A stoma is a surgically created opening on the abdomen that allows bodily waste, such as feces or urine, to exit into a collection pouch. Redness around the stoma, known as peristomal skin irritation, is a common concern. Understanding its causes and management is important for maintaining skin health.
Common Reasons for Redness
Several factors frequently cause redness around a stoma. Effluent leakage, where digestive waste or urine contacts the skin, causes irritation and breakdown due to its enzymatic or alkaline nature. This irritant contact dermatitis can lead to significant skin damage, even from small amounts over time.
Poor ostomy appliance fit also contributes to redness. An opening that is too large allows waste to seep onto the skin. An ill-fitting barrier can also cause friction or pressure on the skin, contributing to irritation and redness. Skin folds or creases can complicate the seal, increasing leakage risk.
Allergic reactions to stoma care product components, such as adhesives or pouch material, can cause redness. This allergic contact dermatitis involves the skin reacting to specific allergens, with symptoms including itching, redness, and sometimes broken skin in the affected area.
Fungal and bacterial infections are another source of peristomal redness. Fungal infections, often Candida albicans, thrive in warm, moist environments under the pouching system, appearing as a red, itchy rash, sometimes with small bumps or satellite lesions. Bacterial infections, such as folliculitis from Staphylococcus aureus, involve inflamed hair follicles, often due to hair removal or trauma.
Mechanical trauma or pressure can also cause skin redness. This includes skin stripping from removing the adhesive too quickly or too frequently, which can pull away the top layers of skin. Tight clothing or rubbing against the stoma area can create pressure. Harsh soaps or cleaning agents can also cause chemical irritation.
Immediate Steps for Care
When redness appears around a stoma, immediate steps can help. Gently clean the peristomal skin with warm water and a soft cloth. Avoid harsh soaps, oils, perfumes, or deodorants, as these can leave residue or irritate the skin.
Ensure proper appliance fit. Check that the skin barrier opening is sized correctly, fitting snugly around the stoma with a small margin, typically 1 to 2 millimeters larger than the stoma itself. A secure seal prevents waste contact and worsening irritation. Regularly measure the stoma, as its size and shape can change.
Use specialized skin barriers or stoma powders to soothe irritated skin and absorb moisture. Stoma powder, which is not medicated, absorbs moisture from raw or broken skin, promoting drying and better adhesion. Apply sparingly to moist, irritated areas, brushing away excess before applying the new appliance. These products create a protective layer, shielding skin from further waste exposure.
Allow the skin to air dry completely before applying a new appliance. Dry skin ensures a good adhesive seal and reduces fungal growth risk. If irritation is present, temporarily change the appliance more frequently to reduce prolonged irritant exposure.
When to Contact a Healthcare Professional
Contact a healthcare professional if you observe any of the following:
Severe redness that worsens rapidly or spreads beyond the area immediately surrounding the stoma.
Changes in skin color, such as turning pale, bluish-purple, or black, which are serious indicators.
Pain, swelling, or tenderness around the stoma, suggesting a significant inflammatory process or potential infection.
The presence of pus, a foul odor, or unexpected bleeding from the skin around the stoma, which are clear signs of infection.
Systemic signs of infection, such as fever or chills, along with localized redness.
Any noticeable changes in the stoma’s appearance, including alterations in its color, size, or output.
Persistent leakage from the pouching system that cannot be resolved through self-care measures, or if the appliance does not adhere securely.
Redness or irritation that does not show improvement within a few days of implementing self-care strategies, or if it continues to cause discomfort.
Strategies for Healthy Skin
Regular, thorough cleaning of the skin around the stoma is important. Use only water or a mild, residue-free soap to prevent irritation and ensure proper appliance adhesion. Completely dry the skin before applying a new pouching system.
Regular appliance changes prevent irritation and maintain skin integrity. Change the pouch and barrier on a schedule, ideally before signs of leakage or adhesive breakdown, to minimize prolonged waste exposure and skin damage. The frequency of changes can vary, but a common recommendation is every two to three days for some systems, or when the pouch is two-thirds full.
Correct sizing of the stoma opening in the barrier is important for skin protection. Periodically re-measure the stoma and adjust the barrier opening as needed for a snug fit, preventing waste irritation. The barrier should fit closely around the stoma, typically with a small gap of about 1/8 inch (3-4 mm) to protect the skin.
Using skin barrier products, such as rings, pastes, or protective wipes, adds an extra layer of protection and helps maintain a secure seal. These products fill irregular skin contours, preventing effluent from undermining the adhesive. Some barriers are designed with skin-protective properties to absorb moisture.
For individuals with hair around the stoma, gentle hair removal methods like clipping or shaving can prevent folliculitis. Avoid pulling or ripping the skin when removing the appliance, as this can cause trauma to the hair follicles. Regular visual assessment of the peristomal skin allows for early detection of any changes or signs of irritation.