Living with a stoma can raise many questions, and it is completely normal to encounter a few difficulties along the way. From minor bag management challenges such as ballooning and pancaking, to skin care concerns and digestive changes, most issues that arise have practical solutions. 

This page covers the most common potential stoma issues, with guidance on what to look out for and what to do. If you are ever unsure or concerned, your Stoma Care Nurse is always the best person to contact for advice.

 

Stoma bag ballooning

What causes stoma bag ballooning?

If you notice your pouch inflating with wind, you are experiencing ballooning. This issue typically happens when a stoma bag has a poor filter, or one that becomes easily blocked by waste. The resulting air pressure can push the bag away from your skin. To solve this problem, we developed the unique Active Chamber Filter System for our Salts stoma bags. This specialised design prevents the filter from blocking, ensuring wind is effectively released while fully neutralising odours.

 

How to manage stoma bag ballooning?

If you are experiencing ballooning, there are a few steps that can help. If you are using a filter cover, try removing it, as this allows trapped wind to escape through the bag filter. If your bag has a filter and ballooning persists, the filter may not be working as effectively as it should.

Certain foods and drinks are known to increase wind production and may make ballooning worse. These include spicy foods, onions, cabbage, peas, beans, and fizzy drinks. It is also worth avoiding drinking large amounts with your meals, as this can cause you to swallow excess air.

 

How to prevent stoma bag from ballooning?

Eating regular, smaller meals throughout the day can help to reduce the build-up of wind. Although it is not always possible to prevent ballooning completely, maintaining a consistent eating pattern is one of the most effective ways to manage it over time. For more guidance on diet and your stoma, visit our stoma diet advice page.

 

Stoma bag pancaking

What causes stoma bag pancaking?

Pancaking occurs when the internal layers of the stoma bag stick together, creating a vacuum inside the bag. This prevents the contents from dropping to the bottom of the bag, causing stool to collect near the stoma itself. This can potentially block the bag filter and place pressure on the seal, which may cause the bag to lift away from the skin.

How to manage stoma bag pancaking?

Pancaking is a common issue for people with a colostomy or ileostomy. The following methods can help:

• Before applying the bag, blow a small amount of air into it to keep the walls apart, then apply the filter cover immediately to help retain that air. Once your stoma has functioned, removing the filter cover should allow the stool to drop to the bottom of the bag.
• Some people find it helpful to place a small rolled-up ball of cotton wool or toilet paper inside the bag to keep the walls open.
• Adding a drop of liquid soap or oil into the bag opening can sometimes help the output slide more easily to the bottom of the bag.
• Increasing your fluid intake and including more fibre in your diet may help to soften the output, making pancaking less likely.

 

 

Diarrhoea and your stoma

What causes diarrhoea with a colostomy?

Diarrhoea can be caused by a variety of factors, most importantly a gastrointestinal infection (such as a stomach bug or food poisoning), as well as certain medications, stress, or your diet. Dietary triggers vary from person to person, but loose output can commonly be brought on by spicy foods, green vegetables, or raw fruit. Consuming natural laxatives like prunes and prune juice, or drinking alcohol, can also significantly loosen your output.

 

What causes loose output from your ileostomy?

What causes loose output from your ileostomy?

• Prune juice, fatty/fried foods, spicy foods, fruit juice, alcohol and caffeine.
• Not eating regularly.

Read more about dietary advice here.

 

Managing diarrhoea with a stoma

Experiencing diarrhoea once-in-a-while is nothing to be worried about. However, if you are experiencing three or more loose stools in a row, then this can be a cause for concern and can lead to dehydration. During the week, your stoma care nurse can help review your medications and protect your skin. Over the weekend, call NHS 111 or visit a local pharmacy for expert guidance if you feel unwell.

If you experience diarrhoea, temporarily switching to a drainable bag allows you to empty the loose output easily. This prevents the need for frequent bag changes, which can irritate your skin. If the diarrhoea persists, contact your stoma care nurse or GP.

Staying well hydrated is especially important during a bout of diarrhoea. Aim to drink plenty of fluid to replace what is being lost. For guidance on staying hydrated with a stoma, visit our stoma hydration page.

Food blockages and your stoma

Signs & symptoms of stoma food blockages

Some particular foods can swell in the bowel and some may cause a blockage. This will cause your ileostomy or colostomy to stop working normally.

Please Note: If this is the case, then you should seek urgent advice from your Stoma Care Nurse or GP, if you believe this may be happening to you. Please see below some of the signs & symptoms of food blockages:

• You may experience pain
• You may feel or be sick
• Your abdomen may swell-up
• Your stoma may also swell and appear bigger
• Your output will decrease, stop altogether or may contain large amounts of watery fluid
• You may experience reduced wind or it may stop altogether

 

How to reduce food blockages

It is extremely important to chew your food really well, as this will help reduce food blockages in your stoma bag. The following foods are known to increase the risk of food blockages, so extra care should be taken:

• Raw fruit skins
• Bean sprouts and bamboo shoots
• Dried fruit such as currants and raisins
• Pith, pips and stones
• Popcorn
• Nuts
• Coconut
• Celery
• Mushrooms
• Sweetcorn

 

 

What to do if you think you have a stoma blockage

If you notice that your stoma output has slowed down significantly or stopped, and you are experiencing any of the symptoms listed above, there are some steps you can try at home in the first instance:

• Stop eating solid food but continue drinking fluids
• Try drinking three glasses of water and rest, massaging the stomach and stoma area gently
• Take a gentle walk if you are able to, as movement can help encourage the bowel to work
• If your stoma begins to swell, replace your pouch and cut the baseplate slightly larger than usual to accommodate the swelling

If your symptoms do not improve within a few hours, or if you experience vomiting, severe pain, or your stoma swells significantly, seek urgent medical advice from your GP, Stoma Care Nurse, or by calling NHS 111.

 

 

Peristomal skin problems and leakage

What causes sore skin around a stoma?

Sore or irritated skin around the stoma is one of the most common issues experienced by people with a stoma. It is sometimes referred to as peristomal skin damage. Causes include:

• Leakage of stool or urine under the baseplate, which can cause the skin to become sore or broken
• An ill-fitting appliance, or a bag opening that is too large and allows output to come into contact with the skin
• Skin irritation caused by removing the adhesive too frequently or too forcefully
• Sweating in warm weather, which can affect the adhesive seal and cause moisture to build up under the bag
• Changes in the shape or size of the stoma over time, particularly in the months following surgery.

It is important not to ignore sore skin. If left without attention, skin breakdown can worsen and make it harder to get your appliance to seal properly, which can lead to further leakage.

 

How to manage sore peristomal skin

If you are experiencing skin problems around your stoma, the following steps may help:

• Check that your bag is the right size and shape for your stoma, and use the template provided with your appliance to ensure a snug fit
• Use an adhesive remover when changing your bag to minimise skin trauma
• Make sure the skin is clean and thoroughly dry before applying a new bag
• If you are sweating in warm weather, consider using a barrier product around the stoma site.

If skin problems persist or worsen, contact your Stoma Care nurse, who can review your appliance fit and recommend suitable skin care products.

 

Constipation and your stoma

What causes constipation with a stoma?

Constipation is more common in people with a colostomy than those with an ileostomy, and can occur for a number of reasons, including a low-fibre diet, dehydration, reduced physical activity, or as a side effect of certain medications such as pain relief.

Signs that you may be constipated include a significant reduction in stoma output, stools that are harder than usual, abdominal discomfort or bloating, and reduced or absent wind.

 

How to manage constipation with a stoma

In many cases, making simple changes to diet and fluid intake can help to relieve constipation:

• Increase your fluid intake, aiming for six to eight glasses per day
• Gradually introduce more fibre into your diet, including fruits, vegetables, and wholegrain foods
• Stay as physically active as possible, as gentle movement can encourage the bowel to function
• Review any medications you are taking with your GP, as some may be contributing to the problem.

If constipation is severe, persists for more than a few days, or is accompanied by pain or vomiting, contact your GP or Stoma Care Nurse. Do not use laxatives without seeking medical advice first, as some types are not suitable for people with a stoma.

 

Stoma odour

What causes stoma odour?

Some degree of odour when emptying or changing a stoma bag is completely normal, but persistent or strong odour at other times can be a concern for many ostomates. Common causes include certain foods and drinks, a bag that is not sealing correctly, or a filter that has become saturated or wet.

Foods known to increase odour include fish, eggs, garlic, onions, asparagus, and some spices. Alcohol can also contribute. On the other hand, foods such as yoghurt and parsley may help to reduce odour for some people.

 

How to manage stoma odour

Modern stoma bags are designed to contain odour effectively. If you are experiencing persistent odour between bag changes, the following tips may help:

• Check that your bag is sealed correctly and that the baseplate is adhering fully to the skin
• Make sure the filter is not wet or blocked, as a saturated filter will stop functioning
• Use deodorising drops or sachets inside the bag, which are available on prescription
• Consider a bag with a built-in odour-reducing filter if you are not already using one
• Review your diet and monitor whether any particular foods are worsening the problem.

If you notice an unusual or particularly foul odour that is different from your normal output, this may indicate an infection or another issue that should be assessed by your Stoma Care Nurse or GP.

 

Parastomal hernia

What is a parastomal hernia?

A parastomal hernia occurs when part of the bowel pushes through the abdominal muscle wall around the stoma site, creating a bulge under the skin near the stoma. It is one of the more common long-term complications of stoma surgery and is most likely to develop in the months or years following the operation.

Signs of a parastomal hernia include a noticeable swelling or bulge around the stoma, a change in the shape of the stoma site, difficulty fitting your appliance correctly, or discomfort around the stoma area. The bulge may be more visible when you stand, cough, or strain, and may reduce when you lie down.

 

What to do if you suspect a parastomal hernia

If you think you may have a parastomal hernia, you should contact your Stoma Care Nurse or GP for assessment. Many parastomal hernias do not require surgery and can be managed with the right support belt or hernia garment, alongside advice on protecting the abdominal wall during everyday activities.

Seek urgent medical attention if the hernia becomes very painful, the skin over the bulge changes colour, or you experience nausea, vomiting, or a sudden change in your stoma function, as these may indicate a more serious complication.