STOMA/SKIN CARE

The stoma refers to the piece of intestine that you see on your belly. No matter what type of ostomy you have, stomas have common features.

A normal stoma is:

• Pink-red in color
• Moist like the inside of your mouth
• May slightly bleed when rubbed
• May move and change shape
• Without nerve endings for touch

Even though a red stoma looks like it should hurt, it doesn’t! The stoma stays red and may bleed slightly when cleaned because of a rich blood supply within the tissues. After surgery, you may see sutures (stitches) around the outside of the stoma which will gradually dissolve. The stoma is also swollen after surgery which will decrease in size over 6-8 weeks. You will not have control over when the stoma will pass waste. When the waste is ready to leave the body, it will pass through the stoma into the pouch on your belly.

The stoma is unique to you, depending on your body shape and the way the stoma was made. Your stoma may be:

• Round, oval, or irregular in shape
• Even with the skin, protrude above the skin level or pulled inward below the skin level
• Located on either the left or right side of the belly

• End stoma – The functioning end of the intestines is brought to the belly, is turned back on itself (like a turtleneck sweater) and is attached to the skin with sutures. There is only one opening to pass waste. The other end of the intestines is either removed, sutured closed, or is brought up to the belly as a second end stoma. Since the second stoma is non-functioning, it will only pass mucous.
• Loop stoma – A loop of intestines is brought to the belly and usually a temporary device (rod or tube) holds the loop up until healing occurs. An opening is made only in the top part of the loop exposing two openings into the stoma. The functioning opening will pass waste, the other will pass mucous. Usually a loop colostomy or illeostomy is made when it is intended to be temporary.

The skin around the stoma (peristomal skin) should look normal, without redness, rash or irritation. The skin will usually feel sore if it is damaged, but not always. Be sure to look at your skin at each pouching system change. There are various reasons why skin problems occur, some common ones are listed.

A pouching system that does not fit right may lead to leakage and skin problems. People with ileostomies have a greater risk for skin damage due to small intestinal enzymes in the stool. However, those with colostomies and urostomies can experience skin problems too. Skin damage may be redness, irritation or open, weepy skin. Some tips to prevent and treat skin problems include:

• Re-measure the stoma regularly the first 8 weeks to down-size your barrier opening as your stoma shrinks.
• Change your pouching system regularly before leakage.
• Consider other pouching systems or accessories for a better fit.
• Use pectin powder to treat skin until healed.
• Contact your ostomy nurse or doctor if the skin does not heal.

Allergies can develop to any products you are using. This can occur anytime, even if you have been using the same product for a long time. The skin may itch, blister, develop a rash, or become weepy. The skin problem may match the shape of the product, such as under a tape border. Ostomy tips include:

• Patch test products on the other side of your belly to check for redness, itching, and irritation after 48 hours. Change to another product if needed.
• Talk with your WOC nurse or supplier for alternate products.
• Contact your WOC nurse or doctor if the skin does not heal.

A skin infection can occur. Moisture at the ostomy site may contribute to a fungal infection (yeast) especially if you have recently been on an antibiotic. Symptoms include itching, redness, and rash with white or red bumps that continue to worsen without treatment. Tips include:

• Treat the skin with antifungal powder prescribed by your doctor.
• Change your pouching system more often during treatment.
• Continue to treat the skin for a couple of weeks after the skin is normal.
• Contact your doctor or WOC nurse if the skin does not heal.

If any of the following problems occur, call your doctor:

• Stoma turns darker in color or becomes longer
• Excessive bleeding from the stoma or at the stoma-skin margin • No stool for 48 hours for colostomy; or 6 hours for ileostomy
• Abdominal pain, cramps, severe diarrhea, and/or nausea & vomiting
• Bulge that develop under or around your stoma
• Peristomal skin problems that do not resolve.