Wound ostomy refers to a specialized area of healthcare focused on two related but distinct needs: caring for complex wounds and managing ostomies, which are surgically created openings in the body. The term is most commonly encountered as part of “wound, ostomy, and continence” (WOC) care, a nursing specialty recognized by the American Nurses Association in 2010. Roughly 1 million people in the United States alone live with a urinary or fecal ostomy, and millions more require professional wound management for conditions like pressure injuries and diabetic ulcers.
What an Ostomy Actually Is
An ostomy is a surgical opening made through the abdominal wall to redirect the flow of stool or urine out of the body. Surgeons create this opening, called a stoma, by bringing a section of intestine (or in the case of urinary diversion, a small piece of intestine connected to the ureters) to the surface of the skin. The stoma connects to an external pouching system that collects waste. There is no voluntary control over output from a stoma, so the pouch does the work that the rectum or bladder previously handled.
The most common reason for ostomy surgery today is bowel cancer. Other conditions that may require one include inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease), fecal incontinence, familial polyposis syndromes, and severe traumatic injuries to the bowel or bladder. Some ostomies are temporary, created to protect a healing surgical connection further down the intestine, while others are permanent.
Three Main Types of Ostomies
The type of ostomy a person receives depends on which organ is being bypassed and where the opening is placed.
- Colostomy: A portion of the large intestine is brought to the skin surface, typically on the left side of the abdomen. Output ranges from loose and watery (when the stoma is higher up in the colon) to soft or even firm (when it comes from the lower sigmoid colon). This is the most recognizable type of ostomy.
- Ileostomy: The lowest part of the small intestine is brought to the skin, usually on the right side. Because food hasn’t passed through the large intestine, output is consistently loose and more frequent. There is no control over gas or stool flow.
- Urostomy: A small piece of intestine is used to create a channel that redirects urine from the kidneys to the skin surface, bypassing the bladder entirely. Urine flows continuously into the pouch.
The Wound Care Side
The “wound” in wound ostomy covers a broad range of skin and tissue injuries that require specialized assessment and treatment plans. WOC nurses and wound care specialists manage pressure injuries (sometimes still called bedsores or pressure ulcers), which are classified into stages based on depth. A Stage 1 injury involves intact but reddened skin, while a Stage 4 injury extends deep enough to expose muscle or bone. There are also “unstageable” wounds covered by dead tissue and deep tissue pressure injuries where damage starts beneath the surface before becoming visible.
Beyond pressure injuries, wound care encompasses diabetic foot ulcers, venous leg ulcers caused by poor circulation, skin tears, moisture-associated skin damage, and complex surgical wounds that aren’t healing normally. Wound care specialists assess what’s preventing healing, select appropriate dressings and treatments, and monitor progress over time. Much of this work overlaps with ostomy care because people with ostomies frequently develop skin problems around their stoma.
Peristomal Skin Complications
Skin problems around the stoma are extremely common. The most frequent issue is peristomal contact dermatitis, which shows up as redness, irritation, and sometimes blistering or raw skin caused by repeated exposure to stool or urine leaking under the adhesive barrier. Studies report this type of skin damage in anywhere from 17% to over 90% of ostomy patients, depending on the population studied. It often appears within the second or third week after surgery.
Other complications include moisture-associated skin damage (affecting roughly half of patients in some studies), mechanical injury from repeatedly removing adhesive barriers, fungal infections, and folliculitis. More rarely, a condition called peristomal pyoderma gangrenosum can cause deep, painful ulcers around the stoma. These skin issues are a major reason why specialized wound and ostomy care exists as a combined discipline: the same principles of skin protection, moisture management, and barrier selection apply to both.
How Ostomy Pouching Systems Work
Every ostomy pouching system has two basic components: an odor-proof bag that collects output and an adhesive skin barrier (sometimes called a wafer) that attaches to the skin around the stoma. These come in one-piece systems, where the bag and barrier are permanently connected, and two-piece systems, where the barrier stays on the skin and the bag snaps or clicks onto a flange built into the barrier. Two-piece systems let you change the bag without removing the adhesive from your skin each time.
Skin barriers come in several configurations. Cut-to-fit barriers let you trim the opening to match an irregularly shaped stoma. Pre-sized barriers come with a round opening already cut. Convex barriers curve outward to help push surrounding skin down and the stoma up, which is useful when a stoma sits flush with or below the skin surface. Flat barriers work best when the stoma protrudes clearly and the surrounding skin is smooth. Pouches themselves are either drainable (with a clip or closure at the bottom for emptying) or closed-end (designed to be removed and thrown away when full).
Daily Ostomy Care Basics
Managing an ostomy involves two main tasks: emptying the pouch and changing the entire pouching system. You should empty the pouch when it’s about half full, which for most people means one to three times per day. Letting it get too full increases the risk of leaks and makes the pouch heavy enough to pull away from the skin. You simply unclip the bottom, drain the contents into the toilet, wipe the opening clean, and reclamp.
The full pouching system needs to be changed about once a week. This means gently removing the old barrier (adhesive remover helps), washing and drying the skin around the stoma, and fitting a new barrier. To get the right fit, you press the barrier against the stoma to create an outline, then cut the opening to match. A ring of ostomy paste around the opening helps seal gaps and protect exposed skin. After the barrier is in place, you attach the pouch and secure the bottom closure. Learning this process is one of the most important parts of recovery after ostomy surgery, and WOC nurses typically guide patients through it step by step before they leave the hospital.
Who Provides Wound Ostomy Care
The professionals most associated with this field are Wound, Ostomy, and Continence (WOC) nurses, sometimes called enterostomal therapy nurses. To earn board certification, a nurse must graduate from an accredited WOC nursing education program and complete at least 1,500 hours of specialty-specific clinical practice within the previous five years. An alternative experiential pathway exists for nurses who have gained expertise through years of hands-on practice and continuing education rather than a formal WOC program.
These nurses work across virtually every healthcare setting: hospitals, outpatient clinics, long-term care facilities, home health agencies, and private practice. Their role spans preoperative stoma site marking (choosing the best location on the abdomen for a stoma before surgery), postoperative education, ongoing skin and wound assessment, product selection, and helping patients adapt to life with an ostomy. The “continence” part of their title adds a third specialty, covering bladder and bowel dysfunction unrelated to ostomies, which is why you’ll see the full abbreviation WOC rather than just wound ostomy in most clinical settings.