Stoma Assessment

Nursing Knowledge

Stoma Assessment

Ostomies are artificial openings that divert bodily waste. These stomas may be temporary or permanent and can significantly impact a patient’s quality of life. Regular assessment is an important nursing task, checking the stoma and the surrounding skin for color, size, shape, and signs of complications like blockage, prolapse, retraction, or necrosis.
Last updated: December 4, 2023

Table of contents

Common types of ostomies

  • Colostomy
  • Ileostomy
  • Urostomy

Assessment of stoma 

Supplies needed for ostomy assessment 

  • Pouching system
  • Gauze
  • Stoma-measuring guide
  • Stoma paste

Stoma assessment steps

  1. Wash or sanitize hands upon entering room.
  2. Provide privacy.
  3. Explain the procedure.
  4. Raise the bed to an appropriate height.
  5. Assist the client to the correct position.
  6. Perform hand hygiene, again.
  7. Put on gloves.
  8. If needed, empty contents of ostomy pouch for clear visualization of the stoma and dispose according to facility policy.
  9. Examine stoma and surrounding skin for changes in physical appearance of the stoma and skin irritation and pain caused by leaking of contents from poor bag adherence.
  10.  Assess ostomy drainage for any changes in odor, color, discharges (such as blood or pus).
  11.  Remove and replace the ostomy bag, if required.

How to document stoma appearance

Key points to cover in stoma assessment documentation include: 

  • Color (pink, red, purple…)
  • Size (dimensions or diameter)
  • Shape (round, oval, irregular)
  • Protrusion (flush with the skin, protruding, retracted)
  • Condition of the surrounding skin (intact, red, irritated…)
  • Output (type and consistency)
  • Any abnormalities  (swelling, bleeding…)
  • Of course, as always, date, time, your signature, and any specifics required by your facility’s protocols. 

Normal stoma appearance

A healthy stoma typically appears pinkish-red, moist, and may have some mucus. 

Unhealthy stoma appearance: examples

  • Stoma blockage: may appear swollen and discolored, may cause pain or decreased output → immediate attention required!
  • Stoma prolapse: extends outward more than usual and appears elongated, may lead to obstruction or strangulation
  • Stoma retraction: sits below the skin level, making it difficult for the appliance to adhere properly and increasing the risk of skin irritation and leakage
  • Skin irritation: redness, rash, or broken skin around the stoma site
  • Leakage: can lead to skin irritation, requires immediate refitting
  • Necrosis: indicated by dark red, purple, or black coloration of the stoma → medical emergency! 

How to clean a stoma: skin care 

General tip: Less is more! Often, only water is sufficient.

  • If required, use mild soap without fragrance or dyes.
  • Do NOT use: lotions, creams, powders, baby wipes, isopropyl alcohol, steroid medications, and ointments.
  • If skin or ostomy abnormalities occur, manage care appropriately and contact the provider.
  • Ensure the client understands ostomy and skin care.


Stoma Assessment

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An overview on ostomy and skin assessment and management

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