Bleeding from a stoma is a common concern for people living with an ostomy. The stoma is a surgically created opening on the abdomen, bringing the end of the intestinal or urinary tract through the abdominal wall. This tissue is highly vascular, similar to the lining inside the mouth, meaning it has a rich supply of blood vessels close to the surface. Because of this, minor contact or friction can easily cause slight bleeding or spotting. While a small amount of blood is often benign, any bleeding should be examined to determine its source and extent.
Identifying Common Causes of Stoma Bleeding
The most frequent cause of blood appearing on or around the stoma is mechanical irritation. The stoma tissue’s delicate mucosal lining can bleed from simple contact, such as during routine cleaning or changing the pouching system. This minor spotting is generally not serious and often stops quickly.
Friction caused by the ostomy appliance is another common source of bleeding. If the opening in the skin barrier is cut too small, it can rub against the stoma, causing abrasions and light bleeding at the edges. Conversely, an opening that is too large allows output to leak onto the surrounding skin, causing irritation that may also lead to bleeding.
Small, red, raised growths known as granulomas can also cause bleeding. These benign tissue overgrowths usually form where the stoma meets the skin, often in response to friction or chronic irritation from effluent contact. Granulomas are fragile and may bleed easily when touched or during pouch changes. Finally, systemic factors, such as the use of blood-thinning medications like aspirin or warfarin, can increase the likelihood of minor bleeding.
Immediate Steps for Managing Minor Bleeding
When minor bleeding occurs, first assess the amount and precise location of the blood. Minor bleeding is defined as spotting or light oozing, usually originating from the stoma edges or surrounding skin, and is manageable at home. Gently clean the area using warm water and a soft cloth, avoiding harsh soaps or vigorous scrubbing.
Apply gentle, direct pressure to the bleeding site using a soft, dry compress, such as gauze or a clean wipe. Maintain this light pressure continuously for five to ten minutes without lifting the compress to check the site. This sustained pressure is often sufficient to constrict the small blood vessels and stop the superficial bleeding.
If the bleeding is minor but persistent, examine your pouching system for proper fit. Localized bleeding often results from a flange opening that is rubbing the stoma or a gap allowing irritating output to contact the skin. Adjusting the barrier opening to fit snugly around the stoma—ideally leaving a 1–2 millimeter gap—can prevent future friction. If the bleeding originated from a granuloma, consult an ostomy nurse for long-term treatment options, such as the application of silver nitrate.
Warning Signs Requiring Professional Medical Attention
While most stoma bleeding is minor, certain signs indicate a need for immediate medical consultation. Contact your ostomy nurse or general practitioner if the bleeding does not stop after applying gentle pressure for ten minutes. Bleeding that is heavy, continuous, or spurting requires urgent medical attention, potentially indicating a larger internal issue.
Note the nature of the blood within the pouch. A significant amount of blood mixed heavily with the stoma output may signal bleeding deeper within the intestinal tract, which is a serious concern, particularly for those with colostomies or ileostomies. For a urostomy, blood in the pouch may suggest a urinary tract infection or other complication.
Systemic symptoms accompanying stoma bleeding also warrant professional evaluation. These include severe abdominal pain, persistent nausea, or vomiting, which can be signs of a bowel obstruction. Signs of infection, such as fever, excessive stoma swelling, warmth, unusual discharge, or a foul odor, require prompt assessment. Any change in the stoma color to dark red, blue, or black indicates a compromised blood supply and requires immediate emergency care.