Ask the Ostomy Nurse

Linda Coulter has been a Certified Wound Ostomy & Continence Nurse for 10 years. In addition to working with hundreds of people with stomas, she has trained several WOC nursing students at the R.B. Turnbull Jr. School of WOC Nursing. Linda has presented nationally and internationally on ostomy related topics. From her home base at University Hospitals’ Ahuja Medical Center, Linda is active in raising Ostomy Awareness, and works to distribute ostomy supplies to people in need throughout the world.

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Granulomas

I have granulomas around my stoma. My surgeon said to just leave them alone, but they can bleed when I change my skin barrier. I also have to cut the hole in the barrier larger than I want to. Any ideas on what to do?

J.K.

Dear J.K., I encounter granulomas frequently in the outpatient clinic. These usually occur on the stoma where it rubs on the pouch or wafer. Sometimes the bleeding site is small – about the size of the tip of a pen. They may be larger, like a pencil eraser, or there may be a cluster of granulomas. Fortunately, they are made of the same tissue as the stoma and aren’t painful. The bleeding can be disconcerting and problematic if it isn’t controlled. So, while adjusting the barrier may be the best course of action, it is often necessary to remove the granulomas as well.
Depending on the size of the irritated tissue, the physician may cut off the excess tissue. If it is small, the physician may instruct an ostomy nurse to cauterize the tissue. This means that the tissue is gently burned off of the stoma with a chemical called silver nitrate. The silver nitrate comes on a wooden stick and looks like a long cotton-tip swab, but with a small gray drop on one end rather than the cotton. After cleaning the stoma, the stick is gently applied to the granuloma. Again, this should be painless. The silver nitrate leaves a gray to black hue at the cauterized area. This discolored tissue will fall off of the stoma over a few days. Applying a pectin-based stoma powder will help this to happen, but you will notice it for the next pouch change or two. When it clears, the granuloma and the bleeding should be gone or greatly decreased. During the same visit, the stoma nurse can measure your stoma, assess your abdomen and make recommendations to help reduce the chance that granulomas will recur. These steps should improve your pouching experience and give you more peace of mind.
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