Examination of a Stoma

Original Author: Mike Bath
Last Updated: September 25, 2016
Revisions: 9

A stoma is a surgically created opening into a hollow organ. It is usually covered by a removable pouching system that collects the output for disposal.

Common examples include a colostomy (opening into large bowel), ileostomy (ileum), and urostomy (urinary system).

In this article, we shall look at how to perform an examination of a stoma.

Fig 1 - Example of a stoma. A colostomy can be used after part of the bowel has been removed.

Fig 1 – Example of a stoma. A colostomy can be used after part of the bowel has been removed.


Introduction

  • Introduce yourself to the patient
  • Wash your hands
  • Briefly explain to the patient what the examination involves and ask their permission to examine them
  • Position the patient at 45o

Before starting any examination of a stoma, ask the patient if they have any pain in their abdomen and if they have had any problems with their stoma (such as pain around the stoma or a change in output).


Inspection

Ask the patient to fully expose their stoma site. You should ask the patient if they would be able to remove their stoma bag.

Most of the examination of a stoma comes from inspection, in which you should be commenting on the:

  • Site
    • If situated in the left iliac fossa, it is probably (but not necessarily) a colostomy.
    • If situated in the right iliac fossa, it is probably (but not necessarily) an ileostomy.
  • Spout
    • A spouted stoma will be an ileostomy (or urostomy) as small bowel contents are an irritant to the skin, whereas a stoma flush with the skin will be a colostomy.
  • Consistency
    • Colostomy output is generally thick and sludgy (like faeces), whereas an ileostomy is waterier and often greener. A urostomy will produce urine.
  • Number of lumens
    • Loop stomas will have two lumens.
    • End stomas will have one lumen.

Also observe for any potential common complications of a stoma, such as parastomal hernia (specially colostomies), prolapse, retraction, or infarction. Any bowel infarction will result in the stoma turning jet black

Fig 2 - An ileostomy is situated on the right side of the abdomen, and has a spouted opening.

Fig 2 – An ileostomy is situated on the right side of the abdomen, and has a spouted opening.


Palpation

  • Gently feel around the stoma site for any tenderness.
  • Ask the patient to cough and feel for a cough impulse for any obvious parastomal hernia.

Completing the Examination

Remember, if you have forgotten something important, you can go back and complete this.

To finish the examination, stand back from the patient and state to the examiner that to complete your examination, you would like to perform a full GI examination.

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