Skin care is such an important part of having a stoma. The skin around the edges of a stoma and underneath the stoma appliance can get easily irritated and wounds may develop. If this happens, you may need to find a better suited appliance to support the size and shape of your stoma or starting treatments such as skins barriers, powders or skin protection which are used directly to the peristomal skin beneath the stoma wafer. Sore skin is a common issue with having a stoma but be rest assured that the skin will settle with the right treatment.
What is a stoma? It isn’t a wound
There is a misconception that your stoma is a wound. It is not actually a wound but is an opening in your abdomen that allows waste to exit your body rather than going through your digestive system.
A stoma is created when part of your bladder or bowel needs to heal or needs to be removed. Stoma surgery involves your surgeon pulling part of your small or large intestine onto the surface of your skin and sewn it into an opening in your abdomen. The intestine, now known as a stoma, will then empty the waste into a stoma bag. The stoma itself is a round or oval shape which is red and moist and has the texture similar to the inside of your mouth.
You will have stitches around the outside of your stoma which are usually dissolvable, or you may need these removed by your stoma nurse a couple of weeks after surgery.
What types of wounds will I have after stoma surgery?
After your stoma surgery, you will have a wound in addition to your stoma. This wound is from where the surgeon has accessed your bowel. There are different surgical techniques which are usually based on whether your surgery was urgent/ lifesaving or whether it was planned surgery.
Open surgery (laparotomy) is where a long cut (incision) is made in the tummy to access the bowel, or laparoscopic (keyhole surgery) is where the surgeon makes several smaller incisions and uses a tiny camera and surgical instrument to access the bowel. Planned surgery is usually carried out by keyhole surgery, but in some cases, you may need lifesaving open surgery. The surgeon will decide based on the safest option for you.
Each type of stoma surgery will result in a wound. Laparoscopic (keyhole surgery) has the advantage of avoiding large open wounds or incisions and thus decreasing blood loss, pain, and discomfort. The fine instruments used are less likely to cause tissue trauma. Following laparotomy (open surgery) you may have one or two larger wounds and if you have had laparoscopic (keyhole surgery) you may have three smaller wounds. These will all be dressed by your nurse immediately following surgery and also checked on by your stoma care nurse once you are home.
How to care for your peristomal skin and wounds
During the first few months following your surgery, it is important to take care of any abdominal wounds. If you are uncertain about the wounds, make sure you see your stoma care nurse or your practice nurse at the GP surgery is helpful with wound care. This is an important stage of your recovery as the muscles around the wound takes longer to heal.
If your rectum has been removed, you will also have a wound in your bottom that will need to be monitored by your stoma care nurse. Your surgeon will check this at your follow up appointment.
Give yourself time to recover after your surgery, don’t be lifting heavy objects or hoovering or moving objects around. Your stoma care nurse will show you some gentle exercises to start building up your core muscles again.
Read more about getting active after stoma surgery here.
What is mucosal separation?
Mucosal separation is the separation of the sutured junction between the stoma and the skin. It may happen with those ostomates who have compromised healing due to other medical conditions. If mucosal separation is going to happen, it usually does within the first 30 days after stoma surgery. It can be quite alarming for the ostomate, as it is often unsightly, but rest assured it will heal given time and the correct treatment. Your stoma nurse will advise you to keep the area clean and dry, often stoma pastes and powders are used to fill the area to encourage wound healing and you may be told by your nurse to change your pouch more often, so you can monitor progress.
Watch out for irritated peristomal skin
Skin irritation around a stoma can often occur for a variety of reasons. Once the skin becomes red, irritated and sore, it can cause breaks in the skin, which in turn causes a great deal discomfort and misery. Be sure to contact your Stoma Care Nurse for advice and support as it is important to find the reason why your skin is sore, before attempting to treat it yourself. There are many remedies especially for the skin around the stoma, which will help soothe the skin and settle the irritation. It is wise to note that not all lotions and potions in your bathroom cupboard are wise to apply on the skin around your stoma, as they may stop the pouch from sticking, making things worse. Your nurse will guide you with what to use and help identify the cause of the sore, she/he will also try to resolve the situation, so you hopefully don’t experience it again.
Reasons the skin around your stoma might become irritated:
- The hole (aperture) in the pouch might be the wrong size
- Uneven surfaces of skin, from skin folds or scarring due to surgery
- Excessive sweating can prevent the pouch from sticking well
- The effluent from your stoma maybe excessive
- The effluent may corrode the hydrocolloid (adhesive of pouch) causing irritation
- An underlying skin irritation may stop the pouch from sticking properly
- Contact dermatitis (an allergy) from any of the stoma products
What is Pyoderma Gangrenosum?
Pyoderma gangrenosum is a rare but treatable skin condition. How it looks can often vary from person to person and tends to cause broken oozing skin, painful wounds/ulcers around the stoma and underneath where the stoma appliance is repeatedly applied and removed. These ulcers tend to have a dark edge to them. They can be difficult to treat, more than one treatment may be required.
The ulcers could be triggered by an injury to the skin such as trauma from a tight appliance or surgery. Sometimes other diseases can be associated with pyoderma gangrenosum, it can be associated with inflammatory bowel disease (IBD) or arthritis but for most, the cause is unknown.
Treatments on the skin can be used such as steroid creams or tablets, antibiotics creams or tablets if an infection is suspected, treatment for the inflammatory bowel (IBD). If it does not improve within a few weeks of treatment, seek help from your stoma care nurse or your GP.
How to care for the skin around your stoma
The skin around your stoma will always need to be looked after and cleaned carefully during a pouch change. With the cold weather and central heating on, we often find our skin dries out more than usual. The weather should not affect the skin around your stoma too much, as it is protected by the baseplate that holds the pouch in place. You should not expect to get sore skin around your stoma, so if this happen, please speak to your stoma care nurse.
Our alginate stoma bags are designed to take care of skin around your stoma, incorporating the healing properties of seaweed to help sensitive skin become less irritated by reducing inflammation and promoting skin integrity. Read more about alginate stoma bags here.
- Gently wash the stoma and surrounding skin with warm water
- Use the dry wipes which are provided to you
- Avoid using soaps, lotions/creams as they can irritate your skin and make you itchy
- Pat your skin gently when drying
- If your skin does get a little sore, your stoma care nurse may give you some special stoma sprays, wipes or powders, so follow their instructions with these.
- You can use the small pack of wet wipes supplied by Goldcare (or other delivery company) to take with you if you are out and about, to clean with if you cannot get to a sink. These are only to be used in an emergency