Medical Oncologist
CION Cancer Clinics
What a healthy stoma looks like, and when to worry | CION Cancer Clinics
A healthy stoma is pink to deep red, moist and a little shiny, like the inside of your cheek, whatever your skin colour. It is swollen at first and shrinks over the following weeks. A few spots of blood when cleaning are common. A stoma that turns dark purple, black or very pale needs a same-day call. This page shows what is normal and what is not. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What colour should a healthy stoma be?
- Which things look worrying but are usually normal?
- How does a stoma change after the operation?
- What do families wrongly think about how a stoma looks?
- Is this normal, or should you call?
- What can a description not tell you?
- Common questions about how a stoma should look
The short answer
What colour should a healthy stoma be?
A healthy stoma is pink to deep red, moist and slightly shiny, much like the inside of your cheek. Its colour does not depend on your skin colour, because it is the lining of the bowel, not skin.
Why it looks the way it does
The stoma is made from the inside of the bowel, which has a rich blood supply close to the surface. That blood supply gives it the pink-red colour and keeps it moist. It is the colour that tells you and your nurse the most about whether the stoma is getting enough blood.
What it does not feel
The stoma has no nerve endings that sense pain, so you will not feel it being touched. That is useful when cleaning, but it also means you will not feel a cut from a badly fitted bag. Look at it at every change, in good light, for a few seconds. A small hand mirror helps if it sits low on the belly.
Take a photo in the first week with your phone. It gives you and your nurse something to compare against later.What is normal
Which things look worrying but are usually normal?
Families often call about these in the first weeks. Each is expected, within limits.
A little bleeding when cleaning
Blood vessels sit near the surface, so a few spots of blood on the cloth are common. Gentle pressure with a soft damp cloth usually stops it within moments.
Swelling after surgery
A new stoma is puffy. It shrinks over the first weeks, so the hole in the bag has to be cut smaller as it does.
It moves
The stoma gently moves, shrinks and swells as the bowel works. This is the bowel pushing output along, not a problem.
An odd shape
Stomas are round, oval or uneven, and a loop stoma has two openings. Shape matters less than colour.
Also normal
- Clear or white mucus
- Slight darkening of the skin around it over time
Not sure whether this applies to you?
Ask an oncologistOver time
How does a stoma change after the operation?
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The first days
The stoma is swollen, and may look darker or bruised at the edges. Nurses check its colour often. There may be little or no output at first while the bowel wakes up.
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The first weeks
Swelling goes down steadily. Measure the stoma with the guide card at each change and cut the bag hole to match, leaving only a small gap. Output becomes more regular.
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Around the second month
The size usually settles. Many people can move to pre-cut bags at this point. Ask your nurse to measure again at the follow-up visit.
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Later on
Weight gain or loss, and a hernia around the stoma, can change its shape and size years later. If bags start to leak after a long time without trouble, get it measured again.
!
Signs that need a same-day call to your surgical team
Call the same day if the stoma turns dark purple, brown, grey or black, or looks very pale. Call if bleeding from inside the stoma does not stop with gentle pressure, if the stoma pulls down below the skin, or if it pushes out much further than usual and changes colour. Do not wait to see whether it improves overnight.
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Commonly believed
What do families wrongly think about how a stoma looks?
"It is red, so it must be infected."
A red, moist stoma is healthy. Infection is far more likely to show in the skin around it, as redness spreading outwards with heat, pain or pus. The stoma itself being red is what you want to see.
"It bled, so the cancer is back."
Small spots of blood during cleaning are almost always from rubbing the surface. Bleeding that keeps coming, or blood mixed through the output, is different, and should be checked by your team without delay.
"It doesn't hurt, so nothing can be wrong."
Because the stoma cannot feel pain, a cut from the bag edge or a problem with blood supply may cause no discomfort at all. Looking at it is the only reliable check.
"We should put cream or turmeric on it to heal it."
Nothing needs to go on a healthy stoma except warm water. Creams, oils and home remedies stop the bag from sticking and can irritate the skin. Use only products your stoma nurse recommends.
Quick check
Is this normal, or should you call?
Usually normal
Call your team
Pink to deep red and moist
Dark purple, black or very pale
A few spots of blood when cleaning
Bleeding that will not stop, or blood in the output
Slowly getting smaller in the first weeks
Suddenly sinking below the skin or bulging far out
Skin around it looks like the rest of your belly
Skin that is raw, weeping or breaking down
Being straight with you
What can a description not tell you?
Words and colours on a page cannot replace someone looking at your own stoma. Shades of red vary with light, phone cameras change colours, and what is normal for one stoma may not be for another.
Know what yours usually looks like
The most useful comparison is with your own stoma on a good day. Keep your early photo and take another whenever something looks different. Note the date, what changed, and whether output has changed too. That makes a phone call with your team quicker and clearer.
When you are unsure
If you cannot decide whether something is normal, call. Nobody on a surgical team minds a call about a stoma that turns out to be fine. They do mind a problem with blood supply that waited until morning. If the stoma belongs to an elderly parent who cannot see it well, a family member should look at every change.
Who this check does not replace
Looking at the stoma is a home check, not a medical review. It does not replace your follow-up visits, where the surgeon also checks the wound, the skin, your weight and how you are eating. It also cannot pick up problems inside the belly that do not show on the stoma, so keep every appointment even when the stoma looks perfect.
Questions we are asked
Common questions about how a stoma should look
My father's skin is dark. Should his stoma be darker too?
No. The stoma is bowel lining, not skin, so a healthy stoma is pink to red whatever the person's skin colour. The skin around it follows skin colour and may darken a little over time. A stoma that itself looks dark purple, brown or black needs a same-day call to the team.
How big should a stoma be?
There is no single right size. Stomas vary from person to person and shrink after surgery. What matters is that you measure it regularly with the guide card and cut the bag hole to fit, so that only a very small ring of skin shows. Ask your nurse to check your measurement.
Is it normal for the stoma to stick out?
Yes, within limits. An ileostomy and a urostomy are usually made with a small spout so output goes straight into the bag. A colostomy often sits flatter. Call your team if it suddenly pushes out much further than usual, especially if it changes colour, swells or output stops.
What does it mean if the stoma goes below the skin?
A stoma that sinks to the level of the skin or below is called retracted. It often causes leaks, because output runs under the bag. It may need a different, curved baseplate. If it happens suddenly after surgery, or the colour changes, call your surgical team the same day.
Why is there white jelly around or in the stoma?
That is mucus, which the bowel lining makes naturally. It keeps the stoma moist and is seen with every type, especially a urostomy. Simply wipe it away with warm water. Mucus that is green, smells unusual or comes with a fever is worth mentioning to your team.
Can I clean the stoma with soap or antiseptic?
Warm water and a soft cloth or dry wipe are enough. Soaps with oils or perfume, antiseptic liquids and baby wipes with lotion can irritate the skin and stop the bag sticking. If you prefer soap, use a plain one and rinse the skin thoroughly before drying.
Should I send a photo of the stoma to the nurse?
Ask your team whether they accept photos and how. A clear picture in daylight, with a coin or the measuring card beside it for size, can help them decide how urgently you need to be seen. A photo does not replace a same-day visit when a red flag is present.
The skin around the stoma is red and sore. Is the stoma unhealthy?
Usually the stoma is fine and the skin is being irritated by output leaking under the bag. Check that the hole is cut to the right size and that the skin is completely dry before fitting. If soreness lasts more than a couple of changes, show it to your stoma nurse.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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Sources
- NHS — Colostomy
- NHS — Ileostomy
- American Cancer Society — Ostomies
- Macmillan Cancer Support — Cancer information and support
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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Worried about how a stoma looks?
If something has changed, call the helpline and we will help you reach a surgical team. If there is a red flag, go to the nearest emergency department first.