maintenance of a good seal between the ostomy pouch and the stoma Contact dermatitis may occur either from leakage around the stoma or from allergy to stomal materials such as tape or pouches Removing the offending material often successfully treats this condition Infection with C albicans is fairly common because of the persistent moisture and the frequent use of antibiotics Treatment with antifungal agents such as clotrimazole, especially powders, is effective The powder can be mixed with a small amount of water and painted onto the skin to enhance adherence of the pouch Ointments and creams should be avoided in fungal infections Skin bleeding resulting from prolonged irritation of the peristomal area is usually minor The cellulitis that can occur if the skin excoriation worsens is treated with systemic antibiotics Stomal Complications Stomal stenosis is not always detectable to the parent or practitioner and may present with reduced or absent output, diarrhea, or cramping abdominal pain When severe stenosis occurs, it usually presents as obstruction To assess the degree of stenosis, the physician should gently examine the stoma digitally unless the stoma is too small In this case, a catheter should be carefully passed If abdominal obstruction is suspected, radiographs of the abdomen and urgent surgical consultation are indicated Prolapse of the stoma occurs in more than 20% of patients with stomas and is usually not an emergency However, skin excoriation, bleeding, and incarceration of the bowel may occur The situation becomes more urgent if the prolapse is associated with pain, decreased output, or a dusky stoma color that represents circulatory compromise; this requires immediate surgical management This includes easing the prolapsed contents back into the stoma using both hands This procedure may need to be done repetitively until such time that definitive surgical repair is undertaken Retraction of the stoma because of excessive tension may cause the stoma to recede beneath the skin This condition occurs more often than prolapse in patients with ileostomies Stomal retraction makes it difficult for a pouch to adhere to the skin Retraction can also result in cellulitis or even peritonitis, depending on the location of the detachment and the flow of the effluent Management usually includes antibiotics and if the retraction is extensive, surgical correction is indicated A hernia of the peristomal contents occurs when there is a protrusion of the colon or ileum into the subcutaneous layers of skin surrounding the stoma This complication may impede adherence of the ostomy pouch but does not usually