Sally Wright has worked as a Stoma Care Nurse for over 15 years, providing specialist care, education, and support to individuals recovering from stoma surgery within the community. Sally recognises that every patient’s recovery journey is unique, and she has a particular interest in the psychological aspects of adapting to life with a stoma. Her previous role as a Dermatology Sister highlighted the importance of emotional wellbeing whilst coming to terms with changes to our bodies and the impact on self esteem.
Why do stoma infections happen?
Your skin naturally hosts millions of bacteria, fungi, and viruses that make up its microbiota that plays an important role in protecting against harmful pathogens; much like the microbes in your gut. Around the stoma, this balance can shift: the warm, moist, and often soiled environment makes it easier for micro-organisms to multiply, sometimes leading to infection with the skin around the stoma.
Anyone can experience peristomal skin infections, but the risk is higher for people with general ill-health, diabetes, or those on immunosuppressive medication.
It is important to note that not all peristomal skin irritation is caused by infection of the stoma, an ill-fitting pouch which allow leaks (a.k.a a stoma leakage), allergic reactions to adhesives and trapped moisture may lead to infections. Ongoing irritation can lead to papules or nodules, so it's worth having your stoma care nurse check any persistent skin changes.
Understanding what can cause
- Leakage: stoma output (urine or stool) getting underneath the adhesive barrier, which can then sit on the skin and cause irritating the skin.
- Moisture Buildup: trapped moisture or excessive sweating under the warm conditions of a stoma pouch
- Poor Fit: an appliance that is not the correct size, causing friction or rubbing.
- Skin Trauma: tearing the skin when pulling off the old adhesive pouch too quickly or without a medical adhesive remover can create tiny tears where bacteria can enter
- Inadequate cleaning: by not cleaning the peristomal skin effectively, or leaving traces of barrier creams or remnants of product under the seal, can trap moisture to the area
- Skin folds or body changes: changes in weight or scars, may create deep skin creases near the stoma which may result in moisture build up and making it more difficult for the stoma appliance to create a good seal
Signs of a stoma infection
So how do you know if your stoma is infected? Common stoma infection signs are:
- Discharge: Cloudy fluid, pus or bleeding coming from the surrounding skin or the stoma itself.
- Skin Changes: Red inflammation, swelling, or discoloured skin around the stoma.
- Pain: Discomfort or increased pain which is ongoing, or an intense burning
- Bumps: The development of small pimples, pustules, or small bumps.
- Odor: An unusual, offensive smelling odor which is not related to normal output
If you notice any of these symptoms, contact your GP. You may need a swab and a course of antibiotics.
Types of stoma skin infections
Stoma skin infections generally fall into three categories: bacterial, fungal, and viral.
Bacterial infections are the most common type of infection around a stoma. Broken peristomal skin (e.g. from leakage, allergic contact dermatitis, or chronic skin conditions) increases the risk, most often from staphylococcus aureus or streptococci. These can also appear as a secondary infection of a surgical wound. Bacterial stoma skin infections may include folliculitis, boils, impetigo, or cellulitis (a more serious infection needing prompt treatment, though rare). A swab from your stoma care nurse or GP confirms the diagnosis, and stubborn cases may need antibiotics.
Yeast infection around the stoma is also common and causes a red, raised, itchy, pimply rash. Antifungal powder or cream usually resolves it, though severe cases may need a skin scraping to confirm. Thrush thrives in warm, moist areas (including under a pouch) while ringworm (tinea corporis) appears as a red, itchy, circular rash, and pityriasis versicolor causes patches lighter or darker than your normal skin tone.
Viral infections are less common but can affect how well your appliance adheres. These include shingles or cold sores (which may need swabbing before antiviral treatment), viral warts, and molluscum contagiosum; a mild, contagious condition that tends to clear on its own.
Peristomal abscess: An abscess causes one or more painful, open lesions around the stoma edge, often surrounded by redness and swelling. This is more common in those with a history of Crohn's disease. Most abscesses are treated with antibiotics and monitored by your stoma care nurse, although severe cases may need surgical drainage.
When should you seek help regarding a possible stoma infection?
If you're unsure whether your stoma is infected, don't wait; a stoma care nurse or GP can quickly assess it and start treatment if needed.
FAQ: Infected stoma
What should you do if your stoma is infected?
Contact your stoma care nurse or GP promptly. They may take a swab to identify the type of infection and prescribe treatment such as antibiotics or antifungal cream.
How do you treat an infected stoma?
Treatment depends on the cause: bacterial infections are usually treated with antibiotics, fungal infections with antifungal cream or powder, and viral infections with antiviral medication where needed.
What does an infected stoma look like?
Signs include swelling, a change in skin colour (pale, bluish-purple, or black), discharge of blood or pus, and increased pain or discomfort.
What is a stoma infection?
A stoma infection is an infection of the skin or tissue around the stoma, caused by bacteria, fungi, or viruses, often linked to broken skin from leaks or irritation.