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What causes sore skin around the stoma?

It is useful to understand the causes of sore skin around your stoma, so you can try your best to avoid them.

Sore skin around the stoma

1. Faecal Enzymes – the enzymes which are normally put to good use inside your body, breaking down your food into digestible components, will be excreted through your stoma and into your stoma bag.  If they come into contact with your skin outside the body, they have the effect of breaking down the skin.  Ileostomies contain high levels of enzymes as the food is being prematurely removed from the digestive system, their output is particularly corrosive.

2. Moisture – a large part of urine or faeces is made up of water.  Prolonged contact with water will weaken and break down your skin.

3. Chemical / Biological Irritants – such as urea, ammonia and bacteria present in stomal output will damage skin over a prolonged period. 

In your everyday life as an ostomate, there are some things that can compromise your healthy skin:

Ill-fitting appliance

Your stoma will take around 8 weeks post surgery to settle down into what will be its average size and shape.  If the hole in the skin protector is too small, it may dig into your stoma and restrict it; if the hole is too big, the output from your stoma will leak out onto your skin.  Please see our 'Pouching Process' booklet for more information.

Tip:  Your stoma can change size, so it is worthwhile measuring your stoma on a weekly basis for the first 8 weeks to check that you are still wearing the correct size.  Using an Eakin Cohesive SLIMS® seal around the base of your stoma and even slightly up the spout will protect your skin against any output seeping through the skin protector on your bag.

‘Pancaking’ (colostomates only)

‘Pancaking’ is caused by thicker stool which gets stuck at the top of the bag when there is no air.  It dries out and sticks around the stoma, instead of falling to the bottom of the bag.  When the stoma starts to work again, the output leaks out under the skin protector and it lifts off the skin.

Tip:  Try putting a small amount of baby oil onto the inside of the bag, where it touches the stoma.  This will help the output to slide to the bottom of the bag.  Another idea is to put a few pieces of crumpled up toilet paper into your bag near the outside edges, this will stop the vacuum effect and keep air in your bag.  If your bag has a filter, place the filter covers over the filter which will also keep air in your bag.

High output stoma

If your stoma produces a lot of output, it is advisable to take extra measures to protect your skin. 

Tip:  An Eakin Cohesive® Seal (839002) will offer you the maximum protection against leakage.  You will also need to empty/change your bag more often.  If your output is particularly watery in content, it is advisable to use Perform Solidifying Agent.  This product comes in a sachet form, which, when placed in your bag, turns your output to gel, decreasing leaks and simplifying emptying.

Poorly sited stoma – retracted stoma

With standard ostomy surgery, your stoma will have been sited pre-operatively.  However with emergency surgery, the stoma can be poorly sited.  The same principle applies for any stoma, you must achieve a flat platform to place your bag.  Any scars, skin folds or dips must be filled in, otherwise you will leave a channel through which the leaking output will flow. 

Tip:  Eakin Cohesive® Seals and Cohesive® Paste can be used individually or in combination, to fill in any areas which are likely to cause leakage.  Stomas which lie flush with the skin or in a little dip can be pushed out, using a Cohesive® Seal (839002) or a convex pouch so that the output flows directly into the bag.  A convex pouch can also be useful for smoothing out creases near the stoma.

Change in body size

The shape of your abdomen can change with weight loss or weight gain.  Considerable weight loss can make your stoma smaller, as considerable weight gain can make it bigger. 

Tip:  If you think that your stoma has changed size, you should ask to be remeasured by your Stoma Care Nurse.

Change in output

There are a number of occasions which can affect your stoma output such as changes in medication, the introduction of chemo or radiotherapy, eating different foods, enduring stressful periods or having a tummy bug/diarrhoea.

Tip:  Please also see our 'Diet' booklet to see the effects that some foods can have on your output.

Too frequent pouch changes

Less is definitely more when it comes to pouch changes.  The less you have to interfere and wash your skin, the better.  Unnecessary washing and cleansing can remove the skin’s natural protective layers and increase the likelihood of irritation.

Tip:  Using an Eakin Cohesive® Seal will prolong the weartime of your bag, meaning that you have to change less often.

Hairy Abdomen

Some people prefer to remove the hair around their stomas as bag removal can be extremely painful when the bag pulls on the hairs. 

Tip:  If you decide to shave, it is less painful to wet shave in the direction of hair growth, once a week.  A clean disposable razor should be used.  Another option is to cut the hairs with scissors.  Hair removal creams are not advisable.

Bleeding

If you experience any bleeding it is important to check the source of the bleeding.  If there is blood in the stoma output, you should seek immediate medical attention.  However if the stoma itself is bleeding after washing, this is quite normal, as it is made of the same tissue as the inside of your mouth.

Lumps around your stoma

If you experience any sort of growths or lumps around your stoma, you should seek medical attention.  A large bulge may indicate a peristomal hernia.

Skin allergies

If you suspect a skin allergy, you need to determine which product you are allergic to.  You can determine this by patch testing the products individually on another part of your body. 

It is possible that you can become sensitized to a product that you have been using for years.  In this case you should speak to your Stoma Care Nurse to discuss your options.

Tip:  Eakin Cohesive® products are the most skin friendly on the market.  If you become allergic to the skin protector on your bag, a large Eakin Cohesive® Seal can be used to cover the area of sensitive skin, before placing your usual bag on top. 


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