If pain is present with the stoma, what should be assessed for?

• A. Granulomas
• B. Peristomal breakdown
• C. PG
• D. Pemphigus

Answer: (B)

Pain around the stoma usually points to irritation or breakdown of the skin surrounding the stoma. The most important assessment is the peristomal skin for issues such as erythema, maceration, erosion, or excoriation, which often result from leakage or an ill-fitting appliance. Inspect the skin all around the stoma, check for moisture pooling under the wafer, and evaluate whether the flange fit, seal, or convexity is appropriate. Consider how well the appliance protects the skin, and look for any signs that stool or effluent is contacting the skin.

If peristomal breakdown is present, manage by optimizing the barrier approach (appropriate skin barrier, barrier rings or paste as needed), ensuring a proper fit and seal, and reducing moisture and friction. A referral to a wound, ostomy, and continence nurse can help fine-tune fit and skin care. Other conditions like granulomas, pyoderma gangrenosum, or pemphigus are less likely to explain new pain at the stoma; granulomas are localized tissue growth that can bleed and cause discomfort but aren’t the typical cause of acute peristomal pain, while pyoderma gangrenosum and pemphigus are rarer and present with different skin findings.