What is the treatment for bleeding around an ostomy site?

Management of Bleeding Around an Ostomy Site

The treatment of bleeding around an ostomy site should focus on identifying the specific cause of bleeding and applying appropriate targeted therapy, with direct pressure being the first-line intervention for active bleeding.

Initial Assessment and Management

For Active Bleeding:

• Apply direct manual pressure to the bleeding area using sterile gauze 1
• Maintain pressure for at least 5-10 minutes
• If bleeding persists, apply an elastic adhesive bandage over gauze to maintain pressure 1

Identify the Cause of Bleeding:

1. Stomal bleeding (from the stoma itself)

   • Minor bleeding during cleaning is normal
   • Excessive bleeding may indicate trauma or underlying issues

2. Peristomal skin bleeding

   • May be due to skin breakdown, irritation, or lesions

3. Variceal bleeding

   • Serious complication occurring in patients with cirrhosis and portal hypertension 2, 3

Management Based on Specific Causes

Traumatic Bleeding:

• Clean the area with tap water (avoid ice or ice water) 1
• Apply direct pressure until bleeding stops
• Assess for proper fit of ostomy appliance to prevent recurrent trauma

Bleeding from Granulation Tissue:

• Clean the area daily with antimicrobial cleanser
• Apply topical antimicrobial agent under fixation device
• Consider foam or silver dressing over affected area 4
• For persistent cases, silver nitrate application may be needed

Bleeding from Ulceration/Skin Breakdown:

• Ensure proper tension between internal and external bolsters 4
• Apply zinc oxide-based skin protectants to protect surrounding skin 4
• Reassess current pouching system for proper fit
• Consider foam dressings, barrier films, or pastes containing zinc oxide 4

Stomal Varices Bleeding:

• More serious condition requiring specialist intervention
• Local measures including direct pressure and ligation of bleeding varix may be temporarily effective 2
• For persistent cases, referral for interventional procedures such as embolization, sclerotherapy, or TIPS (transjugular intrahepatic portosystemic shunt) may be necessary 5, 3

Prevention of Recurrent Bleeding

• Ensure proper fit of ostomy appliance to prevent trauma to stoma and surrounding skin 1
• Clean stoma site regularly with soap and water, gently drying afterward 4
• Minimize traction on the stoma site with appropriate fixation 4
• Regular assessment of the stoma and surrounding skin for early detection of complications 4

Red Flags Requiring Urgent Intervention

• Purple/black discoloration of stoma (indicating ischemia) 1
• Persistent heavy bleeding despite pressure
• Signs of systemic compromise (hypotension, tachycardia)
• Bleeding associated with pain and obstipation 1

Special Considerations

• For fungal infections contributing to skin breakdown and bleeding, apply antifungal powder to the skin and seal with skin sealant 1
• For patients with IBD presenting with painful ulcers surrounded by a purple halo, assess for possible peristomal pyoderma gangrenosum 1
• Patients on anticoagulants may require adjustment of their medication regimen if bleeding is persistent

Remember that early consultation with a wound ostomy and continence (WOC) nurse specialist or enterostomal therapist is crucial for proper assessment and treatment of persistent bleeding or complex cases 4.