Understanding Stoma Assessment for Student Nurses
Learn what to observe when caring for a patient with a stoma, how to recognise changes in appearance, output and surrounding skin, and when findings should be communicated or escalated.
What is a stoma?
A stoma is a surgically created opening that brings part of the bowel to the surface of the abdomen. Different types of stoma have different expected patterns of output, so assessment should always take account of the patient's individual situation and care plan.
Large bowel
A colostomy is formed from the colon. Output characteristics can vary depending on the site of the stoma and the individual patient.
Small bowel
An ileostomy is formed from the ileum and its output is generally more liquid than output from many colostomies.
Know the patient's baseline
The expected appearance and output should be understood in the context of the patient's surgery, recovery and established pattern.
Four areas to consider during stoma assessment
Stoma appearance
Observe colour, moisture, swelling and any significant change from the patient's expected appearance.
Stoma output
Consider the amount, consistency, colour and any significant change in output according to the type of stoma.
Peristomal skin
Observe the surrounding skin for soreness, irritation, breakdown, leakage or other changes.
The patient
Assess abdominal symptoms, hydration, oral intake, urine output, observations and overall clinical condition.
What should you notice about the stoma itself?
Student nurses should become familiar with observing a stoma while recognising that interpretation depends on the patient's clinical circumstances and stage of recovery.
Observe tissue colour
Notice whether the stoma's colour appears consistent with its expected appearance or has changed significantly.
Look at the surface
The bowel tissue forming the stoma normally has a moist appearance. Unexpected changes should be reported.
Notice structural change
Significant changes in size, protrusion, position or surrounding swelling should be communicated for further assessment.
Assess more than whether the bag contains stool
| Feature | What to assess | Why it matters |
|---|---|---|
| Amount | Has output increased, decreased or stopped compared with the expected pattern? | A significant change may require further assessment. |
| Consistency | Is the output liquid, loose, formed or different from usual? | Consistency varies by stoma type, but a new change may be clinically relevant. |
| Colour | Has the appearance of the output changed significantly? | Unexpected changes should be considered alongside diet, medicines and the patient's condition. |
| Blood | Is there unexpected or significant blood in the output? | Bleeding should be assessed in context and communicated appropriately. |
| Trend | How does current output compare with earlier observations? | Changes over time are often more useful than a single isolated observation. |
High or changing output can affect the whole patient
Significant gastrointestinal fluid losses can contribute to dehydration and electrolyte disturbance. This makes fluid balance particularly important when stoma output becomes substantially greater than the patient's expected pattern.
Track gastrointestinal losses
Measure and document output when this is required by the patient's care plan or local practice.
Consider replacement
Look at whether the patient is able to maintain adequate oral intake alongside ongoing losses.
Watch urine output
Reduced urine output alongside substantial gastrointestinal loss may add to concern about hydration and perfusion.
Look after the skin around the stoma
The peristomal skin is exposed to potential irritation from moisture, leakage and appliances. Changes should be identified early and managed according to the patient's care plan and specialist advice.
Check the skin
Look for redness, soreness, excoriation, broken skin or other changes.
Check appliance fit
Repeated leakage can damage surrounding skin and may indicate that the appliance or care approach requires review.
Know when to ask for help
Seek support from the registered nurse or specialist stoma team when significant skin problems or appliance difficulties occur.
A stoma assessment is also a conversation
Patients often develop considerable expertise in managing their own stoma. Their knowledge of what is normal for them can provide valuable information when something changes.
- Ask what the patient's usual stoma output is like.
- Ask whether they have noticed a change in appearance or function.
- Ask about leakage, discomfort or problems with the appliance.
- Respect privacy and dignity during stoma care.
- Encourage appropriate independence rather than automatically taking over care.
- Recognise anxiety or concerns about body image and adjustment.
Changes that should increase concern
- A significant unexpected change in stoma colour or appearance.
- New or worsening abdominal pain or distension.
- Persistent vomiting alongside a change in stoma function.
- A substantial unexpected reduction or cessation of output with concerning symptoms.
- Markedly increased output accompanied by signs of fluid loss.
- Reduced urine output, poor intake or worsening hydration.
- Unexpected significant bleeding.
- Worsening physiological observations or general clinical condition.
The output has changed
Example
A patient with an established ileostomy tells you that the output has become much more watery and frequent than usual.
During your assessment you learn that they have been drinking poorly. Their urine output has also fallen compared with earlier in the day.
Rather than concentrating only on the stoma bag, you recognise the pattern: increased gastrointestinal losses + reduced intake + reduced urine output.
You assess the patient's wider clinical condition and communicate the change promptly to the registered nurse.
Describe what has changed
Example escalation
“I'm concerned about Ms Patel. Her ileostomy output has become much more watery and frequent compared with her normal pattern. She has had poor oral intake today and her urine output has reduced.”
This communicates the stoma finding and explains why the wider pattern requires assessment.
Errors to avoid
- Looking at the appliance without assessing the patient.
- Assuming all stomas should produce the same type of output.
- Ignoring a significant change from the patient's normal pattern.
- Failing to connect high output with fluid balance and urine output.
- Ignoring the condition of the surrounding skin.
- Overlooking the patient's own knowledge of their stoma.
- Attempting specialist stoma management beyond your competence.
Stoma → output → skin → patient
Assess the stoma and the whole patient
Confidence develops when you move beyond simply observing the appliance and connect stoma appearance and output with skin integrity, fluid balance, abdominal symptoms and the patient's wider clinical condition.
Explore Clinical Confidence →