Stomal refers to anything related to a stoma, a surgically created opening on the surface of the body that connects to an organ inside. The word comes from the Latin “ostium,” meaning opening or mouth. Between 725,000 and 1 million people in the United States live with a stoma, and roughly 100,000 ostomy surgeries are performed each year.
Most people encounter the term in one of two contexts: either a digestive stoma (the most common type, where part of the intestine is brought through the abdominal wall) or a breathing stoma in the neck. Understanding what a stoma is, what the different types look like, and what stomal care involves can help whether you’re preparing for surgery, supporting someone who has one, or simply trying to make sense of a medical report.
Types of Stomas
A stoma can connect to several different organs depending on why it’s needed. The four main types are:
- Colostomy: Part of the colon (large intestine) is brought to the surface of the abdomen. Stool passes through this opening instead of the rectum. Surgeons create colostomies after removing a section of the colon, often due to cancer, diverticulitis, or injury.
- Ileostomy: The ileum (the last section of the small intestine) is brought to the abdominal surface. Because waste hasn’t yet passed through the colon, output tends to be more liquid than with a colostomy. Ileostomies are common in conditions like Crohn’s disease and ulcerative colitis.
- Urostomy: Part of the urinary tract is rerouted to a stoma on the abdomen, allowing urine to drain into an external pouch. This is typically done after bladder removal.
- Tracheostomy: A hole is made in the front of the neck into the windpipe. This type of stoma helps people breathe when the upper airway is blocked or when long-term ventilation is needed.
Intestinal stomas (colostomies and ileostomies) can be further classified as “end” or “loop.” In an end stoma, the bowel is divided and only the upstream portion is brought to the skin surface. In a loop stoma, a section of bowel is partially opened and stitched to the skin without fully dividing it. Loop stomas are often temporary, created to give a downstream surgical site time to heal before the bowel is reconnected.
What a Stoma Looks and Feels Like
An intestinal stoma appears as a small, round piece of pinkish-red tissue protruding slightly from the abdomen. It looks similar to the inside of your cheek. Healthy stoma tissue is moist, and its color should stay consistently pink to red. A stoma that turns very dark, pale, or grayish may not be getting enough blood flow, which needs prompt medical attention.
One important detail: the stoma itself has no nerve endings that sense pain. You can touch it without discomfort. The skin surrounding it, however, is fully sensitive, and that skin is where most day-to-day comfort issues arise.
Common Stomal Complications
Stomal complications are relatively common. A systematic review of clinical trials found that skin problems around the stoma (called peristomal skin complications) had the highest rate across all stoma types, affecting about 14% of patients. In a detailed survey of patients with skin issues, roughly 63% experienced dermatitis, 60% had itching or dry skin, and 35% developed ulceration around the stoma site.
Beyond skin problems, other complications include:
- Parastomal hernia: The bowel pushes through the abdominal wall muscle next to the stoma, creating a bulge. This is especially common with end colostomies, where the median incidence was as high as 59% in clinical studies. For loop ileostomies, it’s much rarer at around 2.4%.
- Stoma prolapse: The bowel telescopes outward through the stoma, making it noticeably longer. Loop colostomies have the highest prolapse rates at roughly 8%, while loop ileostomies rarely prolapse.
- Stoma retraction: The stoma pulls below skin level, making it difficult for pouching systems to seal properly. This occurs in about 3 to 5% of patients depending on stoma type.
Pouching Systems and Daily Care
Most intestinal and urinary stomas require an external pouch to collect waste. These appliances come in one-piece or two-piece designs. A two-piece system has a baseplate (also called a wafer) that adheres to the skin around the stoma and a detachable pouch that clips or snaps onto it. The baseplate acts as a barrier, protecting the surrounding skin from the digestive enzymes and acids in stool or urine.
Getting the right fit matters more than almost anything else in stoma care. The opening in the baseplate needs to match the size of your stoma closely. If the opening is too large, waste leaks onto exposed skin and causes irritation. If it’s too small, it can press against the stoma tissue. Each time you change the pouch or wafer, checking the stoma and surrounding skin for redness, moisture, or signs of breakdown helps catch problems early. Skin that looks red or wet usually means the seal isn’t holding.
Diet and Hydration With a Stoma
Food choices affect stomal function directly. Certain high-fiber and hard-to-digest foods, including nuts, popcorn, seeds, corn, coconut, dried fruit, and mushrooms, can physically block the stoma opening. This doesn’t mean these foods are permanently off limits for everyone, but they should be introduced cautiously and chewed thoroughly.
Dehydration is a particular concern for people with ileostomies. Because the colon is bypassed, the body loses its main site for reabsorbing water and electrolytes. Ileostomy output is already liquid, and anything that increases output (illness, heat, certain foods) can tip the balance quickly. Interestingly, drinking large amounts of plain water, tea, or coffee can actually worsen dehydration in ileostomy patients because these low-sodium fluids aren’t absorbed well without the colon. Oral rehydration solutions that contain sodium and glucose are generally more effective. Some guidelines suggest limiting plain water and similar drinks to 500 to 1,500 milliliters per day for people with high-output ileostomies, supplementing the rest with electrolyte-containing beverages.
Colostomy output tends to be more formed and closer to normal stool, so dietary adjustments are typically less dramatic. Still, paying attention to which foods cause gas, odor, or changes in consistency helps people manage their comfort and confidence in social situations.
Temporary vs. Permanent Stomas
Not all stomas are lifelong. Loop ileostomies, for instance, are frequently created as a temporary measure during colorectal surgery. Once the downstream bowel has healed (often after several weeks to months), a second, smaller surgery reconnects the intestine and closes the stoma. End colostomies created after emergency surgery may also be reversed, depending on the underlying condition and how well the remaining bowel has recovered.
Permanent stomas are more common when the rectum or anus has been entirely removed, or when the underlying disease makes reconnection unsafe. In either case, the daily management routine is the same. People with permanent stomas often find that the adjustment period lasts a few months, after which pouch changes and dietary awareness become routine.