Complications of a Stoma UK: Medical Guide to Recognising and Treating Problems 2026

Stoma complications are alterations of the stoma or surrounding skin that can appear at any time — from the first days after NHS surgery to years later. Although they affect 20-70% of UK ostomates at some point, most are preventable, manageable, and treatable when recognised in time.

This UK-focused guide helps you identify the most common complications, distinguish which require A&E attention from those you can manage with your stoma nurse's support — including referrals through the NHS pathway and your DAC (Dispensing Appliance Contractor).

Types of Stoma Complications

By time of appearance

Early complications (first 30 postoperative days): bleeding, ischaemia, retraction, dehiscence, peristomal infection.
Late complications (after 30 days): parastomal hernia, prolapse, stenosis, dermatitis, granulomas, chronic leakage.

By location

Stoma complications (the pink mucosa).
Peristomal skin complications (around the stoma).
Systemic complications (dehydration, electrolyte deficiencies).

Stoma Complications

Parastomal hernia

Parastomal hernia affects 30-50% of permanent colostomies at 10 years. It appears when intestine or abdominal fat protrudes around the stoma due to abdominal wall weakness.

Symptoms: bulging around the stoma, especially when coughing or standing; discomfort; baseplate sealing difficulty; frequent leaks.

Treatment: a hernia support belt resolves symptoms in many cases. NHS surgery only if there's risk of obstruction or strangulation.

Stoma prolapse

Excessive protrusion of intestine. More frequent in transverse colostomies and children.

Symptoms: stoma appears "elongated"; colour change (pink = normal; bluish/dark = ischaemia → URGENT 999/A&E).

Management: if pink, gentle manual reduction with cold compresses. If dark or painful, A&E immediately.

Stoma stenosis

Narrowing of the stoma orifice.

Symptoms: ribbon-thin stools, painful evacuation, abdominal distension.

Treatment: digital dilations by stoma nurse. Severe stenosis may need NHS reconstructive surgery referral.

Stoma retraction

The stoma sinks below skin level. Causes: weight gain, poor healing, suture tension.

Solution: convex baseplates (available on NHS prescription via your DAC), barrier rings, paste. Severe cases: surgical revision.

Ischaemia and necrosis

Loss of blood supply. MEDICAL EMERGENCY.

Symptoms: stoma turns purple, dark brown, or black. Foul odour.

Action: A&E immediately. May require revision surgery.

Peristomal Skin Complications

Irritant contact dermatitis

The most common complication. Cause: output contact with skin due to leaks, poor fit, or infrequent changes.

Prevention and treatment:

Adjust baseplate opening to stoma size (1-2 mm margin).
Change baseplate before it fails.
Clean with warm water and pat dry (no perfumed soap).
Specific barrier powder (NHS prescribable).
Convex baseplates if stoma is flat.

Allergic contact dermatitis

Allergic reaction to adhesive. Redness shape exactly matches the adhesive shape.

Treatment: change brand. Your stoma nurse can request samples from your DAC of hypoallergenic options (Coloplast SenSura Mio, Hollister CeraPlus, ConvaTec Esteem).

Folliculitis, granulomas, fungal infection

Folliculitis: trim hair with scissors (NEVER shave) and use adhesive remover.
Granulomas: silver nitrate by stoma nurse.
Fungal (Candida): nystatin powder topically.

Systemic Complications

Dehydration

Especially in ileostomy. Output exceeding 1,500 ml/day for several days = serious risk.

Prevention: 2.5-3 litres/day, isotonic drinks (Diorolyte, Lucozade Sport), sodium-containing diet.

Severe dehydration: A&E for IV fluid therapy.

Vitamin and mineral deficiencies

After ileostomy with extensive resection:

Vitamin B12 deficiency (NHS injectable supplementation).
Magnesium deficiency (oral supplementation).
Iron deficiency (periodic GP monitoring).

Bowel obstruction

Causes: whole fibrous foods, postoperative adhesions, strangulated hernia.

Symptoms: severe pain, output stopped, vomiting, distension.

MEDICAL EMERGENCY — A&E immediately.

When to Seek Emergency Care (A&E)

🚨 Stoma turning purple, black, or very dark.
🚨 Profuse bleeding from stoma or skin.
🚨 Output stopped >12 hours + pain + vomiting.
🚨 Fever above 38°C with abdominal/peristomal pain.
🚨 Hernia changing colour or not reducing.
🚨 Severe dehydration signs.
🚨 Very large or colour-changing prolapse.

When to Consult Your NHS Stoma Nurse (Non-Urgent)

Frequent leaks you can't control.
Persistently red, irritated, painful skin.
Stoma changing size or shape.
New granulomas or lesions.
Product, diet, or care questions.
Parastomal hernia without urgency signs.

How to Prevent Complications

Rigorous daily care

Change baseplate before it fails.
Clean with water and gentle drying.
Exact opening adjustment.
Visual inspection at every change.

Appropriate products

Baseplates adapted to stoma type — request samples through your DAC.
Abdominal support belt for those at hernia risk.
Stoma protector to avoid bumps and crushing.
Barrier rings and powder for sensitive skin (NHS prescribable).

Lifestyle

Abundant hydration.
Varied diet with slow chewing.
Avoid problem foods.
Moderate exercise to maintain abdominal tone.
Body weight control.
Don't smoke.

NHS scheduled reviews

Annual colorectal surgeon visit.
Stoma nurse review every 6 months (first 2 years).
Annual blood tests: FBC, U&Es, B12 (in ileostomy).

UK Resources & Support

Colostomy UK, Crohn's & Colitis UK, Ileostomy & Internal Pouch Association: support and information.
Your DAC (Fittleworth, Securicare, Pelican, Amcare, Respond): free home delivery, sample requests.
NHS stoma nurse specialist at your hospital.
SIIL Ostomy: adaptive products with UK delivery.

FAQ — Stoma Complications UK

Is mild stoma bleeding when cleaning normal?

Yes, minimal bleeding is normal because the stoma is highly vascularised. Heavy bleeding, clots, or spontaneous bleeding: contact your stoma nurse.

Can I exercise with a parastomal hernia?

Yes, with an abdominal support belt. Avoid extreme impact or maximum-weight lifting. Swimming, walking, parkrun, yoga, gentle cycling are safe.

Will irritated peristomal skin heal on its own?

Eliminate the cause and skin heals in 7-14 days. Persistent more than 2 weeks: stoma nurse review.

Can complications appear years later?

Yes. Parastomal hernia and dermatitis can appear years post-surgery. Periodic NHS reviews and adapted products throughout life are important.

Are support belts available on NHS prescription?

Some support belts are prescribable through your stoma nurse and DAC. SIIL belts can be purchased privately for additional comfort and discretion.

SIIL UK Products to Prevent Complications

The ostomy belt — continuous abdominal support, prevents hernia, reduces leaks 92%.
The stoma protector — prevents bumps and bag crushing.
Adaptive UK clothing — distributes pressure, prevents localised irritation.

Stoma complications are frequent but, in their vast majority, preventable and treatable. With NHS medical follow-up, adapted products, and knowledge, you can live your ostomy with security and peace of mind.