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Routine care of patients with an ileostomy or colostomy and management of ostomy complications

Ron G Landmann, MD
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


Ileostomy or colostomy creation may be required temporarily or permanently for the management of a variety of pathologic conditions, including congenital anomalies, colon obstruction, inflammatory bowel disease, intestinal trauma, or gastrointestinal malignancy [1]. Anatomic location and type of stoma construction have an impact on management. Loop colostomies tend to be larger and somewhat more difficult to manage than end colostomies. The type and volume of output (effluent), and therefore fluid loss, is determined by the location of the stoma relative to the ileocecal valve. Fluid loss is primarily a factor with end or loop ileostomies.

With proper stoma care and attention to nutrition and fluid management, most ostomy patients are able to have full, healthy, active social and professional lives, and normal sexual activity. In many cases, quality of life can be improved, even in the context of a permanent ostomy, with treatment of the underlying disease.

The routine care and management of common issues and complications of stoma creation are reviewed here. The types and indications, and principles of ostomy construction and reversal are discussed separately. (See "Overview of surgical ostomy for fecal diversion" and "Parastomal hernia".)


Patient preparation for adaptation to life with a temporary or permanent ostomy begins in the preoperative period, whenever possible. (See "Overview of surgical ostomy for fecal diversion", section on 'Preparation and counseling'.)

The patient must adapt to new patterns of fecal elimination and to their altered body and image of themselves. Successful adaptation requires the patient to master new skills and to deal effectively with the many emotional issues associated with their altered anatomy and with altered continence. Interventions that promote adaptation include:

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Literature review current through: Nov 2017. | This topic last updated: Feb 23, 2017.
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  1. Doughty D. Principles of ostomy management in the oncology patient. J Support Oncol 2005; 3:59.
  2. Salvadalena G, Hendren S, McKenna L, et al. WOCN Society and ASCRS Position Statement on Preoperative Stoma Site Marking for Patients Undergoing Colostomy or Ileostomy Surgery. J Wound Ostomy Continence Nurs 2015; 42:249.
  3. Piwonka MA, Merino JM. A multidimensional modeling of predictors influencing the adjustment to a colostomy. J Wound Ostomy Continence Nurs 1999; 26:298.
  4. White C. Ostomy adjustment. In: Fecal and Urinary Diversions: Management, Colwell, J, Goldberg, M, Carmel, J (Eds), Mosby, St. Louis 2004. p.326.
  5. Erwin-Toth P, Doughty D. Principles and procedures of stomal management. In: Ostomies and Continent Diversions: Nursing Management, Hampton, B, Bryant, R (Eds), Mosby, St. Louis 1992. p.29.
  6. Colwell JC, Goldberg M, Carmel J. The state of the standard diversion. J Wound Ostomy Continence Nurs 2001; 28:6.
  7. Bass EM, Del Pino A, Tan A, et al. Does preoperative stoma marking and education by the enterostomal therapist affect outcome? Dis Colon Rectum 1997; 40:440.
  8. Lyons AS. Ileostomy and colostomy support groups. Mt Sinai J Med 2001; 68:110.
  9. Nugent KP, Daniels P, Stewart B, et al. Quality of life in stoma patients. Dis Colon Rectum 1999; 42:1569.
  10. Haugen V, Bliss DZ, Savik K. Perioperative factors that affect long-term adjustment to an incontinent ostomy. J Wound Ostomy Continence Nurs 2006; 33:525.
  11. Colwell J. Principles of stoma management. In: Colwell, J, Goldberg, M, Carmel, J, Fecal and Urinary Diversions: Management Principles (Ed), Mosby, St. Louis 2004. p.240.
  12. Annells M. The experience of flatus incontinence from a bowel ostomy: a hermeneutic phenomenology. J Wound Ostomy Continence Nurs 2006; 33:518.
  13. Floruta CV. Dietary choices of people with ostomies. J Wound Ostomy Continence Nurs 2001; 28:28.
  14. McCann E. Routine assessment of the patient with an ostomy. In: Wound, Ostomy, and Continence Nursing Secrets, Milne C, Corbett I, Dubuc D (Eds), Hanley and Belfus, Philadelphia 2003.
  15. Carmel J, Goldberg M. Preoperative and postoperative management. In: Fecal and Urinary Diversions: Management Principles, Colwell, J, Goldberg, M, Carmel, J (Eds), Mosby, St. Louis 2004. p.207.
  16. Nagle D, Pare T, Keenan E, et al. Ileostomy pathway virtually eliminates readmissions for dehydration in new ostomates. Dis Colon Rectum 2012; 55:1266.
  17. Black P. Healthy eating. In: Holistic Stoma Care, Bailliere Tindall, 2000. p.177.
  18. Leong AF, Yunos AB. Stoma management in a tropical country: colostomy irrigation versus natural evacuation. Ostomy Wound Manage 1999; 45:52.
  19. Schaube J, Scharf P, Herz R. [The quality of life after extirpation of the rectum for carcinoma]. Dtsch Med Wochenschr 1996; 121:153.
  20. Woodhouse F. Colostomy irrigation: are we offering it enough? Br J Nurs 2005; 14:S14.
  21. Manderson L. Boundary breaches: the body, sex and sexuality after stoma surgery. Soc Sci Med 2005; 61:405.
  22. Arumugam PJ, Bevan L, Macdonald L, et al. A prospective audit of stomas--analysis of risk factors and complications and their management. Colorectal Dis 2003; 5:49.
  23. Park JJ, Del Pino A, Orsay CP, et al. Stoma complications: the Cook County Hospital experience. Dis Colon Rectum 1999; 42:1575.
  24. Leong AP, Londono-Schimmer EE, Phillips RK. Life-table analysis of stomal complications following ileostomy. Br J Surg 1994; 81:727.
  25. Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum 1994; 37:916.
  26. Porter JA, Salvati EP, Rubin RJ, Eisenstat TE. Complications of colostomies. Dis Colon Rectum 1989; 32:299.
  27. Robertson I, Leung E, Hughes D, et al. Prospective analysis of stoma-related complications. Colorectal Dis 2005; 7:279.
  28. Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis 2010; 12:958.
  29. Persson E, Berndtsson I, Carlsson E, et al. Stoma-related complications and stoma size - a 2-year follow up. Colorectal Dis 2010; 12:971.
  30. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum 1998; 41:1562.
  31. Colwell J. Stomal and peristomal complications. In: Fecal and Urinary Diversions: Management Principles, Colwell, J, Goldberg, M, Carmel, J (Eds), Mosby, St. Loius 2004. p.308.
  32. Cottam J, Richards K, Hasted A, Blackman A. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis 2007; 9:834.
  33. Caricato M, Ausania F, Ripetti V, et al. Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis 2007; 9:559.
  34. Tang CL, Yunos A, Leong AP, et al. Ileostomy output in the early postoperative period. Br J Surg 1995; 82:607.
  35. Güenaga KF, Lustosa SA, Saad SS, et al. Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev 2007; :CD004647.
  36. Harris DA, Egbeare D, Jones S, et al. Complications and mortality following stoma formation. Ann R Coll Surg Engl 2005; 87:427.
  37. Cataldo PA. Technical tips for stoma creation in the challenging patient. Clin Colon Rectal Surg 2008; 21:17.
  38. De Raet J, Delvaux G, Haentjens P, Van Nieuwenhove Y. Waist circumference is an independent risk factor for the development of parastomal hernia after permanent colostomy. Dis Colon Rectum 2008; 51:1806.
  39. Duchesne JC, Wang YZ, Weintraub SL, et al. Stoma complications: a multivariate analysis. Am Surg 2002; 68:961.
  40. Leenen LP, Kuypers JH. Some factors influencing the outcome of stoma surgery. Dis Colon Rectum 1989; 32:500.
  41. Nastro P, Knowles CH, McGrath A, et al. Complications of intestinal stomas. Br J Surg 2010; 97:1885.
  42. Rondelli F, Reboldi P, Rulli A, et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 2009; 24:479.
  43. Noubibou M, Douala HC, Druez PM, et al. Chronic stomal variceal bleeding after colonic surgery in patients with portal hypertension: efficacy of beta-blocking agents? Eur J Gastroenterol Hepatol 2006; 18:807.
  44. Conte JV, Arcomano TA, Naficy MA, Holt RW. Treatment of bleeding stomal varices. Report of a case and review of the literature. Dis Colon Rectum 1990; 33:308.
  45. Roberts PL, Martin FM, Schoetz DJ Jr, et al. Bleeding stomal varices. The role of local treatment. Dis Colon Rectum 1990; 33:547.
  46. Cheung MT. Complications of an abdominal stoma: an analysis of 322 stomas. Aust N Z J Surg 1995; 65:808.
  47. Maeda K, Maruta M, Utsumi T, et al. Pathophysiology and prevention of loop stomal prolapse in the transverse colon. Tech Coloproctol 2003; 7:108.
  48. Mäkelä JT, Turku PH, Laitinen ST. Analysis of late stomal complications following ostomy surgery. Ann Chir Gynaecol 1997; 86:305.
  49. Shapiro R, Chin EH, Steinhagen RM. Reduction of an incarcerated, prolapsed ileostomy with the assistance of sugar as a desiccant. Tech Coloproctol 2010; 14:269.
  50. Husain SG, Cataldo TE. Late stomal complications. Clin Colon Rectal Surg 2008; 21:31.
  51. Beraldo S, Titley G, Allan A. Use of W-plasty in stenotic stoma: a new solution for an old problem. Colorectal Dis 2006; 8:715.
  52. LYONS AS, SIMON BE. Z-plasty for colostomy stenosis. Ann Surg 1960; 151:59.
  53. Hughes AP, Jackson JM, Callen JP. Clinical features and treatment of peristomal pyoderma gangrenosum. JAMA 2000; 284:1546.
  54. Walling AD, Sweet D. Pyoderma gangrenosum. Am Fam Physician 1987; 35:159.
  55. Lyon CC, Smith AJ, Griffiths CE, Beck MH. The spectrum of skin disorders in abdominal stoma patients. Br J Dermatol 2000; 143:1248.
  56. Callen JP. Pyoderma gangrenosum. Lancet 1998; 351:581.
  57. Kiran RP, O'Brien-Ermlich B, Achkar JP, et al. Management of peristomal pyoderma gangrenosum. Dis Colon Rectum 2005; 48:1397.
  58. Erwin-Toth P. Prevention and management of peristomal skin complications. Adv Skin Wound Care 2000; 13:175.