This topic is about understanding why someone with a permanent colostomy might experience bright red spotting in and around their stoma, and what steps they can take to address it. The person has had their colostomy for three years and notices:

- Frequent, small bowel movements about every three hours, with some days being busier than others.
- Bright-red spotting both around the stoma and inside the stoma opening.
- The bleeding usually appears after output, not during, and stops within minutes when a cold compress is applied.

They are curious if this is due to irritation from solid stool or the pattern of multiple daily movements. They also mention that the blood sometimes comes from inside the stoma, especially after heavy physical activity, and they are taking blood-thinning medication.

Here are some helpful insights and advice:

1. Minor bleeding or spotting on the skin around the stoma is common:
- It can happen from wiping or accidental trauma when cleaning.
- Often, it's nothing to worry about, and many people with long-term ostomies experience it and just keep an eye on the area.

2. Bleeding from inside the stoma opening:
- One person with a long-term ileostomy has never experienced this and suggests consulting a doctor, as it might indicate a more significant issue.
- Another person on blood thinners reports similar bleeding, and their doctors considered it acceptable and not dangerous, noting that anticoagulants can make stomas bleed more easily.

3. General suggestions:
- Pay attention to whether the bleeding is related to physical activity or medication.
- It's important to seek medical advice if the bleeding is persistent, heavy, or comes with other symptoms, especially if it originates from within the stoma rather than the surrounding skin.