Stoma Bleeding: What’s Normal, What’s Not and What to Do

Is stoma bleeding normal?

Usually, yes. A stoma is the lining of your bowel turned outwards, and that lining is packed with tiny blood vessels sitting very close to the surface.

It also has no pain-sensing nerves, so you won't feel it when something rubs it. That's why a few spots of blood on the wipe when you clean, or a small red streak on the inside of the barrier, are so common, and why they are rarely a sign of anything serious. This kind of surface bleeding should stop on its own, or with gentle pressure, within a few minutes.

What matters is how much, where it's coming from and whether it stops. This quick check helps you decide what to do:

• Usually normalA few spots when you clean or change the pouch, from the surface of the stoma, that stop within minutes.
• Call your stoma nurseBleeding that keeps coming back, comes from a bump at the edge or from sore skin, or is new since you started a blood thinner.
• Get urgent helpBleeding that won't stop after 10 to 15 minutes of pressure, blood filling the pouch, black or tarry output, or feeling faint.

Where is the blood coming from?

"Bleeding" covers a few very different things. Take a calm look before you decide what to do, because the source tells you most of what you need to know.

One more thing before you worry: beetroot, red drinks, red sweets and some medicines can turn output red, and iron tablets can make it very dark. If the "blood" appeared a few hours after a beetroot salad, that's probably all it is. Our stoma color guide explains what each shade of stoma and output usually means.

My stoma is bleeding: what should I do right now?

For the everyday kind of stoma bleeding, these steps are usually all you need.

1. Pause and breathe

   Sit or lie down somewhere comfortable. A little blood looks like a lot on white tissue.

2. Press gently

   Hold a soft, clean, damp cloth or gauze against the spot for 5 to 10 minutes. Press, don't rub.

3. Cool it

   A cold compress, or ice wrapped in a cloth, for a few minutes helps the tiny vessels close. Never put ice directly on the stoma.

4. Find the cause

   Check the barrier opening, the edge of the stoma, your waistband and anything that might have knocked it.

5. Refit

   Once it has stopped, pat dry and apply a fresh pouch, with the opening cut about 1/8 inch (2 to 3 mm) larger than the stoma.

6. Make a note

   When it happened, roughly how much, and what you were doing. It helps your nurse spot a pattern.

Why does my stoma bleed? The usual causes

1. Cleaning a little too enthusiastically

Rough paper towels, scrubbing or textured wipes can make the surface bleed. Warm water and soft, lint-free wipes, used with a dabbing motion, are all you need.

2. A barrier opening that's too small or off-center

If the edge of the barrier presses on the stoma, it can rub every time you move. Stomas change size, especially in the first 6 to 8 weeks, so re-measure and recut regularly.

3. Rubbing from clothes, belts and seatbelts

A waistband sitting right across the stoma, a belt pulled tight over it, a seatbelt, a toddler on your lap or contact sport can all rub or bump it. High-waisted styles that sit above the stoma, and a stoma guard for knocks, take the pressure off.

Protection from knocksA stoma guard that takes the hit for youA slim, curved shield that sits over the pouch under your clothes, so seatbelts, sports, hugs and toddlers press on the guard, not on your stoma. It works with any ostomy bag.Discover the SIIL stoma guard →

4. Bleeding around the edge, often from granulomas

Granulomas are small, raised, red bumps of extra healing tissue where the stoma meets the skin. They bleed easily and can sting. They're common and usually simple for your stoma nurse to treat, and a better-fitting barrier helps stop them coming back.

5. A stoma that has become longer

If part of the bowel pushes further out, as in a prolapsed stoma, it can rub against the inside of the pouch and bleed. A roomier pouch helps, and your nurse should take a look.

6. Blood thinners and some treatments

Anticoagulants, aspirin and treatments that lower your platelets, such as some chemotherapy, make bleeding more likely and slower to stop. Tell your care team you have a stoma whenever a new medicine is started.

7. Bleeding from further up the bowel

Blood mixed into the output, rather than on the surface, can come from inflammation such as an inflammatory bowel disease flare, an infection, polyps or other bowel conditions. It always deserves a call to your doctor.

8. Swollen veins around the stoma (less common)

In people with certain liver conditions, veins around the stoma can swell and bleed heavily. If you have liver disease and notice bleeding around your stoma, treat it as urgent.

When does stoma bleeding need a doctor?

If you're not sure which list you're on, call your stoma nurse or doctor anyway. Nobody minds a call about bleeding, and a quick conversation is usually all it takes to put your mind at rest. For a broader look at problems to watch for, read our guide to complications of an ostomy.

How to prevent stoma bleeding

Most bleeding comes down to friction. Reduce the rubbing and you'll see much less of it.

• Clean with warm water and soft, lint-free wipes. Dab, don't scrub.
• Measure the stoma and cut the opening about 1/8 inch (2 to 3 mm) bigger.
• Use an adhesive remover and peel the barrier off slowly, top to bottom.
• Wear waistbands above or below the stoma, never pressing across it.
• Protect the stoma from seatbelts, sport and little ones with a stoma guard.
• Choose a pouch with enough room if your stoma is long or changes size.
• Ask your nurse to treat bumps at the edge early, before they get bigger.

Getting on with life after a scare

Most people have a small bleed now and then, especially in the first year, and it rarely means anything more than a bit of friction. Once you know what's normal for your stoma, a few spots on a wipe stop being frightening.

Keep doing the things you love. If you play sport, carry children or drive a lot, protecting the stoma from knocks and holding the pouch steady are the two habits that make the biggest difference. Many people pair a stoma guard with a supportive ostomy belt or high-waisted ostomy underwear, so nothing shifts or rubs when they move.

Stoma bleeding: quick answers