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Some of the Most Common Stoma Problems

10th September 2020

People with stomas will know that from time to time, they may experience a problem with their stoma. The most common stoma problems are not serious and can be overcome with good stoma care, a change in product, a review of diet and adjustment of lifestyle. Some of these problems can be self-managed and other problems will need nursing intervention from your Stoma Care Nurse to resolve the issue.

Here is a list of the most common stoma problems people face. They are usually related to leaks, skin irritation/sore skin, diarrhoea/loose stools, ballooning, hernias, prolapses and a few of the less common problems which may occur for some.

Leaks:

Leaks can occur for a number of reasons. It’s important to speak with your local stoma care nurse to determine the cause of the leaks. Often an ill-fitting pouch can often be the cause of leaks. Following surgery you may find that your abdomen changes shape, which will then affect the size of your stoma. So it is important that the size of your stoma is checked regularly and the template adjusted accordingly.  If the pouch doesn’t fit properly, it can result in sore skin.

A change in your output can also cause issues with leakage. Speak with your stoma nurse if your output has suddenly changed. If your output becomes loose, it can often find ways to leak, which is a miserable cycle and soon causes skin irritation and soreness.

Leaks can also occur if your stoma protrusion has altered. Again speak with your Stoma Nurse as they may initiate a different product to try, such as convexity. This needs to be monitored by your stoma nurse to check its effect and that there are no side effects from its use.

Skin irritation/sore skin:

Looking after your skin is the most important part of caring for your stoma. Occasionally the skin becomes sore, red and broken, causing discomfort. There are a number of reasons why this can happen. Leaks often result in sore skin as the stool or urine is sat on your skin causing irritation.

Another cause can be trauma to the stoma or skin. Your stoma and the skin around it, is at risk of damage and therefore needs to be cared for. If an incorrectly sized template rubs, it can cause injury to the side of the stoma which may cause small ulcers. Try to check the size and shape of your stoma, template and the surrounding skin on a regular basis.

Sensitivity to the adhesive in certain products, is uncommon but can happen, even if you have been using the products for a long time. It may initially start with minor irritation but get gradually worse if left.

Folliculitis is an inflammation of the hair follicles. It appears like small pimples which are occasionally pus filled and can be painful. It is often seen after shaving the hair on the skin around the stoma.

A change in output may also cause skin irritation. If you are using a closed pouch and experience loose stools try changing to a drainable pouch as you may find this easier to manage and to save you from frequent pouch changes which can lead to skin soreness.

Tips:

Ensure your template is fitting well

Check the skin isn’t exposed to the output of the stoma as this can cause soreness

Check the back of the flange area of your pouch when you remove it to change it. Look for any signs of faeces or urine which may have caused the irritation

Check that the adhesive hasn’t eroded, which could indicate the pouch needs changing more often

Diarrohea/Loose stools:

If you have an ileostomy or a colostomy, from time to time you may experience diarrhoea/loose stools. Loose, watery stools may mean you need to empty you bag more than often, so if you are using a closed pouch, you may want to use a drainable appliance instead. Diarrhoea can be caused by illness, a tummy upset or even food poisoning. Often the diarrhoeal can ease after a few days, if you think it is caused by lifestyle or diet you could try the following foods which will help thicken the output (please note these are not suitable for diabetics)

  • Under ripe bananas
  • Jelly babies
  • Marshmallows
  • Smooth peanut butter
  • White rice
  • Pretzels
  • Natural Yogurt
  • Noodles, pasta & potatoes
  • White bread

If the diarrhoea does not ease after 48hours and you are concerned about a high liquid output, contact your Stoma Care Nurse for advice to ensure you do not dehydrate. Your stoma care nurse may suggest you take a sample of your stoma output for testing.

Ballooning:

Stoma ballooning can happen with a colostomy or occasionally with an ileostomy, less seldom with urostomies. Ballooning occurs when your stoma bag fills with wind. This is usually due to the filter becoming wet or blocked from the stoma output. The pressure of the wind in the bag can cause the bag to come away from the body, resulting in leaks.

Tips:

If you are using a filter cover, remove it or cover half of the filter only

Look at your diet and try to avoid gas inducing foods such as fizzy drinks, or vegetables such as onions, cabbage, peas and beans.

Limit the amount of drinks you are consuming with a meal.

Eating regular meals can reduce the build-up of wind

Avoid chewing gum and try to avoid smoking as they increase the amount of air you ingest

Try rolling up a small piece of toilet paper and drop into your bag prior to application as this can help weigh the bag down and prevent the internal surfaces sticking together to create a vacuum

Also try dipping your forefinger in a drop of olive oil/baby oil and then rub your finger tip through the hole of the pouch and onto the opposite side of the material, prior to application, as this can help the stool slide down into the bottom of the pouch.

If the ballooning persists, contact your Stoma Care Nurse as she/he may trial another pouch with a different filter to help.

Hernias:

Hernias develop when there is a weakness in the muscle wall. A parastomal hernia occurs around the stoma, when part of your bowel pushes through the abdominal muscle to create a swelling beneath the skin. It can vary in size and can be as small as an “egg” and as a large as a “football”. Hernias can cause a dragging sensation, discomfort or pain in some people and no discomfort in others. This can vary from person to person and is usually dependant on the size.  A hernia can develop at any time during or after your stoma surgery. They can develop over time, if the muscle stretches or become weaker.

Risk factors for parastomal hernias:

  • Age
  • Weight
  • Smoking
  • Heavy lifting
  • Multiple abdominal and/or emergency surgery

Prevention:

It’s important to partake in some form of exercise even if it is a gentle walk, daily.

Try to support your stoma area by holding firmly when coughing, which will offer support to the muscles surrounding this area.

Try wearing a light support garment as prevention.

If you are doing more strenuous activities, your Stoma Care Nurse can measure you for a more supportive garment.

Hernias can be repaired surgically but this is dependant the quality of life for the person with the hernia and also on the Surgeon’s opinion.

Prolapse:

Sometimes the bowel may prolapse causing it to extend in length. It can happen if the muscles supporting it are weakened, or it may happen as a result of straining the abdominal muscles through lifting. It usually doesn’t cause any pain but can be quite a shock!  Despite the prolapse the stoma should always maintain its pink/red colour and should continue to function normally. If it becomes darker in anyway you MUST seek urgent medical attention.

As the prolapse causes the stoma to become larger in size, it is important to re- check the template size as it will often need adjusting so the edge of the aperture does not rub on the stoma. You may find a larger pouch suits you better. Lying flat will reduce the size of the stoma and it may help when trying to change your pouch. Often a support garment is used and can be applied lying down to manage the prolapse.

Contact your Stoma Care Nurse and they will assist you with this. He/she may measure and monitor the size of the stoma. If the prolapse is severe you may be referred back to the Surgeon.

Granulomas:

Granulomas are small red lumps that can appear around the edges or on the actual stoma. These are caused by rubbing/friction of the wafer or base plate. Bleeding can occur which can be alarming and may stop the bag from sticking properly. The template should be checked to see if it is fitting correctly. Try not to cut the template larger as this may encourage the granulomas to increase in size.

Contact your Stoma Care Nurse and she/he may treat them with silver nitrate or an alternative. In extensive granulomas, the surgeon may perform an excision, but this is rare and is only done if the granulomas affect the adhesion of your appliance. 

Ulcers:

Ulcers can occur for a variety of reasons. Causes can be an ill-fitting appliance, medications, or linked to your original diagnosis.

Contact you Stoma Care Nurse for assessment.

Stenosis:

Stenosis is the result of your stoma reducing in size, so it becomes very small and tight. It can often occur after an infection post operatively. The output from your stoma can become ribbon like or liquid

Contact your Stoma Care Nurse as she/he may try dilatation to try and get the stoma to open up. This is simple and painless and the stoma care nurse can teach you how to do this yourself. She/he may also suggest laxatives to keep the output soft enough to pass easily and to avoid constipation. If the stoma stops functioning, you may need to have a surgical review and possible surgery to re-fashion your stoma.

Necrosis:

Necrosis is rare, but happens when the stoma has a restricted blood supply. It will become darker red/purple in colour and even black. It may feel hard and cold to the touch.

It is vital to seek urgent medical attention if this happens!

Constipation for colostomy:

Constipation can occur for a number of reasons, such as reduced fluid intake, reduced mobility, reduction in fibre or introduction of new medications. It often results in hard stools, which are passed less often and also can be difficult to pass. Often abdominal cramps are accompanied with the hard stools. Increasing your fluid intake and introducing more fibre can usually help.

If this does not help within 2-3 days, contact your Stoma Care Nurse advice, they may suggest a gentle laxative which you can purchase without a prescription.

Change in urine:

Any change in urine for people with urostomies, can contribute to sore skin. Acidic urine can affect the adhesion of your appliance and may even be a sign of infection. Phosphate deposits can occur when your urine is too alkaline and grey crusty deposits can form, causing sore skin and leaks.

These deposits must be covered by your stoma appliance.

Tips: try white vinegar soaks by dabbing the surrounding areas with a cloth soaked in equal parts of vinegar and water.

Also try to increase your fluid intake.

Please consult your Stoma Care Nurse for advice if this persists for you.

Urine tract infections (UTI’s)

UTI’s can still occur after urostomy surgery.  Your body is still vulnerable to infections in the urinary tract. The symptoms are usually dark, cloudy and strong smelling urine and mucus production can increase.  Sometimes you may get back pain (from where your kidneys are), fever, nausea, vomiting and loss of appetite. If you notice any of these symptoms, contact your Stoma Care Nurse to discuss. You may need to provide a sterile sample of urine (which your stoma or practice nurse will explain how to obtain)  for the GP, which will determine if you may need a course of antibiotics.

Tips:

Drink at least 6-8 glasses of water each day (unless you have been told to limit your intake by your surgeon.

Try to limit the amount of caffeine in coffee and tea, as this simply dehydrates you.

If you use a night drainage bag make sure you thoroughly clean this after each use (including the leg bag).

Empty your pouch when it is one-third to half full. 

Mucosal separation:

During surgery the bowel will be stitched to the skin to form the stoma. Occasionally the stitches and skin can separate. This can sometimes look unpleasant but like any other wound it will heal over time.

Speak with your stoma nurse who will monitor this and suggest treatments options.

Rectal Discharge:

It is normal for those who still have their rectum in place, to experience rectal discharge. This is usually a clear or putty coloured mucus from their anus. The bowel produces mucus as a lubricant to assist the stools to pass through the colon. Following stoma surgery you now have a stoma for the stools to exit, but as the rectum is still a living organ, it will continue to produce this mucus which is a combination of dead skin cells.

The amount varies from person to person, for some they may pass it a few times a week and for others less often. If you feel the sensation to sit on the toilet to pass the mucus, this is a very normal sensation and go with it. Try to bear down slightly as if you are having a bowel motion.

Tips:

Wear a pad to help with any leakage

Apply barrier cream such as sudacrem to your bottom, to avoid any sore skin.

If the mucus become troublesome to pass or blood stained, reach out to your Stoma Care nurse for advice and support. It may be that a suppository may help clear the mucus better.

Closing thoughts…

Some of these problems are a lot more common than others. If you are worried about any problems you’re currently having, remember you can always speak to your stoma nurse or HCP.

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