An ostomy is a surgical opening, or stoma, created on the abdomen to allow for the passage of waste into a collection pouch. Living with an ostomy involves focusing on the skin immediately surrounding the stoma. Maintaining the integrity of this specialized area is necessary for comfort, security, and the proper function of the pouching system, as it is constantly challenged by unique environmental factors.
Defining Peristomal Skin
Peristomal skin is the area, typically about four inches, around the stoma where the adhesive skin barrier must adhere. This skin is unique because it is repeatedly subjected to the application and removal of strong medical adhesives, which can cause trauma. Furthermore, it is constantly at risk of contact with effluent (stoma output), which contains digestive enzymes and chemical irritants that can rapidly damage the skin barrier.
Healthy peristomal skin should look and feel exactly like the skin on the rest of the abdomen: intact and free from irritation. It should be smooth, dry, and clean, with no signs of redness, rash, or open areas. Any persistent discoloration, pain, or discomfort suggests a problem. Compromised skin prevents the pouching system from forming a secure seal, making specialized care an ongoing requirement for ostomy management.
Routine Care for Healthy Skin
Proactive and gentle cleaning techniques are the foundation for preventing peristomal skin breakdown. When changing the pouching system, wash the skin with warm water and use only mild, oil-free, and residue-free soap. Residues from lotions or creams interfere with the skin barrier’s adhesive, increasing the chance of leakage and irritation. The peristomal area must be fully dried before applying the next pouch, as moisture promotes microorganism growth and compromises the adhesive seal.
Proper sizing of the skin barrier significantly reduces the risk of skin damage. The barrier opening should fit closely around the base of the stoma, typically allowing only a small gap of about one-eighth of an inch larger than the stoma itself. An opening that is too large allows caustic effluent to contact the skin, leading to rapid irritation and skin loss. Since the stoma can change size and shape, measuring it periodically is important to ensure the barrier fit remains accurate.
Safe removal of the adhesive barrier is another key preventive action to avoid mechanical injury. The barrier should never be ripped off quickly, which can strip away the outer layers of skin. Instead, remove it gently by peeling it back from the skin, starting at one corner. Using an adhesive remover spray or wipe can help dissolve the bond, making the separation less traumatic.
Recognizing Common Skin Complications
Identifying changes in the peristomal skin is the first step toward effective management, as skin complications are common. Irritant contact dermatitis, or peristomal moisture-associated skin damage, is the most frequent issue, resulting from stoma effluent leaking onto the skin. This condition ranges from redness and inflammation to moist or weeping areas of skin loss. The location of the damaged skin, often directly under where a leak occurred, provides a strong clue to the cause.
Mechanical injury, also known as skin stripping, is caused by aggressive or frequent removal of the adhesive barrier. This trauma causes patches of moist, pink, or red skin loss that often mirror the shape or edge of the pouching system. The loss of the top layer of skin makes the area painful and highly vulnerable to further damage.
Fungal infections, often caused by Candida yeast, thrive in the warm, moist environment under the barrier. This infection typically appears as a rash with small, distinct red bumps or pustules, often with smaller “satellite lesions” scattered outward. Folliculitis, the inflammation of hair follicles, appears as small red bumps or pimple-like lesions near the stoma, especially in individuals who shave the area.
Managing and Treating Peristomal Skin Injury
Once a skin complication is identified, immediate intervention is necessary to protect the skin and restore a secure pouch seal. The primary action for irritant contact dermatitis is correcting the cause of the leakage, often by adjusting the size or type of the skin barrier. For weeping or denuded skin areas, lightly dust a pectin-based stoma powder onto the skin and brush off the excess before applying the new barrier. The powder absorbs moisture and creates a protective surface, allowing the adhesive to bond.
For fungal infections, topical antifungal powders can be used, but avoid creams and ointments as they prevent the pouch from sticking. A liquid skin barrier film can be applied over the antifungal powder to protect the skin and enhance adhesion. In cases of mechanical injury (skin stripping), a no-sting barrier film helps protect the raw skin from the adhesive and promotes healing.
If a complication is severe, persistent, or fails to improve within a few days, seek professional medical advice. A Wound, Ostomy, and Continence (WOC) nurse is a specialized healthcare professional who can accurately assess the problem and recommend appropriate changes or specific treatments. They can help determine if a change to a convex appliance, a barrier ring, or a different product type is needed to achieve a reliable, skin-friendly seal.