Colostomy: Stoma Assessment, Pouch Care, and Peristomal Skin Protection
Teach that a healthy stoma is moist and pink to red; a dark red, purple, or black stoma requires emergency care, and a pale stoma requires a report. Empty the pouch when one-third to one-half full. Change the skin barrier every 3 to 7 days and cut the opening to within 1/8 inch (2 to 3 mm) of the stoma.
Who needs this teaching
Every client with a new or established colostomy and the caregiver who helps with pouch care. A colostomy diverts stool through a stoma on the abdominal wall. Descending and sigmoid colostomies produce formed stool; transverse colostomies produce soft or semiformed stool. Self-care competence before discharge prevents leakage, peristomal skin damage, and social isolation.
The priority teaching points
- Stoma assessment. A healthy stoma is moist, pink to red, and slightly raised. It has no sensation. Slight bleeding during cleaning is expected. A dark red, purple, or black stoma indicates ischemia and requires emergency care. A pale stoma indicates anemia; report it to the provider.
- Postoperative changes. Stoma edema decreases over 6 to 8 weeks after surgery. Measure the stoma with a measuring guide at each barrier change during this period.
- Emptying the pouch. Empty the pouch when it is one-third to one-half full. A heavier pouch pulls on the seal and causes leakage. Clean the outlet and close it securely.
- Changing the skin barrier. Change the skin barrier and pouch every 3 to 7 days, and immediately for leakage, itching, or burning under the barrier. Cut the opening to within 1/8 inch (2 to 3 mm) of the stoma. A larger opening exposes skin to stool; a smaller opening injures the stoma.
- Peristomal skin care. Clean the skin with warm water and pat it dry. Avoid soaps that contain oils or lotions; they prevent adhesion. Inspect the skin for erythema, erosion, or rash at each change. Stool contact causes irritant dermatitis; correct the barrier fit first.
- Diet and fluids. Chew food well and add new foods one at a time. Beans, cabbage, broccoli, onions, carbonated drinks, and beer produce gas. Eggs, fish, garlic, and onions produce odor; yogurt and buttermilk reduce odor. Straws and chewing gum increase swallowed air. Drink about 8 cups (2 L) of fluid daily unless a fluid restriction is prescribed.
- Bathing and activity. Shower with the pouch on or off; water does not enter the stoma. Avoid lifting more than 10 lb for 6 to 8 weeks after surgery to prevent a parastomal hernia. Resume work, travel, swimming, and sexual activity as the surgeon advises.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Red, eroded, or broken peristomal skin | Heavy bleeding from the stoma, or blood filling the pouch |
| A bulge around the stoma (parastomal hernia) | A stoma that turns dark red, purple, or black |
| No stool or gas for the prescribed time, with cramping | Severe abdominal pain with distention and repeated vomiting |
| A pale stoma, or repeated pouch leakage | Syncope with bleeding |
Teach-back questions
- "Describe how a healthy stoma looks."
- "When will you empty your pouch?"
- "Show me how you measure the stoma and cut the barrier opening."
- "Which foods cause gas or odor for you?"
- "Which stoma color means you call 911?"
Teaching tips
- Begin hands-on practice early; the client completes a full pouch change before discharge.
- Refer to a wound, ostomy, and continence (WOC) nurse and an ostomy support group.
- Write the barrier size and the client's no-output time limit on the handout.
- Address body image and intimacy concerns in private.
Read more on NCLEXPace
- Perioperative Nursing: Safety Across the Surgical Journey
- GI and Liver Map: Cirrhosis, Pancreatitis, GI Bleeding, and Ostomies
Sources
- Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Lower Gastrointestinal Problems.
- Goldberg M, et al. WOCN Society Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy - An Executive Summary. J Wound Ostomy Continence Nurs. 2018;45(1):50-58.
Why this matters for the NCLEX
Teaching is effective when the client states, "I will empty my pouch when it is one-third to one-half full," and "My stoma should look moist and red." Statements requiring further teaching include, "I will cut the opening 1/2 inch larger than my stoma," "A purple stoma is normal after surgery," and "I will wait until the pouch is full."
Frequently asked questions
Is slight bleeding from the stoma during cleaning normal?
Yes. The stoma mucosa is highly vascular. Heavy bleeding or bleeding that does not stop requires emergency care.
Why measure the stoma at each change after surgery?
Stoma edema decreases over 6 to 8 weeks. An opening cut to the old size exposes peristomal skin to stool.
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