Preparation and Consent
Examination of stoma Begin by introducing yourself to the patient and confirming their identity. Wash your hands thoroughly. Explain, in simple and reassuring terms, that you will be examining their stoma to check that it is healthy and functioning well. Obtain verbal consent before proceeding.
Position the patient comfortably, ideally reclined at around 45 degrees. Before you start, ask if they are experiencing any abdominal pain or if they have noticed any recent issues with their stoma, such as discomfort around the site, changes in output, bleeding, or problems with the appliance.
Inspection (Examination of stoma)
Inspection is the most important part of stoma assessment.
Ask the patient to expose the stoma site. If appropriate, politely ask whether they are able to remove the stoma bag themselves, as this allows better visualization while respecting dignity.
During inspection, assess the following:
Site of the Stoma
- A stoma in the left iliac fossa is most commonly a colostomy.
- A stoma in the right iliac fossa is more suggestive of an ileostomy.
Appearance and Spout
- A spouted stoma usually indicates an ileostomy (or urostomy), as small bowel contents are more irritating to the skin.
- A stoma that lies flush with the skin is more typical of a colostomy.
Output Consistency
- Colostomy output is generally thicker and more formed, similar to stool.
- Ileostomy output is looser, more watery, and often greenish.
- Urostomy output consists of urine.
Number of Lumens
- End stomas have a single lumen.
- Loop stomas have two lumens, usually visible within the same opening.
Signs of Complications
Look carefully for common stoma-related complications, including:
- Parastomal hernia (particularly common with colostomies)
- Prolapse
- Retraction
- Ischemia or infarction, suggested by a dark or blackened stoma
Also inspect the surrounding skin for redness, ulceration, excoriation, or any signs of fistula formation.
Palpation (Examination of stoma)
With the patient’s permission, gently palpate around the stoma site, assessing for tenderness or masses.
Ask the patient to cough while you feel for a cough impulse, which may indicate a parastomal hernia.
If appropriate and tolerated, gently insert a gloved, lubricated finger into the stoma to assess patency and exclude stenosis.
Completing the Examination
Thank the patient and ensure they are comfortable before allowing them to replace the stoma appliance.
If this were a formal clinical examination, state that to complete the assessment, you would proceed with a full abdominal and gastrointestinal examination, along with relevant investigations as indicated.