Advice: How to Solve Peristomal Skin Issues

Disclaimer: This information is based on my own personal experience since my ostomy surgery in August 2016 and is not intended to replace medical advice from a trained professional. If you are requiring advice regarding your own stoma, routines which might benefit you most, or products that suit your needs best, please contact your stoma care nurse for further assistance.

This is important to note in the weeks after your surgery. As the intestine calms down, the size of your stoma goes down too. This means the template you use to cut your ostomy bag will change too. Recommended gap between stoma and your bag should be 1/8” – it should be snug to your stoma but not tight. Tightness can lead to it being strangulated. If it too big, output will seep under the bag, leading to a leak and irritated skin. It is useful in those first weeks to regularly – like every other bag change – check the size and shape of your stoma. If you are having regular check-ups with your SCN, let them change the bag for you. I’ve found that mine is a pro at noticing the smallest change in my stoma.

A proper fit for your bag is the first port of call and most skin issues are down to leaks happening when the bag is cut too large

2. Change in output

As you heal from surgery and you become more used to your stoma, the output will also change. This is mostly down to your diet changing. An increase in your fluids and the eating of certain foods will make the output thinner, possibly leading to leaks under the bag.

With thicker output, it can get stuck around the top of the bag close to your stoma, leading to ‘pancaking’. This can force the faeces under the adhesive of your pouch and onto your skin. I’ve found that chewing food well and drinking plenty usually helps to thin out what could be thick output – from the likes of meat, fibrous veggies and starchy foods. I also leave my bag a little air inside it to help the output fall to the bottom of my bag.

3. Change in abdomen shape

As we get used to our new diet and new lifestyle, we can lose and gain weight. This can lead to changes in the shape of your abdomen, meaning output can get under the pouch and onto the skin through the gaps around your stoma. It is important to maintain a good weight so that these fluctuations don’t happen so drastically. You may need some convexity to your bag to help push your stoma away from your abdomen so the output call fall into the pouch, instead of settling around your stoma.

4. Lumps and bumps

Likewise, with the above, dips in the skin around your stoma can cause the bag to not stick and output to seep on to the skin. These dips can be caused by scarring or the stitching of your stoma from surgery healing irregularly. There are products that can help fill in those gaps.

5. Irritation to products

If after all the above issues have been investigated and your skin is still irritated, you could be having a reaction to the bag your using. As hard as it is to move to another bag, this will help you find something that keeps your skin healthy. Your SCN can help advise what brand you could switch too and provide you with some sample to try.

If you are using a lot of products in your change routine, you could be having a reaction to one or more of the products. Again, it is worth having a discussion with your SCN to help figure out what is causing your irritation.

Remember:

• It is best to nip skin issues in the bud.
• Do not ignore, seek medical attention through your SCN or GP
• There are plenty of products available to sample through ostomy companies, get in contact with them to discuss your needs.
• You are entitled to help, you do not need to live with a rash or any skin problem.

My Tips:

• Measure your stoma size regularly. I do mine once a month.
• Keep hydrated. This will help keep your stoma output consistent and you will feel a long term benefit when it comes to hotter weather and / or exercising.
• Order samples from companies. You never know when you’ll need something new and waiting can make your skin worst.
• Do not use scented products to clean your skin. Keep it as simple as possible.
• Thoroughly clean your skin around your stoma – make sure it is free from residue from both products and output
• Simple is best – the less you use is better for your skin. This can be hard sometimes, I know, but it keeps the skin healthy; long term.

If you want to know what products I would recommend, please message me, I’m happy to share but I am not a SCN nor am I medical trained. Please seek help from your SCN if you are concerned about your skin.

Here are articles I’ve found which provide a solid basic knowledge of peristomal skin issues:

• Article from Colostomy Association’s Tiding magazine in conjunction with Salts Healthcare: this has some excellent tips of how to keep your skin healthy whilst you have a stoma.
• Medical article from Ostomy Wound Management on ‘Complications: Prevention and Management’: medical insight into how doctors look at stoma skin issues.
• Peristomal Skin Assessment Guide from Wound, Ostomy and Continence Nurses Society (WOCN): they provide a thorough step by step guide on specific skin issues.
• OstomyLife article from Shield Healthcare on skin complications: looks at the specific types of complications, beyond what is mentioned above.