Healing sore skin around a stoma is a common concern for individuals with an ostomy, a surgically created opening on the abdomen. While a stoma has no nerve endings and should not cause pain, the surrounding skin, known as peristomal skin, can become irritated. Addressing this irritation is important for comfort and proper pouching system adherence.
Causes of Sore Skin Around a Stoma
Sore skin around a stoma often results from exposure to stoma output like urine or feces, which irritates and breaks down the skin. This typically occurs when the ostomy pouching system does not fit correctly, allowing leakage under the adhesive barrier. An improperly sized skin barrier, or one that doesn’t account for skin folds or creases, can cause this.
Skin stripping, from removing the adhesive barrier too quickly or frequently, also damages the skin’s top layers. Allergic reactions to components in ostomy products, including adhesives, tapes, or even soaps used for cleaning, can cause redness, itching, or burning. The warm, moist environment under an ostomy barrier also creates conditions for infections. Fungal infections, such as candidiasis, are common and appear as red, itchy rashes. Bacterial infections can also occur, especially if the skin is compromised, leading to redness, swelling, and pain.
Essential Steps for Skin Healing
Maintaining healthy peristomal skin requires consistent, gentle care. Each time the ostomy pouch is changed, thoroughly clean the peristomal skin. Warm water is generally sufficient, but mild, pH-balanced soaps without oils or fragrances can be used. Avoid scrubbing; use gentle, circular motions.
After cleaning, the skin must be completely dry before applying a new pouching system. This ensures proper barrier adhesion and prevents fungal growth. Gently pat the skin dry with a soft cloth or paper towel. Ensuring a secure, proper fit of the ostomy pouch is fundamental to preventing leakage and protecting the skin. Regularly assess the stoma and surrounding skin to identify issues early.
Targeted Treatments and Products
When peristomal skin is irritated, specific products can assist in healing and protection. Barrier films, available as wipes or sprays, create a protective layer on the skin, shielding it from corrosive stoma output and reducing skin stripping from adhesive removal. These alcohol-free formulations prevent irritation and are applied to clean, dry skin before the pouching system.
For moist or broken skin, the “crusting technique” uses stoma powder and a skin barrier film. Stoma powder, which is non-medicated, absorbs moisture from the irritated skin, creating a dry surface for the pouch to adhere to. Lightly dust powder on affected, moist areas, brushing away any excess. A skin barrier film, like a no-sting wipe or spray, is then dabbed or sprayed over the powder to seal it, forming a protective “crust” that helps the pouch stick. This process can be repeated if the skin remains moist.
Ostomy pastes, rings, or seals are additional products that enhance the pouch seal and protect the skin. Pastes fill uneven skin surfaces, creating a flatter area for barrier adherence and minimizing leakage. Barrier rings or seals are moldable, adhesive products placed around the stoma before the pouch. They conform to body contours, filling gaps and creases, providing a more secure seal and protecting the skin. These products are useful for irregular stoma shapes or recessed stomas, where achieving a flat seal is challenging.
When to Consult a Healthcare Professional
While many instances of peristomal skin irritation can be managed with home care, certain signs indicate the need for professional medical evaluation. Persistent pain, severe skin breakdown, or ulceration that does not improve with standard care requires attention. Signs of infection, such as increasing redness, swelling, warmth, pus, or a spreading rash around the stoma, should prompt a consultation. A fever accompanying skin issues also suggests a potential infection.
If the skin condition worsens despite consistent home care, or if there is unusual bleeding from the skin around the stoma, seek advice. An Ostomy Nurse (Wound, Ostomy, and Continence or WOC nurse) specializes in stoma care. They can provide tailored advice, assess the underlying cause of irritation, and recommend specific products or changes to the care routine. They can also help determine if the pouching system needs adjustment or if a different product type would be more beneficial.