Colostomy - Complications of a colostomy

It's important to be aware of a number of problems you may experience after a colostomy is formed.

Some of these are outlined below.

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 a liquid produced by the lining of the bowel that acts as a lubricant, helping 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 is 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 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 help 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 you insert in your anus 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 about different creams available.

Some people have reported that eating certain foods increases the production of mucus. While there is 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 the production of mucus.

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

Parastomal hernias aren't usually painful, but they can make holding the colostomy appliance in place, and changing it, more difficult.

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 due to a build-up of food. Signs of a blockage can include:

reduced stool production, or passing watery stools
bloating and swelling in the abdomen (tummy)
tummy cramps
a swollen stoma
nausea and/or vomiting

If you suspect your stoma is obstructed, it is 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 is no improvement within two hours and you have tried these steps you should immediately contact your stoma nurse for advice or visit your local Accident and Emergency (A&E) department because there is a risk your colon could burst (rupture).

You can help reduce your chances of developing a blockage in your stoma by chewing your food slowly and thoroughly, keeping well hydrated and by 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

There are also a number of other complications that can occur after a colostomy is formed, such as:

skin problems – where the skin around the stoma becomes irritated and sore; your stoma care team will be able to offer advice about ways to manage this problem
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 is required 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 is 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