Stoma Infection Signs: What to Look Out For   

A stoma is an opening surgically created in a person’s stomach that allows waste to leave the body. A stoma might be necessary if the person can’t have bowel movements naturally due to disease or trauma.

If the stoma is permanent, it will require regular care and checkups. Unfortunately, infections are common for people with stomas.

What causes stoma infections?

Stoma infection can occur for a number of reasons, including:

1. Poor hygiene: Not cleaning the stoma well can cause bacterial growth and lead to infection.
2. Improper stoma care/routine: This includes incorrect changing of stoma appliances.
3. An immune system that doesn’t work as well as it should: People with weakened immune systems tend to be more likely to get infections.
4. Damage to the skin: Damaged or irritated skin around the stoma can cause bacteria to grow there more easily. 

Types of stoma infections

Stoma infections are divided into bacterial, fungal and viral infections. All kinds of infections require medical attention and can pose a serious danger to one’s health. Infected skin around the stoma can also affect  the ability of the barrier adhesive part of the ostomy appliance to stay in place and protect your skin from leakage.

Bacterial infections

Bacterial infections are the most common infection type for people with a stoma. Any damage to peristomal skin (also referred to as the skin around the stoma), can increase the likeliness of an infection. If you suspect you might have an infection ­– reach out to your healthcare provider as soon as possible. They will do a swab to confirm the presence of the infection. The most common bacterial infections are caused by staphylococcus aureus or streptococci or both entering through damaged skin².

Treatment may include medications to fight the infection (antibiotics).

Bacterial infections can cause complications, for example, folliculitis, an inflammation of the hair follicles, or boils (also called furuncles), hard painful lumps that fill with pus.

Fungal infections

Fungal (yeast) infections can affect the skin around the stoma. These infections are most common in areas of the body that trap moisture or have a lot of rubbing. Prolonged moisture and heat under the ostomy appliance is a common cause for fungal infections such as cutaneous candidiasis ^2,3. Fungal infections usually present as a red itchy rash. Diagnosis is usually determined by a physical examination and conversation about  your symptoms. Your doctor or stoma nurse may take a skin scraping to confirm the diagnosis and determine the type of fungus causing the infection. Topical antifungals, such as cream or powder, are usually prescribed.

Viral infections

Viral stoma infections are less common than the other two types. Causes of viral infections on the skin around the stoma include herpes zoster and herpes simplex, though it is rather uncommon.  

Signs of infected stoma

Recognizing the signs of a stoma infection is important for receiving quick treatment. The most common signs of a stoma infection include:

• Redness
• Swelling
• Pain around the stoma
• Burning sensation around the stoma
• Pus or discharge from the stoma
• Warmth around the stoma
• Unusual pain or soreness
• Changes to skin color around the stoma

When to contact your doctor

Big changes in the color of your stoma, including extreme paleness or darkening (also referred to as necrosis), can be a sign that the tissues are not receiving enough blood.

Another sign of an emergency is a severe case of cellulitis. Cellulitis is a common bacterial infection of the skin that can cause swelling, redness, swelling and pain in an infected area⁴. Most cases of cellulitis are not an emergency, however, if the area affected by redness, swelling, heat or pain is rapidly spreading, hardening, starting to go numb or you experience fever, nausea or vomiting, contact your healthcare provider urgently or go to the emergency room.

How to avoid a peristomal skin infection

Most stoma infections can be treated with antibiotics. However, treatment can be long and if your infection is severe you may need to be hospitalized.

Preventing stoma infections is preferable to treating them. Here are some of the things you can do to prevent a stoma infection:

1. Keep your stoma and surrounding area clean
2. Always wash your hands before touching the stoma
3. Change your stoma bag regularly. Consult your healthcare provider if you have questions about how often to change your stoma appliance.
4. Clean and rinse the skin around your stoma as recommended by your healthcare provider. Please visit self-assessment tool ARC (Apply-Remove-Check) for more details.
5. After washing, pat dry the skin and avoid rubbing
6. Eat a healthy diet[.
7. Avoid swimming in chlorinated pools  

Try wearing clothes that are loose around the stoma. This will help air get to the area.

A stoma infection can be serious, but with good self-care and education, it can often be prevented or treated effectively. Take all the steps above and check in with your healthcare provider on a regular basis.

References:

1. Stoma Infection Signs, Causes, Treatment, & Prevention. Ostomy Association of Boston. Retrieved from: Stoma Infection Signs, Causes, Treatment, & Prevention (bostonoab.org)
2. M. Kwiatt, M. Kawata. Avoidance and Management of Stomal Complications. Clinics in Colon and Rectal Surgery, 2013. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709920/#JR00596-51
3. B. Alvey, D. E. Beck. Peristomal dermatology. Clinics in Colon and Rectal Surgery, 2008. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780183/
4. N. Mahmoud. Diagnosis and treatment of peristomal skin conditions. Quality Medical Publishing; 2004. Retrieved from: https://www.researchgate.net/publication/279411890_Diagnosis_and_Treatment_of_Peristomal_Skin_Conditions