A stoma is a surgically created opening on the abdomen that serves as a new pathway for waste (stool or urine) to leave the body. This opening is a portion of the intestine or urinary tract brought to the surface. It is dark pink or red, moist, and has no nerve endings, meaning it is not painful to the touch. The goal of ostomy care is to collect this waste in a secure, external pouching system and protect the surrounding skin. While the initial process may seem complicated and overwhelming, it quickly becomes a manageable part of a daily routine.
The Routine Step-by-Step Appliance Management
Managing the ostomy appliance involves regularly emptying the pouch and periodically changing the entire system, which includes the skin barrier or wafer. Empty the pouch when it is approximately one-third to one-half full to prevent the weight of the effluent from pulling on the seal and causing leaks. To empty a drainable pouch, open the tail closure over the toilet, direct the contents into the bowl, and then clean the end of the pouch before sealing it again.
Changing the entire appliance generally occurs every three to five days, though this can vary based on the appliance type and individual output. The best time for a change is often first thing in the morning or several hours after a meal when the stoma is less active.
The removal process must be gentle to prevent trauma to the skin, which is often accomplished using the “push-pull” technique. One hand gently peels the barrier away while the other pushes the surrounding skin downward. Adhesive remover wipes or sprays can help dissolve the sticky residue and facilitate a pain-free removal. After the old barrier is removed, the skin and stoma should be gently cleaned with warm water and a soft cloth, avoiding harsh or scented soaps that interfere with the new adhesive.
Measuring the stoma is a necessary step, especially in the first few months after surgery, as the stoma size can change significantly as swelling decreases. A measuring guide helps determine the largest diameter of the stoma, and this measurement is then traced onto the back of the new skin barrier. The opening must be cut precisely to fit closely around the stoma, leaving only a small gap of about one-eighth of an inch to prevent output from touching the skin.
Applying the New System
Applying the new system requires a secure, wrinkle-free seal to ensure optimal wear time and skin protection. If using a paste or a moldable ring, apply these accessories around the inner edge of the wafer opening to fill in any surface irregularities. Center the wafer over the stoma and apply gentle, firm pressure, starting from the area immediately surrounding the stoma and moving outward. Holding a hand over the newly applied barrier for a minute or two helps the warmth enhance the adhesive’s tackiness and bond to the skin.
Maintaining Peristomal Skin Health
The skin immediately surrounding the stoma, known as peristomal skin, is highly susceptible to irritation from potent digestive enzymes or corrosive urine output. Maintaining this skin in a healthy, intact state is a primary objective of ostomy care, as damaged skin causes discomfort and prevents the pouching system from adhering properly. Healthy peristomal skin should look like the skin on the rest of the abdomen, without signs of redness, open areas, or weeping.
If the skin is raw, wet, or broken down, specialized non-medicated ostomy powder can be sprinkled lightly onto the affected area to absorb moisture. Excess powder must be gently dusted off, as too much powder will prevent the appliance from sticking. Next, a skin barrier wipe or spray is gently patted over the powdered area to seal it, creating a protective crust that allows the new appliance to adhere.
Barrier wipes and sprays also create a thin, protective film on the skin before the appliance is applied, shielding the skin from the adhesive. After cleaning the skin, ensure it is completely dry before applying any protective products or the new barrier. Using a hair dryer on a low, cool setting helps ensure the skin is thoroughly dry, which is necessary for achieving a strong, reliable seal.
Addressing Common Stoma Issues
Minor complications can arise, and knowing how to troubleshoot them is a necessary part of stoma management. Persistent leakage is typically a sign of an improper fit or an issue with the skin barrier seal. If leaks occur consistently, the stoma should be remeasured, as changes in weight or abdominal shape can alter its size. This may require an adjustment to the barrier opening or a switch to a convex barrier to push the skin outward.
Another common issue is odor or gas, which, if not controlled by the pouch’s integrated charcoal filter, can be managed with internal pouch deodorants or lubricating drops. These products are placed directly into the pouch to neutralize odors and lubricate the inside of the bag. A related problem, known as “pancaking,” occurs when thick output sticks to the top of the pouch instead of sliding down, which can block the filter and compromise the seal. Pancaking can be remedied by slightly inflating the pouch with air before application or by placing lubricating deodorant into the bag to help the output slide.
Minor bleeding from the stoma itself is generally not a concern, as the stoma is made of delicate, blood vessel-rich tissue and may bleed lightly when wiped or during a change, similar to gum tissue. However, any persistent or heavy bleeding should be reported to a healthcare provider.
There are certain signs that require immediate medical attention:
- A stoma that has retracted below skin level.
- A stoma that has changed color (pale, purple, or black), which may indicate a lack of blood flow.
- Severe abdominal pain or persistent fever.
- A complete absence of output for several hours, which could signal a blockage.
Contact a doctor or a Wound, Ostomy, and Continence (WOC) nurse right away if these symptoms occur.
Living Well With a Stoma
Integrating stoma care into a full life involves managing diet and approaching daily activities with confidence. For those with an ileostomy, hydration and managing output consistency are important, as the small intestine is less efficient at absorbing water. Chewing food thoroughly and increasing fluid intake helps prevent blockages and manage output. It may be wise to temporarily limit high-fiber foods like nuts, seeds, and unpeeled fruits that can be difficult to digest.
After the post-operative recovery period, most people can return to their previous levels of physical activity, with many engaging in sports and exercise. It is recommended to avoid heavy lifting for a period to allow abdominal muscles to heal and to reduce the risk of a parastomal hernia. Specialized support garments or belts are available for those who need extra security during physical activity or who wish to flatten the profile of the appliance.
Clothing choices rarely need to be drastically altered, as modern appliances are discreet and sit flat against the body. Many people find their usual clothes fit well, but some prefer supportive undergarments or clothing with a higher waistband for extra peace of mind. Regarding intimacy, emptying the pouch beforehand and choosing a comfortable position are simple steps that can help maintain confidence.
Traveling with a stoma is straightforward with proper preparation. This includes packing twice the necessary amount of supplies in case of delays and dividing them between carry-on and checked luggage. Carrying a doctor’s note or a travel certificate from an ostomy nurse can help ease passage through airport security. Ultimately, the stoma becomes a manageable part of life, allowing individuals to maintain a healthy, active existence.