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Nursing Field Notes / Gastrointestinal · Med-Surg Course

Ostomy Care 🧷

Colostomy vs ileostomy vs urostomy · the stoma colors · diet and appliance

NG-401 Gastrointestinal ADHD-friendly visual edition

The further along the bowel the stoma is, the thicker the output and the lower the fluid loss. That single sentence answers most ostomy questions. The other half is the stoma color.

Healthy stomaPink to beefy red, moist, slightly swollen at first
Report nowPale, dusky, purple or black — the blood supply is failing
IleostomyLiquid output, high fluid and electrolyte loss
ColostomyThe further along, the more formed the stool

🧨 What starts it

The bowel drawn as a straight run with the stoma sites marked in order and the output under each getting thicker as you move along - liquid from the ileum, pasty from the transverse, formed from the sigmoid. Beside it the stoma colors.
The further along the bowel the stoma sits, the thicker the output and the lower the fluid loss. That sentence answers most of the questions. Swipe it sideways if it is cut off, or tap to open it full size.
Three ostomies, three outputs
  • Ileostomy — from the small bowel. Output is liquid to semi-liquid, continuous, and enzyme-rich. Highest risk of dehydration, electrolyte loss and skin breakdown. Expect 500 to 1300 mL a day.
  • Colostomy — from the large bowel. The further along, the more water has been reabsorbed: ascending is liquid, transverse is pasty, descending and sigmoid are formed and may become predictable.
  • Urostomy (ileal conduit) — urine, continuous, with mucus in it because a piece of bowel is used as the conduit. Mucus strands are normal and expected.
What is normal early on
  • The stoma is edematous for the first weeks and shrinks over 6 to 8 weeks — the appliance opening is re-measured each time until then.
  • It has no nerve endings, so touching it does not hurt. Bleeding a little when cleaned is normal because it is vascular.
  • An ileostomy may not work for the first 24 hours; a colostomy may take 3 to 6 days while the ileus settles.
Why the color matters most

The stoma is a piece of living bowel with its own blood supply. Pink to beefy red means perfused. Pale suggests anemia. Dusky, purple or black means ischemia or necrosis — the bowel is dying. That is an immediate call, not a next-round observation.

🔎 What you will see

Assessing it
  • Color: pink to beefy red is healthy. Pale, dusky, purple, black — report.
  • Moisture: moist and shiny is healthy. Dry and dull is not.
  • Height: should protrude slightly. A retracted stoma leaks under the wafer; a prolapsed one telescopes out and needs review.
  • Surrounding skin: intact, no redness or erosion. Excoriation means the appliance is leaking or the opening is cut too large.
  • Output: amount, consistency and color, matched to the type.
What to report
  • Any color other than pink or red
  • No output for 4 to 6 hours from an ileostomy with cramping and distension — that is an obstruction, often a food blockage
  • High-volume watery output — dehydration risk
  • Severe skin breakdown, or the wafer failing within a day
  • Fever, or a stoma that is bleeding more than a trace
Urostomy specifics

Mucus in the urine is normal. Cloudy, foul-smelling urine is not — that is infection. Empty the pouch when it is one-third full and connect to a night drainage bag, kept below the level of the stoma.

🩺 What you do

Appliance technique
  • Empty the pouch when it is one-third to one-half full. A heavy pouch pulls the wafer off.
  • Change the wafer every 3 to 7 days, or immediately if it leaks. Change it in the morning before eating, when output is lowest.
  • Measure the stoma and cut the opening 1/8 inch (2 to 3 mm) larger. Too big exposes skin to effluent; too small strangles the stoma.
  • Clean with warm water only. No soap with oils, no alcohol, no adhesive removers that leave residue — they stop the wafer sticking.
  • Dry the skin completely before applying. Warm the wafer in your hands and hold it in place 30 seconds.
  • Skin barrier powder and paste for weeping skin; a belt for a heavy pouch.
Diet teaching
  • Introduce one new food at a time and chew everything thoroughly.
  • Ileostomy: avoid high-fiber and stringy foods — nuts, popcorn, corn, celery, coconut, mushrooms, raw cabbage. They block it.
  • Gas: beans, onions, fizzy drinks, beer, chewing gum, drinking through a straw.
  • Odor: fish, eggs, garlic, asparagus. Parsley, yoghurt and buttermilk help.
  • Fluids: 2 to 3 liters a day for an ileostomy, and salty foods to replace sodium.
  • Watch for dehydration in hot weather or with vomiting — an ileostomy has no colon to reabsorb.
Living with it
  • Colostomy irrigation can regulate a sigmoid colostomy — same time daily, warm water, container no higher than shoulder height sitting. It is never done for an ileostomy.
  • Odor-proof pouches exist; there is no need to avoid social life. Empty before going out.
  • Showering with or without the pouch is fine. Water does not hurt the stoma.
  • Avoid heavy lifting for 6 to 8 weeks — hernia around the stoma is common.
  • Refer to a wound, ostomy and continence nurse and to a support group. Body image is part of the care plan, not an afterthought.

⚡ Quick recall

Healthy stomaPink to beefy red, moist, slightly swollen at first
Report nowPale, dusky, purple or black — the blood supply is failing
IleostomyLiquid output, high fluid and electrolyte loss
ColostomyThe further along, the more formed the stool
What color is a healthy stoma?
Pink to beefy red, moist and shiny.
Purple or black stoma — what do you do?
Report immediately. The blood supply is compromised.
How much larger than the stoma do you cut the wafer opening?
About 1/8 inch, or 2 to 3 mm.
When is the pouch emptied?
At one-third to one-half full.
Which ostomy dehydrates fastest, and why?
The ileostomy. There is no colon left to reabsorb water and sodium.
An ileostomy stops draining and she is cramping. What is it?
A blockage, often a food bolus. Report it — do not give a laxative.