Living with a stoma requires consistent peristomal skin care, as skin irritation can impact your quality of life. Our article will provide valuable tips to help manage skin irritation and ensure your comfort at all times.
Causes of Peristomal Skin Irritation
Peristomal skin irritation can stem from various causal factors.
Leakage
Leakage is the most common cause of peristomal skin irritation and damage. Leaks tend to occur when the stoma’s size changes in the first few months after surgery, but may also be due to an improperly fitted stoma appliance.
Pancaking
Pancaking occurs when the stoma’s output cannot flow into the bag. It usually happens when the stoma bag’s internal layers stick together, preventing the output from settling to the bottom. This occurrence may expose your skin to waste matter, slowly causing skin irritation.
Skin Folds/Creases
Sometimes, the area around your stoma may have folds or creases, making it difficult to position the stoma appliance. It could prevent the appliance’s skin barrier or flange from adhering securely to the skin’s surface, leading to leakage.
Friction & Pressure
Occasionally, friction or pressure on or against the skin could gradually cause damage, thereby increasing the risk of skin irritation. A common cause is wearing a belt, which can rub against the peristomal skin.
Infection
There may also be a risk of infection, either due to improper cleaning or shaving around the stoma (which can lead to red, pimply skin) or a fungal infection (characterised by reddish, purplish, or white patches).
Bleeding
While minor bleeding can occur (as the stoma has many blood vessels), if it persists even after light cleaning, contact a wound care nurse or specialist immediately.
Improper Appliance Changes
Inappropriate removal of the stoma appliance, such as pulling it away from the stoma or picking at the flange edges, can also result in skin irritation.
What You Should Do to Care for Your Peristomal Skin
To maintain your skin’s health, it is helpful to include these steps in your daily routine.
Check Your Skin Frequently
A regular skin care routine can help you stay on top of your peristomal skin’s condition. Look for potential warning signs of minor or early skin damage, such as frequent itching or discoloured skin. Be aware of signs of leakage or moisture buildup to prevent gradual skin damage or infection. Healthy peristomal skin should look like the rest of your skin. Some redness is expected when you remove the appliance’s adhesive, but if it persists, consult a wound care nurse or specialist immediately.
Change Your Appliance Regularly
It helps to change your stoma appliance at regular intervals, typically every 2 to 4 days, or as advised by your wound care nurse or specialist. If you notice moistness, itching, or other irregularities with your appliance on, carefully remove and replace it. Regular changes ensure that your stoma’s condition is appropriately managed and reduce the risk of complications, such as leakage.
Ideally, ensure the output bag does not exceed two-thirds of its capacity to prevent leaks or other issues. You can also change the appliance before participating in activities, especially if you feel more comfortable doing so. Be sure to record every time you change your stoma appliance to make your daily stoma care more manageable.
Gently Clean the Peristomal Skin
Water is usually sufficient to clean the area around the peristomal skin, especially when changing your appliance. Avoid using lotions, creams, or other cleansers that may contain oil or residue, as these can irritate your skin. Gentle, skin-friendly soaps or cleansers are allowed, as long as they are free of additives such as fragrance. You also need to be mindful of your skin’s pH levels (between pH 4 and 5.5), as leakage or other complications can raise or lower pH, making your skin more vulnerable to irritation or damage.
Before using any stoma-related products, read the usage instructions carefully or consult a wound care nurse or specialist for advice.
Be Aware of Stoma Changes
Your stoma’s size can change for various reasons, including weight loss or gain, pregnancy, or other medical conditions. The first few months after surgery may also lead to changes in stoma size. You should constantly adjust your stoma appliance to ensure it fits your stoma properly and prevents complications such as leaks or poorly fitted appliances, which could also irritate the peristomal skin. A stoma measuring guide can be invaluable for regularly tracking your stoma’s size.
Take a Skin Break
A skin break is when you leave the peristomal skin uncovered for 15 to 30 minutes after removing your stoma appliance. Doing so helps to reduce the risk of irritation by allowing your skin to “breathe”, especially when it is covered by your appliance’s flange for hours a day. Keep a towel, container, or bag over the stoma during this time to prevent leakage.
Seek Medical Support
If you have any doubts or concerns, seek assistance from a licensed wound care nurse or specialist for additional medical advice, treatments, and preventive care for your stoma.
Tips to Reduce Peristomal Skin Irritation
Reducing skin irritation can be much easier with these handy tips.
Consider the Right Appliance
One-piece appliances combine the skin barrier (where the flange is) and the output bag as a single unit, while two-piece appliances allow you to separate the output bag from the skin barrier.
When choosing between one-piece and two-piece appliances, consider your overall lifestyle and stoma needs. A one-piece offers simplified appliance application and removal, while a two-piece only requires replacing the output bag. If you are unsure, consult a wound care nurse or specialist for further advice on which option best suits you.
Dry Off Properly
Drying your skin prevents moisture buildup, which could increase the risk of infection or other complications. Use a dry towel or cloth to gently wipe the peristomal skin clean, and double-check for any spots you may have missed.
Double-check Your Fitting
When applying your stoma appliance, be sure there are no gaps of skin between the stoma and the skin barrier or flange. This will help you minimise the risk of leakage and ensure your comfort throughout the day.
Carry Extra Supplies
It never hurts to bring extra supplies with you, as they can be invaluable in an emergency. Additional preparation can also be needed, such as pre-cutting the flange in case you forget to bring a pair of scissors. You can even bring a spare change of clothes along if that gives you some measure of comfort.
Keep Things Simple
Avoid overcomplicating your routine, especially if you are still getting used to your stoma. Practice with a wound care nurse or specialist, and consult them on simple yet effective practices for caring for your stoma.
Sozo Wound & Stoma Care team can support your stoma journey and offer valuable tips, advice, and suitable products to help you manage your stoma care. Contact us today to learn how we can provide stoma care for you or your loved one.