An abdominal stoma is a surgically created opening that allows body waste to exit into an external collection pouch. The skin directly surrounding this opening, known as the peristomal skin, should ideally remain intact and look like the skin on the rest of the abdomen. A burning sensation indicates a peristomal skin complication (PSC), signaling that the skin’s protective barrier is compromised. This discomfort is often a result of chemical irritation, mechanical trauma, or infection, and requires immediate attention to prevent the problem from worsening and leading to difficulty in securing the pouching system.
Causes Related to Effluent Exposure
The most common reason for a burning sensation is contact between the peristomal skin and the stoma output, or effluent, which causes irritant contact dermatitis. Effluent is chemically harsh, containing digestive enzymes and corrosive compounds that can quickly break down the skin’s outer layer. Damage begins when even a minute amount of stool or urine leaks beneath the adhesive barrier and pools on the skin surface. The presence of this moisture and chemical irritant leads to a painful, scalded appearance, often described as a severe burn.
The specific chemical nature of the effluent determines the severity of the irritation. Output from an ileostomy, which originates in the small intestine, is particularly enzymatic and alkaline. These proteolytic enzymes actively “digest” the skin tissue, causing rapid excoriation, which is a shallow wound where the top layer of skin has been worn away. Similarly, output from a urostomy is urine, which is highly alkaline and can cause irritation or the formation of crystal deposits on the skin if not promptly removed. Any chronic, low-grade leakage against the skin will cause maceration, where the skin becomes waterlogged and white, making it fragile and highly susceptible to painful breakdown.
Causes Related to Appliance Fit and Physical Irritation
Appliance Fit and Mechanical Trauma
Beyond chemical exposure, the burning sensation can stem from issues related to the equipment itself. Improper sizing of the skin barrier is a common issue. If the opening is cut too large, it directly exposes the sensitive peristomal skin to the effluent, initiating a chemical burn. Conversely, if the opening is too small, the barrier may rub against the stoma, causing friction and trauma to the tissue. Mechanical trauma, or “skin stripping,” occurs when the adhesive barrier is removed too frequently or too forcefully, physically tearing off the outermost layer of skin cells.
Allergic Reactions and Infections
Allergic contact dermatitis is a less common cause, producing a burning, itchy rash that perfectly mirrors the shape of the adhesive product. This reaction is typically to a specific component within the adhesive, tape, or other accessory products, such as sprays or pastes. Another source of intense burning and itching is a fungal infection, most commonly Candida, which thrives in the warm, moist environment trapped beneath the pouching system. Continuous pressure from a rigid appliance or ostomy belt can also create localized pressure ulcers on the skin, which are painful and can progress to deep wounds.
Immediate Steps for Soothing and Skin Recovery
Cleaning and Drying
The first step in addressing a burning sensation is to gently remove the current pouching system and thoroughly clean the irritated skin. Use only lukewarm water and a soft cloth or gauze, avoiding harsh soaps, cleansers, or wipes containing oils, perfumes, or alcohol. These substances can sting and further strip the skin’s protective layer. After cleaning, the skin must be completely dried by carefully patting it with a clean towel or allowing it to air dry, since a new barrier will not adhere properly to wet skin.
The Crusting Technique
For skin that is weeping, raw, or oozing fluid, a technique called “crusting” can be used to create a protective layer. This involves lightly dusting the affected area with stoma barrier powder, gently brushing off the excess, and then sealing the powder with a non-sting skin barrier wipe or spray. This process can be repeated two to three times to build up a durable surface that shields the raw skin from the adhesive and any potential leakage. Finally, measure the stoma carefully and ensure the new barrier is cut to fit snugly around the stoma base, leaving no exposed skin, before applying the new pouching system.
When to Seek Professional Medical Care
A persistent burning sensation that does not improve after one or two pouch changes requires professional evaluation to prevent serious complications. You should contact a Wound, Ostomy, and Continence (WOC) Nurse or your healthcare provider if the irritation worsens or shows no signs of healing within 24 to 48 hours of implementing self-care measures. Furthermore, any deep ulceration, persistent bleeding, or the presence of blister-like or wart-like bumps should be assessed by a specialist. Seeking expert help ensures the underlying cause is correctly diagnosed and that specialized products, prescription antifungal treatments, or a change in appliance type can be instituted.
Emergency Signs
Signs of a severe infection or complication demand immediate attention:
- Spreading redness, red streaking away from the stoma, a foul odor, or fever.
- Deep ulceration, persistent bleeding, or the presence of blister-like or wart-like bumps.
- A sudden change in the stoma itself, such as a drastic change in color to dusky blue or black.
- If the stoma retracts below skin level.