Infected stoma – Everything you need to know

One of the biggest worries of ostomates is an infection. Although inflammation around the stoma is not quite common, but can occur for various reasons. It is therefore important to take special care of your skin to protect it. Check your stoma and the surrounding skin regularly every time you change your stoma supply in order to identify any new issues at an early stage.

How do infections occur?

Our skin is home to millions of bacteria, fungi and viruses that build up the skin microbiota. Similar to the microorganisms in our gut, the microorganisms in our skin also have an important role to protect us from invading germs. These can easily multiply in a stoma because the area is warm, moist and dirty. They can colonise the stoma without causing any major problems. However, people who suffer from poor physical condition, have diabetes or are taking immunosuppressive medication are more likely to develop infections.

The skin around the stoma can become inflamed and seem irritated due to an infection, but there are also other reasons for sore skin, such as a leaky stoma supply or a pre-existing illness. Often minor skin infections can also lead to red, inflamed skin around the stoma. Persistent skin irritation also commonly leads to the development of papules (small bumps) and nodules (larger bumps). It is therefore advisable to have the affected skin examined by your stoma care nurse. Skin irritation can usually be treated very well by identifying the cause and starting to apply skin protection powders, creams, wipes and sprays to help heal and protect the affected skin.

What are signs of an infected stoma?

When the skin becomes infected, it can look inflamed and this usually leads to swelling around your stoma. The skin colour often changes from a healthy pink/red colour to pale, bluish-purple or even black. If blood or pus is oozing, this is a clear sign of an infection. In addition, infections can lead to increased pain and discomfort. If you notice any of these symptoms, please speak to your GP. They will take a swab based on your symptoms and prescribe treatment with antibiotics.

Types of infections

It is definitely useful to be aware of the types of infections that can occur if you have a stoma. Infections of the skin are usually either bacterial, viral or fungal. Regardless of the type of infection, they are all unpleasant and can affect the stoma itself and the supply attached to the skin.

Bacterial infections

Bacterial infections are among the most common infections experienced by ostomates. Every injury to the peristomal skin, no matter how small, that may be caused by leakage, contact dermatitis or other chronic skin diseases, increases the risk of infection.

The most common bacterial infections are caused by Staphylococcus aureus, streptococci or both at the same time. These are usually diagnosed by taking a swab. It is therefore essential that you contact your stoma nurse or GP if you suspect an infection. Persistent/serious infections must be treated with antibiotics.

A bacterial infection can also occur as a secondary infection of a surgical wound. The risk of infection is therefore increased during stoma surgery. However, they can also cause folliculitis (inflammation of the hair follicles) or boils (hard, painful lumps filled with pus).

Examples

Bark lichen (impetigo): A highly contagious skin infection that often starts with red sores or blisters and leaves golden-brown patches.

Cellulitis: A potentially serious bacterial skin infection that requires immediate treatment. It affects the surface of the skin and can result in painful, hot and swollen skin. It can also infect the underlying tissue and spread to the lymph nodes and bloodstream. Warning: life-threatening if no action is taken. However, don't be frightened - this type of infection is very rare!

Fungal infections

Yeast infections can also occur on the skin around the stoma. These types of skin infections cause a red, raised, itchy, pimply rash. It usually improves and disappears with antifungal powder or cream. Severe yeast infections can be detected by skin scrapings by your stoma care nurse.

Examples

Candidiasis/Soor: Can occur on almost any part of the body, but preferably on warm, moist body folds such as armpits, groins, under the breasts and in the perineal area. Therefore, these fungi can find the perfect conditions for growth under a warm and moist ostomy pouch!

Ringworm (Tinea corporis): Is a rash that is usually red, itchy and circular, with a lighter area in the centre.

Pityriasis versicolor: Causes blemishes on your skin that may be lighter or darker than your normal skin.

Viral infections

Viral infections are not quite that common among ostomates. However, if they do occur, they can cause issues as they can have a huge impact on the adhesion of an ostomy supply.

Examples

Shingles (herpes zoster) & cold sores (herpes simplex): These vesicles caused by the herpes viruses can often also become infected with staphylococci. Before starting antiviral treatment, an additional bacterial infection should be checked/excluded with the help of a medical test.

Viral warts: Warts are small bumps on the skin that are often caused by human papillomaviruses (HPV). They spread easily through skin contact and infected surfaces.

Molluscum contagiosum: Is quite uncommon among people with stoma. It can appear as small, firm spots that have a dimple in the centre and can be very itchy. Caution: They are contagious! Therefore, try not to share towels with others, for example. The disease heals itself over time.

Peristomal abscess

At the edge of your stoma there may be one or more open and painful lesions surrounded by redness. This is not uncommon among people with Crohn's disease in the distal bowel area. Abscesses can often be treated with antibiotics and monitored by your stoma care nurse.

In severe cases, referral to surgery may be necessary to drain or completely remove the abscess.

Please be aware that if you notice any unusual skin changes or pain, it is always best to consult your trusted GP or stoma care professional.

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