• Ensure the stoma bag is cut to the correct size around the stoma
• Use a stoma measuring guide to measure accurately
• Stoma bags should be cut only 1mm bigger than the stoma
• Ensure the stoma bad is not being changed too frequently
• Assess the need for a barrier product or stoma powder to assist with the healing of the peristomal skin

• This is when the bowel prolapses out of the abdomen
• This is not a serious situation as long as the stoma stays pink, healthy and continues to function
• Check template size
• Consider stoma appliance review or change

• This is when the bowel drops back into the abdomen
• When this occurs, leakages and sore skin can be a problem
• Refer to stoma nurse specialist for review for appropriate seals or convexity

• Ensure the stoma bag is cut to the correct size around the stoma
• Use a stoma measuring guide to measure accurately
• Stoma bags should be cut only 1mm bigger than the stoma
• Assess the patients abdomen for any skin creases. Assess the need for stoma paste or a barrier ring
• Monitor and observe any changes, for example, herniation, prolapse or retraction of the stoma, and assess the appropriateness of the stoma bag
• Consider a stoma appliance review or change

• When cleaning the stoma, it is normal for there to be a little blood present in the stoma
• The stoma is a vascular organ and has a good blood supply
• Blood from inside the stoma requires further investigation from your patient’s GP

• This can be normal after surgery when the rectum or rectal stump has not been removed
• In most cases the discharge will gradually decrease
• The discharge will generally be mucous, faeces and (or) old blood
• Patients may experience the urge to have their bowels opened, sitting on the toilet can alleviate this feeling
• Good hygiene and a barrier cream may be necessary to protect the skin

Constipation only applies to colostomy patients. Please provide the following advice:

• Increase fluid intake as necessary
• Encourage fruit juice
• Encourage a high fibre diet
• Encourage mobility if appropriate
• Laxatives if required
• Continued assessment and management

This is a particular problem for colostomies, when the faeces remains stuck around the stoma instead of dropping down into the bag. The following may help:

• Encourage your patient to increase their fluid intake
• Stoma lubricants or baby oil to lubricate the bag can encourage the faeces to drop down into the bag
• Cover the filter with a filter cover to prevent a vacuum from forming in the bag
• Put a piece of screwed up tissue or cotton wool ball into the bag. This enables some air to remain in the bag and prevents a vacuum from forming.

• This is when a hernia develops behind a stoma
• Check template size
• Consider the need for a hernia support belt or girdle
• Consider a stoma appliance review or change