Common intestinal stoma complaintsBMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2310 (Published 23 September 2021) Cite this as: BMJ 2021;374:n2310
- Catherine Strong, general surgery registrar,
- Julia Hall, specialist stoma nurse,
- George Wilson, patient author,
- Kate Carney, colorectal consultant
- Northumbria Healthcare Trust, Cramlington, UK
- Correspondence to: K Carney
What you need to know
The type of stoma may indicate the likelihood of a particular complication
Consider incomplete obstruction in patients with high output stomas
When a patient is at risk of dehydration from high output, advise drinking oral rehydration solutions instead of plain water, which can compound the problem
Avoid modified release medications if patients are experiencing high stoma output. Some capsules can be opened, some tablets may be crushed to allow for faster absorption—consult a pharmacist for assistance
Prolapsed stomas can be safely reduced in primary care settings and rarely need urgent referral
Removal of the stoma bag is essential to complete examination. Ask the patient to do this to reduce discomfort and always make sure they have a replacement bag
Approximately 100 000 people in the UK have an intestinal stoma,1 which are most commonly formed after surgery for cancer or inflammatory bowel disease (IBD). They can be described according to the part of the bowel (small or large) used to create the stoma and can be temporary (with potential for reversal at a later date) or permanent. Many different types of stoma exist (eg, nephrostomy, urostomy), but in this article we focus on common complaints associated with intestinal stomas that may lead patients to present to general practice.
How should I approach the examination?
Imagine a patient presenting to you in general practice with concerns about discomfort in their stoma. After a thorough history, you might examine them as follows:
Ask the patient whether the stoma has changed in appearance. Then, inspect the stoma looking specifically at whether it sits proud of the skin and if it is healthy, pink, and moist.
Consider digital examination of the stoma if you have concerns about function. This is an intimate examination, so good communication is essential. Ensure your patient has a replacement stoma bag and ask them to …