Reference — Gastrointestinal
Ostomy Basics
Quick reference for ostomy nursing care — colostomy, ileostomy, and urostomy output characteristics, stoma assessment, skin care, appliance management, and patient education.
Educational use only. This content is intended for nursing students and exam preparation. Always involve a wound, ostomy, and continence (WOC) nurse for complex ostomy management. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Stoma Assessment — Normal vs Abnormal
| Finding | Normal | Report to Provider |
|---|---|---|
| Color | Red or pink (well-perfused intestinal mucosa) | Purple, black, or gray (ischemia/necrosis) — surgical emergency |
| Appearance | Moist, glistening mucosal surface | Dry, dull, or crusted (dehydration or necrosis) |
| Size | Round, symmetric; slight postoperative swelling resolving in 6–8 weeks | Retraction below skin level or extreme prolapse (>5 cm protrusion) |
| Bleeding | Mild oozing with appliance changes (mucosal fragility) | Active bleeding or bleeding that does not stop with gentle pressure |
| Skin around stoma (peristomal) | Intact, same color as surrounding skin | Redness, erosion, maceration, bleeding — indicates leakage or contact dermatitis |
| Output color (colostomy) | Brown stool consistent with segment location | Black tarry stool (upper GI bleed) or frank blood |
| Output color (ileostomy) | Yellow-green to brown liquid | Bloody, absence of output >4–6 hrs (obstruction) |
| Output color (urostomy) | Clear yellow urine, mucous strands normal | Frank blood, turbid, cloudy with odor (UTI or infection) |
Surgical opening in the colon — brings a loop or end of the large intestine to the abdominal surface.
| Common indications | Colorectal cancer; Diverticulitis with perforation (Hartmann's procedure); Bowel obstruction; Trauma; Volvulus; Hirschsprung's disease (pediatric) |
| Location | Left lower quadrant most common (descending/sigmoid colostomy). Right side for transverse or ascending. |
| Output character | Formed to semi-formed stool (varies by location). Ascending colostomy: liquid/paste. Descending/sigmoid: formed. |
| Output amount | Varies by diet. Descending/sigmoid: 1–2 formed stools per day. Ascending/transverse: 400–800 mL/day liquid |
| Stoma appearance | Red/pink, moist, round, slightly raised. Should protrude 1–2 cm. Mucosal lining is intestinal tissue. |
| Appliance management | Drainable pouch or closed-end pouch (for solid stool). Change every 3–7 days or as needed. |
| Skin concerns | Alkaline stool can cause peristomal skin breakdown if leakage occurs. Peristomal hernia risk. |
Surgical opening in the ileum (small intestine) — most commonly an end ileostomy after total proctocolectomy, or a loop ileostomy for bowel rest.
| Common indications | Ulcerative colitis (total proctocolectomy); Crohn's disease; Familial adenomatous polyposis (FAP); Colorectal cancer requiring total colectomy; Loop ileostomy to protect distal anastomosis or fistula |
| Location | Right lower quadrant (RLQ) — standard location. Stoma should protrude 2–3 cm (spout) to protect skin from liquid output. |
| Output character | Liquid to porridge consistency. Continuous drainage — no reservoir. High in digestive enzymes — VERY irritating to skin. |
| Output amount | 800–1200 mL/day (initial); adapts to 500–800 mL/day. Varies significantly with diet. |
| Stoma appearance | Red/pink, moist, should protrude 2–3 cm (spout formation reduces skin contact with alkaline output). |
| Appliance management | Two-piece or one-piece drainable system. Empty when 1/3 to 1/2 full. Change appliance every 3–5 days. |
| Skin concerns | HIGH risk of peristomal skin breakdown — enzymatic liquid output is highly corrosive. Meticulous skin barrier essential. Protective skin barrier paste/powder recommended. |
Urinary diversion — a segment of ileum is isolated to create a conduit that diverts urine from the ureters to the abdominal surface. Also called an ileal conduit.
| Common indications | Bladder cancer requiring cystectomy; Neurogenic bladder (refractory to conservative management); Bladder exstrophy; Severe radiation cystitis; Traumatic bladder injury |
| Location | Right lower quadrant. Stoma should protrude 1–2 cm. May have mucous threads in urine output (from ileal segment — normal). |
| Output character | Urine — clear to yellow. Mucus threads are normal from the ileal segment. Should NOT be bloody (except immediately postoperative). |
| Output amount | Continuous urine drainage — approximately 1–2 mL/kg/hr (normal urine output). No voluntary control. |
| Stoma appearance | Red/pink, moist. Mucus from ileal segment visible in output is normal. Stoma should be round and symmetrical. |
| Appliance management | Urinary pouch with drainage valve. Empty frequently (every 3–4 hours). Night drainage bag recommended to prevent backflow. Change every 3–5 days. |
| Skin concerns | Urine is acidic and irritating to skin. Ammonia from urine can cause crystal deposits on stoma (white crystals). Treat with dilute white vinegar soaks. |
Patient Education Priorities
Appliance Care
- ✦Empty pouch when 1/3 to 1/2 full
- ✦Change appliance every 3–7 days (per type)
- ✦Measure stoma opening — size changes in first 6 weeks
- ✦Cut skin barrier within 1/8 inch of stoma base
Peristomal Skin Care
- ✦Cleanse skin with warm water and mild soap
- ✦Pat dry thoroughly before applying new appliance
- ✦Use skin barrier paste or powder for irritated skin
- ✦Assess peristomal skin at every pouch change
Diet Considerations
- ✦Ileostomy: avoid foods causing blockage (corn, nuts, skins, popcorn)
- ✦Colostomy: normal diet typically; note gas-producing foods
- ✦Odor-reducing foods: yogurt, buttermilk, parsley
- ✦Urostomy: cranberry juice helps reduce crystal formation, maintain pH
When to Call Provider
- ✦No output for >4–6 hours (obstruction)
- ✦Purple or black stoma (ischemia)
- ✦Peristomal skin breakdown with pain
- ✦High ileostomy output >1200 mL/day (dehydration risk)
- ✦Signs of infection around stoma site
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American College of Gastroenterology (ACG) / AGA · ASPEN (nutrition support). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →