Complications of an Ostomy: Medical Guide to Recognising and Treating Problems 2026

Ostomy complications are alterations of the stoma or surrounding skin that can appear at any time — from the first days after surgery to years later. Although they're frequent (affecting 20-70% of ostomates at some point), most are preventable, manageable, and treatable when recognised in time.

This guide helps you identify the most common complications, distinguish which require urgent medical attention from those you can manage at home with your stoma nurse's support.

Types of Ostomy 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 that protrudes).
Peristomal skin complications (the area around the stoma).
Systemic complications (dehydration, electrolyte deficiencies).

Stoma Complications

Parastomal hernia

Parastomal hernia is one of the most frequent complications (affecting 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 or pain; difficulty for the baseplate to seal; frequent leaks.

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

Stoma prolapse

Prolapse is excessive protrusion of intestine through the stoma. Can range from a few centimetres to 20 cm. More frequent in transverse colostomies and children.

Symptoms: the stoma appears "elongated" or longer than normal; colour change (pink = normal; bluish/dark = ischaemia → URGENT).

Management: if pink, you can try gentle manual reduction with cold compresses and clean hands. If dark or painful, go to A&E immediately.

Stoma stenosis

Stenosis is narrowing of the stoma orifice, hindering stool passage.

Symptoms: ribbon-thin stools, painful evacuation, abdominal distension, vomiting in severe cases.

Treatment: digital dilations by stoma nurse. Severe stenosis may require reconstructive surgery.

Stoma retraction

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

Consequences: constant leaks (baseplate can't seal on a concave surface), severe dermatitis.

Solution: convex baseplates that press around the stoma to make it protrude. Barrier rings or paste to fill irregularities. Severe cases may need surgical revision.

Ischaemia and necrosis

Loss of blood supply to the stoma. MEDICAL EMERGENCY.

Symptoms: stoma changes from pink to purple, dark brown, or black. Fragility. Foul odour.

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

Peristomal Skin Complications

Irritant contact dermatitis

The most common complication. Cause: contact of output (stool or urine) with skin due to leaks, poor baseplate fit, or infrequent changes.

Symptoms: red, irritated, painful skin, sometimes with superficial erosions. Can be partial or circumferential.

Prevention and treatment:

Adjust baseplate opening to stoma size (1-2 mm margin).
Change baseplate before it fails.
Clean skin with warm water and pat dry (no perfumed soap).
Use specific barrier powder (not regular talc).
Consider convex baseplates if stoma is flat.

Allergic contact dermatitis

Allergic reaction to adhesive, plastic, or product component.

Symptoms: red, inflamed skin, itching, blisters. The redness shape exactly matches the adhesive shape.

Treatment: change brand/material. Your stoma nurse can request samples of hypoallergenic products.

Folliculitis

Hair follicle infection from pulling hair when removing the baseplate.

Prevention: trim hair with scissors (NEVER shave — irritates) and remove baseplate slowly with adhesive remover.

Peristomal granulomas

Small reddish, sometimes bleeding outgrowths around the stoma. Caused by chronic irritation.

Treatment: silver nitrate applied by the stoma nurse. Resistant cases: electrocoagulation.

Bacterial or fungal infection

Especially Candida albicans (yeast) in moist areas. Symptoms: intense redness, itching, satellite lesions.

Treatment: topical antifungals (nystatin powder) or antibiotics depending on the agent.

Systemic Complications

Dehydration

Especially in ileostomy. When output exceeds 1,500 ml/day for several days, there's serious risk.

Symptoms: scant dark urine, intense thirst, fatigue, muscle cramps, dizziness, tachycardia.

Prevention: 2.5-3 litres/day of fluids, isotonic drinks, sodium-containing diet.

Severe dehydration: go to A&E for IV fluid therapy.

Vitamin and mineral deficiencies

After ileostomy with extensive resection, possible:

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

Bowel obstruction

Blockage of intestinal content passage. Causes: whole fibrous foods, postoperative adhesions, strangulated hernia.

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

MEDICAL EMERGENCY — go to A&E immediately.

When to Seek Emergency Medical Care

Go to A&E immediately if you have:

🚨 Stoma turning purple, black, or very dark (ischaemia).
🚨 Profuse bleeding from stoma or skin.
🚨 Output stopped for more than 12 hours + pain + vomiting (obstruction).
🚨 Fever above 38°C with abdominal or peristomal pain.
🚨 Hernia changing colour or not reducing (strangulation).
🚨 Severe dehydration signs (intense dizziness, no urine output).
🚨 Very large or colour-changing prolapse.

When to Consult Your Stoma Nurse (Non-Urgent)

Frequent leaks you can't control.
Persistently red, irritated, or painful skin.
Stoma changing in size or shape.
New granulomas or lesions around the stoma.
Questions about products, diet, or daily care.
Parastomal hernia without urgency signs (planning belt or surgical referral).

How to Prevent Complications

Rigorous daily care

Change baseplate before it fails (don't wait for it to lift).
Clean with water and gentle drying at every change.
Exact opening adjustment to stoma size.
Visual inspection of skin and stoma at every change.

Appropriate products

Baseplates adapted to stoma type (flat, convex).
Abdominal support belt for those at hernia risk (obesity, physical effort, chronic cough).
Stoma protector to avoid bumps and crushing during sleep or sport.
Barrier rings and powder for sensitive skin.

Lifestyle

Abundant hydration (especially ileostomy).
Varied diet with slow chewing.
Avoid foods you know cause problems with your stoma.
Moderate physical exercise to maintain abdominal tone and prevent hernia.
Body weight control.
Don't smoke (tobacco worsens healing and vascularisation).

Scheduled reviews

Annual visit with colorectal surgeon to review evolution.
Stoma nurse review every 6 months for the first 2 years.
Annual blood tests: full blood count, kidney function, electrolytes, B12 (in ileostomy).

FAQ — Ostomy Complications

Is it normal for my stoma to bleed slightly when cleaning?

Yes, minimal bleeding during cleaning is normal because the stoma mucosa is highly vascularised. If it bleeds heavily, with clots, or without touching, consult your stoma nurse.

Can I exercise with a parastomal hernia?

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

Will irritated skin around my stoma heal on its own?

If you eliminate the cause (better baseplate fit, change before failure, hypoallergenic product), skin heals in 7-14 days. If persistent more than 2 weeks, consult your stoma nurse — could be allergic dermatitis or infection.

Can a parastomal hernia become dangerous?

Most are benign and manageable with a belt. It's dangerous when strangulated (intestine trapped, losing blood supply) — symptoms: severe pain, output stopped, hard painful hernia not reducing. This is a surgical emergency.

Can complications appear years after surgery?

Yes. Parastomal hernia and dermatitis can appear years later. That's why periodic reviews and adapted products throughout your life with an ostomy are important.

Do complications affect life expectancy?

Most don't if treated in time. The only ones that can be serious are acute ischaemia/necrosis and bowel obstruction with strangulation, both surgical emergencies.

SIIL Products to Prevent Complications

At SIIL Ostomy we design products specifically to reduce the risk of the most common complications:

The ostomy belt offers continuous abdominal support, prevents parastomal hernia, and reduces leaks by 92% according to our data.
The stoma protector prevents accidental bumps causing trauma and stoma bleeding.
Adaptive garments distribute pressure uniformly, avoiding localised irritation.

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