
• Crohn's disease or other conditions that cause inflammation
• Diabetes, which can slow healing
• Some medicines can make skin thinner or slow healing — ask your doctor or pharmacist
• Not having regular reviews with a stoma nurse

When to see a doctor

See a doctor urgently if:

• No poo or wind for several hours, with cramping pain or vomiting
• The stoma changes colour, or bleeds heavily
• Skin around the stoma is broken, bleeding or very painful
• Large amounts of watery output that will not settle
• A painful lump or bulge near the stoma
• You feel dizzy, very thirsty, or are passing much less urine than usual

Book a routine appointment if:

• Leaks that keep happening, even with a good routine
• Ongoing redness or itching around the stoma
• The stoma has changed size or shape
• You want help choosing different bags or products
• Worry about smell, wind or noise that affects your daily life
• You feel low, anxious, or avoid going out

Diagnosis

Most problems are found by looking at and gently feeling the stoma and the skin around it, and by asking about your bag routine, your diet and your symptoms. This is usually done by your stoma nurse at a clinic visit or during a home visit.

Tests that may be done

• A physical examination of the stoma and your tummy
• Checking your bag and watching how it fits
• Blood tests to look for infection, dehydration or low salt levels
• A sample of the stoma output if an infection is suspected
• A scan, such as an X-ray, ultrasound or CT scan, if there may be a blockage or a hernia
• A camera test of the bowel (endoscopy) if bleeding or other changes need a closer look

What to expect at your appointment

Most visits are quick and practical. Your nurse may watch you change your bag and suggest a different size or type. You may be asked to keep a short diary of what you eat, how much comes out, and any leaks. Bring a spare bag and your usual supplies so you can practise during the appointment.

Treatment

Treatment depends on the problem. Most issues are fixed by getting the right bag and the right fit, plus good skin care. Some need simple medical treatment, and only a few need surgery.

Self-care at home

• Measure your stoma — it changes size in the first few months and can change with weight
• Change your bag on a regular schedule, not only when it leaks
• Clean the skin gently with warm water and pat dry — avoid harsh soaps and scrubbing
• Use a barrier film or paste suggested by your stoma nurse to protect the skin
• Empty the bag when it is about a third to half full, so it does not pull on the skin
• Drink enough fluid, especially in hot weather or when output is watery
• Chew food well and eat slowly
• Avoid lifting heavy things, and support your tummy with your hand when you cough
• Keep a spare kit with you at all times

Medical treatments

Your doctor or stoma nurse may suggest different types of bag or skin product, medicine to slow a very fast bowel, fluids or salts to replace what you have lost, treatment for an infection, or a support garment for a hernia. They may also refer you to a dietitian or a specialist stoma service. Always ask your pharmacist or doctor before putting anything new on your skin or taking any medicine.

When is surgery considered?

Surgery is needed for only some problems. Examples include a hernia that is painful or getting bigger, a prolapse that cannot be managed with a bag, a blockage that does not clear with treatment, or serious damage to the stoma. Your surgeon will explain the risks and benefits, and the decision is made together with you.

Living with this condition

Life with a colostomy is often busy at first, then it becomes routine. Most people settle into a pattern within a few months: a bag change every few days, emptying through the day, and a spare kit in your bag. Small tweaks — a different bag, a belt, a deodorant drop — often make a big difference. Your stoma nurse can help you fine-tune things as your body changes.

Lifestyle tips

• Keep spare supplies at home, in the car and at work
• Wear clothes you feel comfortable in — high-waisted or looser styles often work well
• Shower or bathe as normal; the bag can stay on, or you can change it after
• Tell people you trust, so you have support when you need it
• Plan travel with extra supplies in your hand luggage
• Carry a small card or note explaining you have a stoma, in case of an emergency

Diet and exercise

Eat regular meals and chew well. Some foods — such as very fibrous vegetables, nuts, seeds, popcorn, sweetcorn and dried fruit — can cause blockages in some people, so try new foods one at a time and in small amounts. Drink plenty of fluid, more so if your output is watery. Gentle exercise, like walking, is good for your heart and helps prevent hernias. Build up slowly, and ask your stoma nurse or a physiotherapist about tummy and core exercises. Avoid heavy lifting until you are told it is safe.

Mental health and emotional wellbeing

It is very normal to feel worried, self-conscious or low at times. Leaks, smell, and the fear of people noticing can affect your confidence, your sleep and your relationships. These feelings usually ease as you gain control and find the right supplies, but they deserve to be taken seriously. If you feel low for more than a couple of weeks, or if you have thoughts of harming yourself, please reach out straight away — contact your doctor, your stoma nurse, or a crisis support service in your country. You are not a burden, and help is available.

Prevention

You cannot prevent every problem, but good stoma care and regular check-ups with your stoma nurse lower the risk a lot. Getting the right bag and fit early, protecting your skin, and avoiding heavy lifting all help.

Screening programmes

Regular reviews with your stoma nurse act like a check-up. Go even when things feel fine — they can spot skin damage, a hernia forming or a change in stoma size before it becomes a problem.

Complications

If left untreated

• Skin damage that gets worse and becomes very painful, making it hard to get a bag to seal
• Dehydration and low salt levels from ongoing high output
• A blockage that is not treated, which in rare cases can lead to a burst bowel — this is a medical emergency
• A hernia that grows and becomes painful, and is harder to repair later
• A prolapse that becomes swollen and difficult to manage
• An infection spreading into the skin and deeper tissues
• Withdrawing from work, social life and relationships because of worry about leaks and smell

Long-term outlook

The great majority of colostomy problems are managed quickly and well, and most people go on to live full, active lives. Many find that after the first year, the stoma becomes a background part of life rather than the main focus. If you do run into trouble, there is almost always something that can be adjusted — so please speak to your stoma nurse rather than putting up with it.

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