Experiencing bleeding around the stoma can be unsettling, but it’s often a manageable part of daily ostomy care. In many cases, mild bleeding is caused by irritation, friction, or sensitive skin rather than a serious issue. Understanding what causes bleeding around the stoma, how to identify warning signs, and how to protect your skin can help you maintain comfort, prevent complications, and care for your stoma with confidence.
Quick Overview: Bleeding Around the Stoma
- Mild bleeding is often normal due to the stoma’s delicate blood vessels, especially during routine ostomy care like cleaning or pouch changes
- Bleeding around the stoma is commonly caused by skin irritation, friction, poor appliance fit, or exposure to ostomy output
- Other causes may include granulomas, infection, or allergic reactions to ostomy products
- Warning signs such as heavy bleeding, blood from inside the stoma, or changes in stoma appearance should be evaluated by a healthcare provider
- Preventing bleeding involves gentle care techniques, ensuring a proper pouch fit, protecting the skin with barriers, and using the right ostomy supplies
Is It Normal for a Stoma to Bleed?
It can be concerning to notice bleeding around your stoma, but in many cases, a small amount of bleeding is normal. The stoma is made from the lining of your intestine, which contains many tiny blood vessels. Due to this, it may bleed slightly when touched, cleaned, or irritated, similar to how your gums might bleed when brushing your teeth.
Mild bleeding is typically not a cause for concern and may happen during routine ostomy care, such as:
- Cleaning the stoma
- Changing your ostomy pouch
- Light friction from clothing or supplies
However, while occasional light bleeding is common, it’s important to know the difference between normal and abnormal bleeding. Normal instances of bleeding include:
- Small spots of blood on your stoma or your pouch
- Brief bleeding that stops quickly
- Bleeding after cleaning or gentle contact
However, if you notice any of the following warning signs, it’s important to contact your healthcare provider or ostomy nurse. They can help determine the cause and ensure there are no underlying complications.
- Bleeding that is heavy, continuous, or worsening
- Blood coming from inside the stoma (rather than the surface)
- Dark or black stool/output (which may indicate internal bleeding)
- Pain, swelling, or changes in stoma size or color
Causes of Bleeding From the Stoma
Bleeding directly from the stoma is less common but can occur in certain situations. Some of the most common causes of this include the following:
- Trauma or injury: Sudden trauma to the stoma, such as bumping or pressing too hard during cleaning, can cause minor bleeding. This is usually short-lived and usually stops on its own.
- Stoma prolapse or retraction: If the stoma becomes prolapsed (sticks out too far) or retracted (sinks inward), it can cause strain on the blood vessels, leading to bleeding. These structural changes may be due to factors like abdominal pressure or changes in weight.
- Granulomas: Granulomas are small, raised growths that can form at the opening of the stoma. They may bleed easily if they are touched or irritated during cleaning or pouching.
- Underlying medical conditions: Conditions such as clotting disorders or inflammation can increase the risk of bleeding from the stoma.
Common Causes of Bleeding Around the Stoma
Bleeding from the skin around the stoma (peristomal skin) is a relatively common ostomy issue and usually a sign of irritation or skin damage rather than something more serious. The surrounding skin should look similar to the rest of your abdomen, so if you notice bleeding in this area, it often means the skin has become inflamed, broken, or overly sensitive. Some common causes of bleeding around a stoma include the following:
Peristomal Skin Irritation and Breakdown
Skin irritation is one of the most common causes of bleeding. When ostomy output comes into contact with the skin, especially with an ileostomy, it can quickly lead to inflammation and breakdown. Over time, this weakens the skin and makes it more likely to bleed, even with gentle contact. This type of irritation is often linked to bowel leakage, prolonged exposure to moisture, and frequent removal of adhesives or aggressive wiping.
Friction or Trauma During Ostomy Care
Even routine ostomy care can contribute to bleeding if the skin becomes overly sensitive. Repeated friction or minor trauma can damage the surface of the skin, especially if it has already been irritated. This may occur due to:
- Scrubbing the skin too firmly during cleaning
- Removing adhesive barriers too quickly
- Changing the pouching system more often than necessary
Poorly Fitting Ostomy Appliance
Your ostomy bag should be properly sized and fit securely around your stoma. When the stoma bag is too big, it can increase the risk of leaks. When it's too small, it can put pressure on the stoma and may increase the risk of bleeding. A bad fit can also result in a barrier that shifts or doesn't seal properly, which can irritate the skin. If you're having problems with fit, talk to your stoma care nurse about properly trying additional products for your stoma's size and shape.
Granulomas Around the Stoma
Granulomas are small, red, raised areas on or around the stoma. These are technically tightly clustered immune cells, or inflammation, and can occur due to repeated irritation or friction. Although they're not technically dangerous, granulomas cause increased sensitivity and can therefore increase the risk of a bleeding stoma. Oftentimes, they develop along the edges of the stoma and appear moist or bumpy. They bleed easily, so you may notice blood when they're disturbed, even if you're cleansing the area gently.
Infection Around the Stoma Site
Infections can further weaken the skin and make it more prone to bleeding. Both bacterial and fungal infections can occur in the peristomal area, particularly if the skin is already damaged. Signs of infection may include:
- Redness, warmth, or swelling
- Itching or unusual discharge
- Increased tenderness or sensitivity
Allergic Reactions to Ostomy Products
Some ostomates may have an allergy or develop a sensitivity to adhesives, skin barriers, or other ostomy products. This can lead to inflammation and skin breakdown over time, making the area more vulnerable to bleeding. However, since a rash could be a sign of something more serious, it's best to see your doctor for a diagnosis.
How to Stop Minor Bleeding Around the Stoma
If you experience slight bleeding that doesn't raise any cause for alarm, there are a few things that you can do to help. Some of the most effective ways to stop bleeding and prevent it from recurring include the following:
- Gently clean the area with warm water and a soft cloth, avoiding harsh soaps or scrubbing, and pat dry gently to prevent further irritation.
- Apply a protective barrier cream or paste to shield the skin from moisture and output, allowing it to heal.
- Check the fit of your ostomy appliance to ensure the opening isn’t too large or too small, which can cause friction or exposure to output.
- Use a silicone-based barrier for added protection, as these are gentle on the skin and reduce friction.
- Avoid unnecessary friction by ensuring the pouch fits securely, wearing loose clothing, and not over-tightening the pouch.
- Give your skin time to heal by spacing out pouch changes and allowing the skin to recover between changes.
- Monitor for infection or allergic reaction by looking for signs like increased redness, pus, or unusual discharge, and switch to hypoallergenic products if needed.
- Consult with your healthcare provider if the bleeding persists or worsens, to assess if adjustments to your care routine are necessary.
When Should You Be Concerned About Stoma Bleeding?
While minor bleeding around the stoma is often not a cause for alarm, there are times when bleeding may indicate a more serious issue. Some of the following symptoms indicate more urgent situations that may require medical attention and treatment.
- Heavy or persistent bleeding: If bleeding continues for more than a few minutes or is more than a small amount, this could signal a more serious problem.
- Blood is coming from inside the stoma: If the blood is coming from within the stoma itself (rather than around the stoma), it could indicate internal bleeding or a problem with the blood vessels.
- Dark or black stool: This could suggest that blood has been present for a while, indicating internal bleeding or a more serious issue like a peptic ulcer or gastrointestinal problem.
- Blood in the urine: If you have a urostomy and notice blood in your ostomy bag, it's important to see your doctor.
- Pain, swelling, or changes in stoma appearance: Pain or swelling, along with changes in the size, shape, or color of the stoma, may indicate a prolapse, retraction, or other complications that need medical evaluation.
- Dizziness or weakness: These could be signs of significant blood loss, especially if the bleeding continues over time. It's important to monitor for signs of anemia or dehydration.
- Unusual discharge or pus: If bleeding is accompanied by a thick, foul-smelling discharge, it may indicate an infection that needs immediate attention.
- Difficulty stopping bleeding: If the bleeding doesn’t stop after applying gentle pressure for several minutes, or if it continues to worsen, this could indicate a need for more urgent care.
Ostomy Products That May Help Reduce Bleeding
Byram Healthcare offers a range of high-quality ostomy products designed to protect the skin and ensure a secure fit. From skin barriers to adhesive removers, our products help reduce friction, prevent leakage, and promote healing. Contact us today to learn more.
