Caring for your skin
Sore skin - You don’t have to put up with it
The area of skin around your stoma needs care and attention to prevent and reduce the risk of soreness. Occasionally, people with a stoma may experience sore skin around the stoma. This could be due to a variety of reasons. If you are experiencing sore skin or any other difficulties related to your stoma, your Stoma Care Nurse will be happy to see you and offer advice and help to solve the problem.
Possible Causes of Sore skin
An incorrect template
Just after surgery, the stoma will be swollen after being handled during the operation. As time passes (approximately 8 weeks), the stoma will gradually reduce in size and, eventually, establish a final size. This is very individual - no two stomas are the same size; and some may be round, some may be oval, for example.
If your template is too large, this will leave skin exposed around the pouch opening: the stool or urine will then collect there, causing soreness. It is important in the early days to have your template frequently checked by your Stoma Care Nurse. If you have had your stoma for a while, it's still advisable to have it checked from time to time - perhaps once or twice a year.
Sometimes, the stoma can become larger, too - another reason to have your template checked. This could be because of:
- A muscle weakness around the stoma. This is known as a parastomal hernia
- The effect of drugs that can inflame the stoma, such as chemotherapy
- Pregnancy
- Weight gain (weight loss will lead to the stoma getting smaller)
Alterations in tummy shape
Again, this may be due to weight gain or loss, or muscle weakness. Sometimes, the tummy becomes more creased than it used to be, so the pouch doesn't adhere securely to the uneven skin, causing the contents to leak under the adhesive. There are many different kinds of filler pastes and washers that can be used to fill these creases, and your Stoma Care Nurse will be the best person to advise you on their use. In addition, there are also different kinds of pouches offering more flexibility.
Changes in your output
There are many reasons why the normal output from your stoma could change:
- Changes in medication e.g. antibiotics or chemotherapy
- Changes in your diet
- Anxiety
- Gastroenteritis
If the stool becomes loose or watery, this will increase the possibility of it leaking under the adhesive onto the skin and causing soreness. If you are experiencing a change in the consistency of your output, speak to your Stoma Care Nurse, who will be able to advise you.
Small lumps may have appeared around your stoma
Your surgeon will have stiched together where the skin and stoma meet during your operation. Occasionally, the area goes through a process of over-healing of the two surfaces, called granuloma, which can appear as moist, red raised areas. Repeated friction from the pouch can make this worse. Granuloma are harmless but can be a nuisance as they bleed readily when touched. This may cause the pouch to leak because, if it is covering the lumps, any moisture from them may cause it to lift and break the seal. If any lumps appear around your stoma, you must seek the advice of your Stoma Care Nurse, as granuloma can be treated quite easily with the right help.
Existing skin disease
If you had a skin disease such as eczema or psoriasis prior to your operation, there is always the chance that it may occur near your stoma, afterwards. This may require a doctor who specialises in skin disease to advise on treatment. If you have previously used an ointment-based treatment on problem skin, this cannot be used around the stoma as it will stop the pouch from adhering. Use the same treatment, but in a cream - rather than ointment - format. Your Stoma Care Nurse will advise whether you need to see a doctor.
Changes in sensitivity
Even if you have happily used the same stoma product for years, it is not unknown to suddenly become sensitive to it. If this has happened to you, please speak to your Stoma Care Nurse, who will give you advice on what to do to solve the problem.
Temporary or loop stomas (not urostomies)
Thanks to recent advances in surgical procedures, fewer long-term stomas are being created. To make reversal of a stoma easier, a loop of bowel is brought to the surface and cut, leaving two openings - although you will probably only see one of them. This can increase the risk of retraction of the stoma; where, instead of the stoma looking like a spout slightly proud of the surface of your skin, it becomes level with it. This is more commonly a problem with temporary ileostomies, and is one of the causes of leakage. Again, your Stoma Care Nurse will advise you on how to treat this.
Hairy tummies
Gentlemen with hairy tummies may notice small pink pimples around the stoma. This is called folliculitis and is due to the pouch pulling on the tiny hair follicles in the skin. This can be reduced by shaving the skin around the stoma periodically, but not more than once a week. Use a new disposable razor and warm water only when doing this, as shaving creams, hair removing creams and gels can all cause irritation and soreness.
Changing your pouch
How to care for your skin while changing your pouch
Check you have everything ready to hand: - Water
- Soft dry wipes*
- Disposal bag (for soiled pouch and wipes)
- Clean pouch to apply
- If you have a urostomy or ileostomy, ensure that the pouch is emptied before you remove it.Then remove it with both hands – one to take off the pouch; and the other to hold the skin, to reduce ‘pulling’ on the area. Always start from the top of the pouch so that, if the stoma starts to work, any output will fall into the pouch.
- Using the soft wipes and water, clean the skin around the stoma and the stoma itself. You may notice a little blood on the wipe. This is because the bowel has a very healthy blood supply, and will bleed slightly when touched – a little like your gums occasionally bleeding when you clean your teeth.
- Once you’ve cleaned the area, make sure it's dried thoroughly.
- Apply the clean pouch, making sure there are no creases in the adhesive.
If you use a delivery company to obtain your prescription, you will be supplied with soft dry wipes to clean the stoma and the surrounding skin. If you obtain your prescription from other sources, you may choose to use toilet paper or kitchen towel to clean around the stoma. If you do use either of these, make sure you only use white, not coloured, paper or kitchen towel. Prolonged use of coloured paper can cause a skin reaction as the coloured dyes contain zinc, which can affect the skin.
If you prefer to use soap on the skin around your stoma, baby soap or simple soap that is unperfumed should be used. It's up to you whether you use soap or not - water alone is perfectly adequate and acceptable for cleaning. However, if you do use soap, you must rinse it off before drying your skin.
Specific care for types of stoma
Colostomy
You may notice that the stool sometimes gets stuck at the top of the pouch, rather than dropping into it. This is called ‘pancaking’, and can cause the stool to push under the adhesive of the pouch, causing a leak and sore skin. There are products available that can help with this problem, and your Stoma Care Nurse will be able to advise you.
Ileostomy
The output from an ileostomy is more fluid than a colostomy, because the colon with the facility to absorb water has been bypassed or removed. Ideally, the consistency should be like porridge. However, if you do experience leaks, this will very quickly make the skin sore because the stool from an ileostomy contains digestive enzymes. There are products available that can help with this problem, and your Stoma Care Nurse will be able to advise you.
Urostomy
If you are experiencing leaks from your urostomy, you may notice that the skin looks wrinkled and soggy (like hands that have been washing up). This can make the skin more delicate and increase the risk of soreness. When urine is alkaline, this can lead to a bluish discolouration of the skin and pouch. There are products available that can help with these problems, and your Stoma Care Nurse will be able to advise you.