Colostomy - Possible complications of a colostomy

It's important to be aware of the possible problems you may experience after a colostomy.

Rectal discharge

People who have a colostomy, but have an intact rectum and anus, often experience a discharge of mucus from their rectum. Mucus is produced by the lining of the bowel to help the passage of stools.

The lining of the bowel continues to produce mucus, even though it no longer serves any purpose. The longer the length of the remaining section of your bowel, the more likely you are to experience rectal discharge.

The mucus can vary, from a clear "egg white" to a sticky, glue-like consistency. If there's blood or pus in the discharge, contact your GP, because it may be a sign of infection or tissue damage.

Managing the discharge

The mucus can either leak out of your rectum and anus or build up into a ball, which can become uncomfortable.

The pattern of rectal discharge varies in each individual. Some people experience episodes every few weeks, while others experience several episodes a day.

Many people find that the most effective method of managing rectal discharge is to sit on the toilet each day and push down as if passing a stool. This should remove any mucus located in the rectum and prevent it building into a ball.

However, some people find this hard to do, because surgery has reduced the sensation in their rectum. If this is the case, contact your GP, because you may need further treatment.

Glycerine suppositories (which you insert into your bottom) can often help. When the capsules dissolve, they make the mucus more watery, so it's easier to get rid of.

In some cases, the mucus can irritate the skin around the anus. Using a barrier skin cream should help. You may need to try a few before you find one that works for you. Your pharmacist can advise on the different creams available.

Some people have reported that eating certain foods increases the production of mucus. While there's no scientific evidence to support this, you may want to consider keeping a food diary for a few weeks to see if certain foods could be linked to an increase in mucus production.

Parastomal hernia

A hernia occurs when an internal part of the body, such as an organ, pushes through a weakness in the muscle or surrounding tissue wall.

In cases of parastomal hernia, the intestines push through the muscles around the stoma, resulting in a noticeable bulge under the skin. People with colostomies have an increased risk of developing parastomal hernias, because the muscles in their abdomen have been weakened during surgery.

Ways of preventing a parastomal hernia include:

  • wearing a support belt or underwear
  • avoiding heavy lifting and straining
  • maintaining a healthy weight, because being overweight can place additional strain on your abdominal muscles

A parastomal hernia isn't usually painful, but it may be more difficult to hold the colostomy appliance in place and change it.

Most hernias can be managed without the need for surgery, with advice and support from your stoma care nurse. In some cases, surgery may be required to repair the hernia. However, even after surgery, the hernia can reoccur.

Stoma blockage

Some people develop a blockage in their stoma because of a build-up of food. Signs of a blockage can include:

  • not passing many stools, or passing watery stools
  • bloating and swelling in your abdomen (tummy)
  • tummy cramps
  • a swollen stoma
  • nausea and/or vomiting

If you think your stoma is obstructed, it's recommended that you:

  • avoid eating solid food for the time being
  • drink plenty of fluids
  • massage your tummy and the area around your stoma
  • lie on your back, pull your knees up to your chest and roll from side to side for a few minutes
  • take a hot bath for 15-20 minutes (to help relax the muscles in your tummy)

However, if there's no improvement within two hours and you've tried these steps, you should immediately contact your GP or stoma nurse for advice, or visit your local Accident and Emergency (A&E) department, because there's a risk your colon could burst (rupture).

Find your local A&E department.

You can reduce your chances of developing a stoma blockage by chewing your food slowly and thoroughly, keeping hydrated, and not eating large amounts of food at one time.

You should also try to avoid foods known to cause blockage problems, such as corn, celery, popcorn, nuts, coleslaw, coconut macaroons, grapefruit, Chinese vegetables such as bamboo shoots and water chestnuts, raisins, dried fruit, potato skins, apple skins and orange rinds.

Other complications

A number of other complications can occur after a colostomy, such as:

  • skin problems‐ where the skin around the stoma becomes irritated and sore; your stoma care team will explain how to manage this
  • stomal fistula‐ where a small channel develops in the skin alongside the stoma; depending on the position of the fistula, appropriate bags and good skin management may be all that's needed to treat this problem
  • stoma retraction‐ where the stoma sinks below the level of the skin after the initial swelling goes down, which can lead to leakages, because it can be difficult for colostomy bags to form a good seal; different types of pouches and appliances can help ease this problem, although further surgery may sometimes be needed to correct it
  • stoma prolapse‐ where the stoma comes out too far above the level of the skin; using a different type of colostomy bag can sometimes ease this problem if the prolapse is small, although further surgery may be required
  • stomal stricture (stenosis)‐ where the stoma becomes scarred and narrowed; further surgery may be needed to correct it if there's a risk of blockage
  • leakage‐ where digestive waste leaks from the colon onto the surrounding skin or within the abdomen; trying different bags and appliances may help an external leak, but further surgery may be needed if the leak is internal
  • stomal ischaemia‐ where the blood supply to the stoma is reduced after surgery; this may require further surgery to correct

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