A stoma is a surgically created opening (ostomy) that connects a portion of the body’s internal tract—such as the intestine or urinary system—to the outside of the abdomen. This opening allows for the diversion of waste into an external collection pouch when the normal route is no longer functional. Recognizing the characteristics of a healthy stoma is fundamental to successful self-care. Understanding the expected colors, textures, and changes helps distinguish normal variations from signs that require medical attention.
The Hallmarks of a Healthy Stoma
A healthy stoma should display a color that is a rich red or deep pink, closely resembling the mucous lining found inside the mouth or the gums. This vibrant coloration is a direct result of the tissue being highly vascular, meaning it has an abundant supply of blood vessels that indicate proper oxygenation and circulation. The presence of this high blood flow is the primary indicator of tissue viability and overall health.
The surface of the stoma, which is intestinal mucosa, should appear consistently moist and shiny. This wet look is normal because the tissue naturally produces mucus, serving as a protective and lubricating layer. Because the intestinal tissue used to form the stoma does not contain sensory nerve endings, touching or cleaning the surface should not cause any pain or sensation.
The stoma is typically round or oval and exhibits a soft, plump texture. While some stomas may sit flush with the skin, the ideal appearance is one that protrudes slightly above the abdominal surface. Protrusion helps direct the output away from the surrounding skin, which aids in maintaining a secure seal with the collection appliance.
Expected Changes Over Time
Immediately following surgery, the stoma will be noticeably larger and swollen due to surgical manipulation and the body’s natural response to trauma. This initial edema is temporary, and the size and shape will gradually stabilize as the swelling subsides and the healing process continues.
This process of maturation and shrinkage often spans the first six to eight weeks after the operation. In some cases, the stoma may continue to reduce in size for up to six months before settling into its final dimensions. Regular measurement is important during this period to ensure the opening in the collection appliance is correctly sized, preventing leakage and subsequent skin irritation.
Small amounts of surface bleeding are a normal and frequent occurrence, particularly during the process of cleaning the stoma or changing the pouching system. This minor bleeding happens because the tissue’s dense network of small blood vessels lies very close to the surface, making them delicate and easily irritated by friction. The bleeding should stop quickly.
Visual Indicators Requiring Immediate Attention
Any significant change in stoma color is the most serious visual sign requiring immediate medical consultation. If the tissue appears dark red, deep purple, blue, or black, it may indicate a compromise in the blood supply (ischemia or necrosis). This lack of adequate blood flow means the tissue is not receiving sufficient oxygen and needs urgent assessment.
Severe retraction is another concerning sign, which occurs when the stoma pulls back significantly into the abdomen, sometimes sitting below the skin level. This change in contour can make it difficult to achieve a proper seal with the appliance, leading to persistent leakage and severe irritation of the surrounding skin. Retraction may be caused by tension on the bowel or changes in body weight or shape.
Deep cuts, ulcers, or lacerations on the mucosal surface are indicators that a healthcare provider should examine the stoma. While minor scrapes are common, deep lesions can suggest trauma from a poorly fitting appliance or other underlying issues. Similarly, any profuse or pulsating bleeding, which is distinct from minor spotting, signals a potential issue with a larger vessel.
Regular self-inspection of the stoma’s appearance is a powerful tool for early detection. Paying close attention to color, moisture, and contour allows individuals to quickly identify deviations from the established healthy appearance. If any sudden or sustained negative visual changes occur, contacting a stoma care nurse or surgeon without delay is necessary.