A stoma is a surgically created opening on the abdomen that allows bodily waste, such as stool or urine, to exit the body into a collection pouch. This procedure, known as an ostomy, becomes necessary when the digestive or urinary system cannot function normally due to disease or injury. While ostomies are life-saving, skin irritation around the stoma, also called peristomal skin, is a common concern. This article provides guidance on understanding, preventing, and treating peristomal skin irritation.
Why Skin Irritation Happens
Peristomal skin irritation stems from several factors, often related to the interaction between bodily output and the skin. Leakage of effluent (stool or urine) from the stoma is a primary cause. Digestive enzymes in stool, particularly from an ileostomy, are highly irritating and can quickly break down skin integrity, leading to inflammation and erosion.
Mechanical trauma also contributes significantly to irritation. This occurs from frequent removal of the adhesive pouching system, which can strip skin layers. Friction from clothing or pressure from a poorly fitting pouch can also cause damage.
Allergic reactions to ostomy product components, such as adhesives or skin barrier ingredients, are another potential cause. These sensitivities can manifest as redness, itching, or rash.
Infections, both fungal and bacterial, thrive in the warm, moist environment under an ostomy pouch. Fungal infections, often caused by Candida albicans, appear as red, itchy rashes with satellite lesions. Bacterial infections can lead to folliculitis or painful pus-filled lumps, especially if the skin is already damaged.
Everyday Skin Care Practices
Maintaining healthy peristomal skin requires consistent daily care. Proper application of the pouching system is fundamental. Ensure the skin barrier opening is cut to the correct size for a snug fit around the stoma, preventing effluent contact.
Gentle skin cleansing is another important step. Clean the skin around the stoma with warm water during each pouch change. If using soap, it should be mild, pH-balanced, and free of oils, fragrances, or residues that could interfere with adhesive adherence.
Thorough drying of the peristomal skin before applying a new pouching system is essential. Damp skin impedes barrier adhesion and creates a moist environment conducive to fungal growth. Pat the skin gently with a soft cloth or paper towel until completely dry.
Skin barrier wipes or sprays can provide an additional protective layer, shielding skin from adhesive trauma and effluent exposure. Regular pouch changes, typically every three to five days, are important to prevent adhesive breakdown and prolonged exposure to moisture or minor leaks.
Solutions for Existing Irritation
Addressing existing peristomal skin irritation requires identifying its cause. For leakage-related irritation, reassess the pouching system’s fit. This may involve remeasuring the stoma and adjusting the barrier opening for a snug seal, possibly using barrier rings or paste to fill contours.
Topical treatments can help manage irritation. Stoma powder, a non-medicated powder, can be sprinkled onto irritated, moist, or broken skin to absorb excess moisture and create a dry surface for better barrier adhesion. After applying the powder, gently brush off any excess, then dab a skin barrier wipe or spray over it to “crust” and seal the powder to the skin.
For fungal infections, apply an antifungal powder after cleansing and drying the skin. Use under guidance, as some over-the-counter creams interfere with adhesive. If irritation is from mechanical trauma from adhesive removal, use an adhesive remover spray or wipe for gentle detachment, reducing skin stripping. A proper pouch fit can alleviate painful irritation.
If an allergic reaction is suspected, switch to different ostomy products, as components can vary between brands. It is important to use products specifically formulated for peristomal skin, as general skincare products can compromise pouch adhesion or further irritate the area.
When to Consult a Healthcare Professional
While many instances of peristomal skin irritation can be managed with diligent home care, certain signs require professional medical advice. Consult a healthcare professional, such as an ostomy nurse or doctor, if skin irritation persists or worsens despite consistent home management.
Signs of infection, such as increased redness, swelling, unusual warmth, foul odor, or pus around the stoma, warrant immediate medical evaluation. Deep skin breakdown, including open sores, ulcers, or bleeding that does not stop, also requires professional attention.
Report any significant changes in the stoma itself, such as changes in color, size, or if it appears to retract into the abdomen. Seek guidance from a specialized ostomy nurse if consistently experiencing difficulty achieving a secure seal with the pouching system or managing your ostomy effectively, as they can provide tailored solutions and support.