Ostomy Care

Ostomy Care Information

 

Potential Skin Issues for Ostomates

 

Frequently Asked Questions

How do I know if my stoma is healthy?

Each person's stoma is unique. The stoma is always red and moist, much like the mucous membrane in your mouth. A stoma is not painful, as there are no nerve endings in it. Minor, temporary bleeding of the stoma is normal if it is rubbed or hit.

How often should I change my ostomy system?

You should expect predictable, sustained wear time from your pouching system. This is related to the type of skin barrier used the shape of the barrier – convex or flat – and a number of other factors: i.e. climate and your activity level. Some people prefer to change their pouches daily, while others wear their pouching systems for up to seven days. If you have trouble getting your skin barrier to stay in place, you may need to get help with fitting and product selection. The best source of help is an ET nurse.

What is the Skin Barrier?

The skin barrier is the waxy part of your pouching system that sticks to your skin. The skin barrier is primarily responsible for holding your pouch to your body. Tape may be used as additional support, but if the skin barrier doesn’t hold the tape alone won’t be enough.

Is that the only purpose of the skin barrier?

Holding your pouch on is a very important role, but the skin barrier also helps to protect your skin. Without the skin barrier, your skin would be exposed to the harmful effects of the urine or stool.

What size should my skin barrier be?

The opening in the skin barrier should be the one eighth to one-sixteenth of an inch larger than your stoma. Sizing guides are available – do not guess in this situation. If you are not sure you have the right size opening or you want to try a skin barrier that is already pre-cut, you need to measure. SIZE DOES MATTER!!!!

How do I care for my skin properly around my stoma?

Caring for the skin around the stoma is an important part of basic ostomy care.

As we age, our skin changes. It becomes thinner, making it more susceptible to injury and changing the way our body reacts to temperature, pain, pressure and chemicals. It becomes less flexible and often sags. It heals half as quickly as before and becomes drier with visible cracks which harbour bacterial growth.

Good skincare can delay many of the natural ageing processes and aid in keeping the skin healthy.

The basics of good skincare include:
  • Soap and water do not hurt the stoma, so you can bathe and shower without your appliance just as you always have. However, it’s a good idea to choose a soap that is residue-free. Soaps containing moisturizers and oils such as cream soaps, liquid wipes and baby wipes leave a residue that can interfere with how well the skin barrier adheres to your skin. IT IS NOT RECOMMENDED THAT SOAP IS USED TO ACTUALLY CLEAN AROUND THE STOMA. The skin is not dirty there, and gently rubbing the area with plain water will give the best results. Soap will excessively dry the skin which may make it raw or itchy.
  • Air drying is beneficial if time permits.
  • If you are applying moisturizers to your skin avoid the skin area where your barrier is required to adhere.
The peristomal skin may need special attention from the adhesives on the pouching equipment and/or the output from the stoma. Barrier products are designed to protect the skin from contact with moisture and prevent friction. Skin films actually plasticize the skin by placing a co-polymer film on the skin.

Products that provide this barrier film include:

  • Bard protective Barrier Film
  • Conva Tec Allkare Protective Barrier Wipes
  • Hollister Skin Protectant Barriers
  • Smith & Nephew Skin Prep
  • 3M No Sting Barrier Skin Protectant
Barrier wipes are not designed to be used with the new extended wear barriers like Conva Tec’s Durahesive or Hollister’s Fextend. These barriers gently melt onto the skin providing a tight seal. Barrier wipes work to defeat this action in these products.

*REMEMBER*

It is important to avoid excessive adhesive buildup. Adhesive removers can help you wash away adhesive residue easily, without traumatizing sensitive skin. Rubbing the adhesive off may damage the delicate top layer of your skin. It is best not to do this. To aid in the removal of your barrier “walk” the adhesive off gently with one hand as you press against the body with the other using a moist cloth or gauze. Push, don’t pull, the barrier off your skin. Use removers when required, but do not rub the skin in an aggressive manner when using them.

What are Fungal Rashes?

Fungal rashes are more prevalent in late spring and summer. This rash is the same as the one you can get on your feet, groin, or in any dark moist skin fold. It is called Candidiasis Albicans, athletes foot, or a yeast infection.

People who have high blood sugars or ear higher quantities of sweets than normal, those with diabetes, or people who take prednisone type medications are more prone to this rash. Persons with an ostomy who wears a plastic pouch on their side – as most do – are also more prone to this. The plastic ostomy pouch along with the contents of the pouch increases the body heat and perspiration in this area during the warmer months.


If you fit into the above-mentioned group of people, actions can be taken before you get the rash.

Simple things for prevention are:
  • Make sure the barrier that sticks to your body is kept dry after showers and baths (showers are best). You may use a hair dryer set to cool or dry this area very well with a towel.
  • Use a micro-granulated, anti-fungal powder around the intact barrier area as well as under the pouch area. The area under the pouch may be applied daily. The most common anti-fungal powders used are tinactin (miconazole nitrate 2%), candistatin and mycostatin.
  • Use a pouch cover between you and your pouch. The newer style pouches have an extra layer of material that is similar to a pouch cover but some are still made of plastic. A good quality cloth or thick and absorbent towel can be cut to fit under the pouch area. Change the cover when it becomes moist or it can also grow the fungus.
  • If you do develop a rash, do not use a cream on your skin area that is under your barrier. The barrier will stick to the cream and not your body, and it will fall off. You only need to use the antifungal powder on the infected area. You can seal in the powder with a skin barrier provided it does not interfere with the adhesion of the barrier you are using.
  • Change your pouch more often until the rash clears.

What is an Allergic Reaction?

ALLERGIES MAY OCCUR WITH ANY PRODUCT. THEY MAY OCCUR WITH THE FIRST USE OF A PRODUCT OR AFTER YEARS OF USING A PRODUCT WITHOUT PROBLEMS.

Actual allergic reactions to ostomy products are not common. Allergic reactions are usually severe. They will cause blistering and wet, weeping skin wherever the products touch you.

Two situations are frequently labelled as allergic by mistake:
  1. If a skin sealant wipe is used, it needs to dry completely to allow the solvents to evaporate. If the pouch is applied while the solvents are still on the skin, sore skin can easily occur. Since the solvents can’t evaporate through the skin barrier the way they can through the paper tape collar, it may look like there is an allergy to the skin barrier.
  2. Each time you remove a barrier, the adhesive takes the top layer of dead skin cells with it. However, if you are removing a pouch more frequently than it was manufactured to perform, cells can be removed faster than they are replaced. This is called skin stripping. Everyone’s skin reacts differently to having the tape removed. It’s important to be gentle and not remove a barrier more frequently than necessary. Skin that is stripped will be sore in some spots and not in others. Sometimes the skin around the stoma becomes fragile and strips easily.
To test whether you are really allergic: Take a small piece of the test material and place it on any convenient part of your skin far away from your stoma. After 48 hours, take it off and see whether you are reacting. If pain, itching or blistering occurs, take it off immediately.

If you develop an allergy to a product you have used for a long time, you can call the manufacturer. They may have made changes in the manufacturing process. Calls from users are sometimes their first notice that the new improvements are or are not working.