An infected stoma typically shows redness spreading outward from the base, swelling, and discharge that looks cloudy, yellow-green, or pus-like rather than the clear or slightly yellowish mucus that’s normal. The skin around the stoma may feel warm, tender, or painful to touch. Peristomal skin complications affect up to 70% of stoma patients at some point, so knowing what’s normal and what signals trouble is genuinely useful.
What a Healthy Stoma Looks Like
Before you can spot infection, it helps to know the baseline. A healthy stoma is red or pink, moist, and shiny. It looks similar to the inside of your cheek. Some swelling is completely normal in the first few weeks after surgery, and the stoma will gradually shrink over the following months. It may bleed slightly when cleaned, which is normal because the tissue has a rich blood supply. The surrounding skin should look like the skin on the rest of your abdomen: no redness, no raised bumps, no broken areas.
Visual Signs of an Infected Stoma
Infection around a stoma can come from bacteria, yeast, or both, and each looks slightly different. But the general warning signs overlap enough that you can learn to spot them at a glance.
Redness that spreads beyond the stoma base. Some pinkness right at the junction of the stoma and skin is expected during healing. Infection causes redness that fans outward, looks angrier, and doesn’t improve with a pouch change. The skin may also feel warmer than surrounding areas.
Unusual discharge. Normal stomal mucus is clear or slightly yellowish and can range from watery to a sticky, glue-like consistency. If the discharge becomes blood-stained, thick, green, or pus-like, that points toward infection. A sudden change in smell, particularly a foul or unusually strong odor that’s different from your typical output, is another signal worth noting.
Swelling and tenderness. The area around the stoma may puff up and become painful, not just during pouch changes but constantly. You might notice that your pouching system no longer fits the way it used to because of the swelling.
Pustules or blisters. Small raised bumps filled with fluid, especially clustered near the stoma, can indicate bacterial or fungal infection. These may break open and leave raw, weeping patches.
Bacterial vs. Fungal Infections
A yeast infection (candidiasis) around the stoma creates shiny, reddened patches with what clinicians call “satellite lesions,” small red bumps or pustules that appear scattered around the edges of the main rash. The borders can be regular or irregular. Yeast thrives in warm, moist environments, which makes the skin under an ostomy pouch an ideal target, especially in hot weather or if the seal isn’t airtight.
A bacterial infection, most often caused by staph bacteria, looks remarkably similar: a red, pustular area that can easily be mistaken for a yeast infection. The key differences are subtle. Bacterial infections are more likely to produce thicker, opaque pus and may be accompanied by increasing pain and warmth. Because the two can look so alike, a wound care nurse or doctor sometimes needs to take a swab to confirm which type you’re dealing with, since the treatments differ.
Conditions That Mimic Infection
Not every alarming change around your stoma is an infection. Several other complications can look similar but require different management.
Mucocutaneous separation happens when the stoma partially or fully detaches from the surrounding skin, leaving a gap or crevice at the base. It can look raw and inflamed, and it may produce drainage that resembles pus. This is actually a wound-healing problem rather than an infection. Most cases heal with proper local care: cleaning with saline, using skin barrier powder to absorb moisture, and sometimes packing the gap with absorbent wound material before applying the pouch. Circumferential separation, where the stoma detaches all the way around, needs closer monitoring because it can lead to the stoma retracting inward.
Irritant dermatitis is the most common peristomal skin problem. It’s caused by stoma output leaking under the pouch and damaging the skin. The result is red, raw, sometimes weepy skin that stings. It looks inflamed, but it’s a chemical burn rather than an infection, though damaged skin is more vulnerable to infection developing on top of it.
Pyoderma gangrenosum is a rarer but more serious condition that can develop around stomas. It starts as a small bump that might look like a spider bite, then rapidly grows into a large, painful open sore with distinctive blue or purple edges. This is an immune-mediated condition, not an infection, and treating it like one can actually make it worse.
Color Changes That Signal Serious Problems
The stoma itself should stay reliably red or pink. Certain color changes point to problems with blood supply rather than infection, but they’re important to recognize because they require urgent attention.
A stoma that looks dark, dusky, or grayish has compromised blood flow. This can happen when the opening in the abdominal wall is too tight or when there’s too much tension on the bowel. Purple or black discoloration indicates tissue that isn’t getting enough blood and may be dying. This is a surgical emergency, not something to manage at home. If your stoma changes from its usual red or pink to any shade of gray, purple, or black, that needs same-day medical evaluation.
When Local Infection Becomes Systemic
Most stoma infections stay localized to the skin and respond well to treatment. But in some cases, bacteria can spread deeper, leading to abscess formation (a pocket of pus under the skin that feels like a firm, painful lump), wound breakdown, or systemic infection. Signs that an infection has moved beyond the skin include fever, chills, increasing pain that doesn’t respond to your usual care, red streaks radiating outward from the stoma site, and feeling generally unwell. Severe infections can progress to sepsis, which is a medical emergency.
People with ileostomies face an additional challenge. The output from an ileostomy is watery and contains digestive enzymes that are highly irritating to skin. This means any break in the skin barrier, whether from infection or irritation, can escalate quickly because the output keeps damaging the exposed area. Keeping the skin intact and the pouch sealed is especially critical with an ileostomy.
Checking Your Stoma Systematically
Healthcare professionals use standardized scoring systems to track peristomal skin health over time. The most widely used are the DET score (which evaluates discoloration, erosion, and tissue overgrowth) and the ABCD-Stoma score. You don’t need to learn these systems formally, but the categories they assess give you a useful framework for your own checks during each pouch change.
- Discoloration: Is the surrounding skin its normal color, or is there new redness, darkening, or pale patches?
- Erosion: Are there any raw, broken, or weeping areas on the skin?
- Tissue changes: Do you see any new bumps, raised areas, blisters, or overgrown tissue?
- Discharge: Has the color, consistency, or smell of any mucus or drainage changed?
- Stoma color: Is the stoma still its usual red or pink, or has it shifted toward pale, dark, or gray?
Taking a photo of your stoma at each pouch change gives you a visual record that makes it much easier to notice gradual changes. It’s also invaluable if you need to describe the problem to a nurse or doctor remotely.