Ostomy Complications: What to Watch For and When to Seek Emergency Care

Most people who leave hospital after ostomy surgery have had thorough teaching on pouch changes and output management. Fewer have a clear picture of what can go wrong over the following weeks, months, and years, or know which symptoms are worth calling the stoma nurse about versus which need same-day emergency attention.

A 2026 narrative review published in the Journal of Emergency Medicine (Long B, DePompolo AM, Koyfman A) addressed this question from the other side of the consultation table: what do emergency clinicians need to know when an ostomate presents to the emergency department? (Long B et al., Journal of Emergency Medicine, 2026) The synthesis covers colostomy, ileostomy, and urostomy complications and offers a framework that patients can also find useful.

Early Complications: The First Weeks After Surgery

Some complications appear soon after surgery, before the surgical team would typically have discharged a patient for long-term community care.

Stomal ischaemia and necrosis is the most time-sensitive early complication. The stoma depends on adequate blood supply from the bowel segment that was brought to the surface. If that blood supply is insufficient, the stoma tissue begins to lose viability. Early signs include a change in colour from the normal pink or red to a dusky purple, and in severe cases to black. The 2026 review notes that immediate recognition is critical because emergency surgical assessment determines whether intervention is needed. If your stoma is darkening or appears to be losing its usual colour, this is not something to watch and wait on. It warrants immediate medical contact or an emergency department visit.

Stomal retraction occurs when the stoma sinks below the level of the skin surface. A properly formed stoma should protrude slightly above the skin to allow output to flow cleanly into the pouch without contact with the surrounding skin. Retraction can make output management considerably harder and increases the risk of leakage and peristomal skin damage. Mild retraction is often managed with convex appliances and specialist input from a stoma nurse; more significant retraction may require surgical revision.

High-output stoma is primarily a concern after ileostomy rather than colostomy. An ileostomy that consistently produces more than around 1,500 to 2,000 millilitres per day puts the body at risk of dehydration and electrolyte loss, including low sodium and potassium levels. Dietary measures, adjusted fluid intake (including oral rehydration solutions), and in some cases medication are used to manage high output. The NHS advises seeking medical attention if high output is persistent, is not improving with dietary changes, or is accompanied by signs of dehydration such as reduced urine output, dizziness, or extreme thirst. (NHS, Ileostomy: Potential Complications)

Late Complications: Months to Years After Surgery

These complications tend to emerge as the body adapts to the stoma long-term and may appear at any point in the years following surgery.

Parastomal hernia is one of the most frequently reported late complications. It occurs when abdominal contents push through a weakness in the abdominal wall around the stoma opening, creating a bulge under the skin around or near the stoma. Many parastomal hernias are small, cause no significant symptoms, and are managed conservatively with a specialist support belt and careful appliance fitting. However, a hernia that becomes irreducible (cannot be pushed back in) or shows signs of strangulation (the trapped tissue losing its blood supply, signalled by severe pain, a hard or tender hernia, vomiting, and no stoma output) is a surgical emergency.

Stomal prolapse is when the bowel telescopes outward through the stoma opening, sometimes protruding significantly beyond the skin. Loop stomas are more susceptible than end stomas. A prolapsed stoma that remains soft and can be gently reduced is generally managed with appliance modification and stoma nurse input. A prolapse that cannot be reduced, turns dark, or is accompanied by severe pain requires emergency assessment.

Stomal stenosis and obstruction can develop when the stoma opening narrows over time, restricting output flow. Symptoms include a change in output consistency, difficulty managing the stoma, and in more severe cases a partial or complete blockage of the bowel. A complete blockage with no output alongside cramping, bloating, or vomiting requires urgent medical assessment, as described in NHS guidance.

Peristomal skin complications are the most commonly encountered category overall, affecting many ostomates at some point. These include contact dermatitis (often from output coming into contact with the skin due to poor seal or leakage), mechanical trauma from repeated appliance changes, allergic reactions to adhesive components, and infections. While rarely an emergency, persistent or severe skin breakdown makes pouch application unreliable and can significantly affect quality of life. A stoma nurse is the first point of contact for peristomal skin problems, and most are resolvable with the right products and technique.

When to Go to the Emergency Department

The 2026 review categorises several ostomy-related presentations as requiring emergency surgical assessment. In plain terms, go to an emergency department if you notice:

• Your stoma has turned dark purple or black
• You have severe abdominal pain alongside no stoma output for several hours
• Your stoma has prolapsed and will not go back in, or appears very dark or painful
• You have symptoms of a strangulated hernia (severe pain, hard bulge, vomiting, no output)
• You are showing signs of serious dehydration (dizziness, very low urine output, confusion)

These situations do not benefit from waiting until the next working day or for a stoma nurse appointment.

Routine Problems: Your Stoma Nurse First

Most other stoma concerns, including minor skin irritation, appliance leakage, changes in output consistency, mild retraction, or questions about adapting to the stoma over time, are best handled through your stoma nurse or specialist team. They can assess whether an issue is within the range of normal management or needs a medical review.

The value of the 2026 emergency medicine review is partly in the reminder that stoma complications exist on a spectrum. Many are manageable with the right specialist support. A few are time-sensitive. Knowing the difference matters.