My stoma, my skin and me – Feeling good starts with the right care

A stoma surgery means a big change – both physically and emotionally. Proper care of the skin around the stoma, the so-called peristomal skin, is particularly important for your well-being and quality of life. This sensitive region requires special attention in order to avoid irritation, infections and other complications.

In this article you will learn what you should pay attention to when caring for your skin after stoma surgery, which products are suitable and how you can keep your skin healthy in the long term.

Basics – What is a stoma?

In general terms, the term comes from the Greek and means “mouth/opening”. From a medical point of view, a stoma is therefore a surgically created opening in the abdominal wall.

A stoma is created when part of the bladder or bowel needs to heal or be removed. To create an enterostoma (stoma opening from the bowel), the surgeon transfers part of the small or large intestine to the surface of the skin and stitches it to an opening in your abdomen. It sounds scary, but it is a routine operation. The bowel, which is now outside your body, also known as a stoma, empties the faeces into a stoma bag. The stoma itself is round or oval, red, moist and feels similar to the inside of your mouth.

Basics – Our skin

The skin is much more than just the outer covering of our body. It is our largest organ and fulfills numerous important tasks – often without us being consciously aware of it.

Protective shield and sensory organ
Our skin protects us from external influences such as cold, heat, germs and harmful environmental factors. At the same time, it is a highly sensitive sensory organ: we feel touch, temperature and pain via countless nerve endings.

Mirror of our health
The skin often shows us how we are really feeling – stress, lack of sleep, diet or hormonal changes leave visible traces. Skin problems are therefore not only superficial, but can also indicate internal imbalances.

Structure

Similar to a Goretex jacket, it offers protection but is also permeable. Three layers of skin are visible under the microscope: epidermis, dermis and subcutis.

Epidermis:
The outermost layer. It protects us from environmental influences, germs and dehydration. On the very outside is the horny layer, which is constantly renewed. The epidermis also contains pigment cells that give our skin its color.
Dermis:
This is the “working center” of the skin. The dermis contains blood vessels, nerves, sweat glands, sebaceous glands and hair roots. It supplies the epidermis with nutrients and is responsible for elasticity and resilience – thanks to collagen fibers.
Subkutis:
The deepest layer consists mainly of lipid tissue. It serves as energy storage, padding and thermal protection. Larger blood vessels also run here.

Persitomal skin

The skin around a stoma, the so-called peristomal skin, does a lot of hard work every day. It forms the interface between the body and the stoma pouch – and is often exposed to particular stress. This small area of skin can have a major impact on your general health and well-being.

Why is proper skin care around the stoma so important?

The peristomal skin is exposed to mechanical and chemical stresses on a daily basis – whether from the adhesive surface of the stoma appliance, from moisture or from leaking stool or urine. Once the skin barrier is damaged, this can lead to pain, leaks and other problems.

An intact skin not only provides better support for your care, but also contributes significantly to your sense of security and quality of life.

Will I have a wound after the stoma surgery?

There is a persistent belief that a stoma is a wound – but this is not the case! A stoma is a surgically created opening in the abdominal wall through which the bowel can release its contents to the outside – without taking the normal route through the entire digestive tract.

After the surgery, you will have a wound in the abdominal area, particularly where the access to the bowel was created. This surgical wound usually heals well. However, the stoma itself is not a wound. It is an opening in the mucous membrane, similar to the mouth.

Different techniques are used depending on the type and urgency of the operation (e.g. emergency or planned). These can leave wound areas of different sizes. Your medical team will choose the method that is best suited to your situation.

Laparotomy: The “open surgery”

A laparotomy is an open procedure in which a longer abdominal incision is usually made to gain access to organs such as the bowel or bladder. This method is often necessary in acute or life-threatening situations, as it is particularly quick and effective. In each case, the treating surgeon decides individually which procedure is safest for you.

After a laparotomy, you will usually have one larger wound, sometimes two. These surgical wounds are treated professionally immediately after the procedure. As soon as you are discharged home, your stoma nurse can – if prescribed by your doctor – take over the wound check and provide you with expert support.

Laparoscopy: The “keyhole surgery”

In laparoscopic surgery (also known as “minimally invasive”), several small incisions are made. Through these, the surgeon inserts a tiny camera and special fine instruments to gain access to organs such as the bowel or bladder.

Planned operations – including stoma surgery – are now usually performed using this technique.

The major advantage of this method is that no large abdominal incisions are necessary. The small incisions lead to less blood loss as well as less pain and general discomfort after the operation than after open surgery. In addition, the fine instruments used cause less tissue damage, which supports healing and often makes the entire post-operative process easier.

Despite the gentle technique, wounds also occur during laparoscopic surgery – but they are usually smaller and heal more quickly than with open surgery.

Peristomal skin care

The basics of skin care

Gentle cleaning
Clean the skin around the stoma with lukewarm water and a soft cloth every time you change the appliance. Usually no soaps or cleansers are necessary – they can irritate the skin unnecessarily. If you still want to use a cleansing product, make sure that it is pH-neutral, fragrance-free and contains no moisturizing substances.
Dry thoroughly
Gently pat the skin dry. Avoid rubbing vigorously to prevent micro-injuries. The skin should be completely dry before you apply the new treatment.
Skin observation
Check the condition of the skin every time you change. Look out for redness, oozing, itching, swelling or sores. If detected early, many skin problems can be treated well or even avoided.

Directly after the surgery

In the first weeks and months after the operation, it is essential that the wound areas in the abdomen are carefully treated. If you are unsure about wound care, your stoma care nurse will be on hand to advise and support you. If the rectum was also removed as part of the procedure, a wound will also remain in the buttocks area. This will be regularly checked and professionally treated by your family doctor. During your follow-up appointments, the treating surgeon will also check the healing process of all relevant wound areas to ensure a complication-free recovery.

Take sufficient time to recover after the surgery. Avoid lifting heavy objects and take it easy on your body in the early stages. During this phase, it is important to refrain from all strenuous activities so as not to jeopardize the healing process. To gradually rebuild your muscles, you can do light, targeted exercises that are shown to you during physiotherapy. These exercises support a gentle and effective convalescence, i.e. healing time. You can ask your doctor to prescribe physiotherapy.

You may feel quickly recovered. However, it is important to take it slowly, as the muscles around the wound take much longer to heal than it sometimes seems.

Read mehr about the recovery phases after a stoma surgery.

After full recovery

The skin around your stoma must be carefully cleaned and cared for every time you change the pouch. The skin can dry out more, especially in cold weather or due to heating. However, the weather should not significantly affect the skin around your stoma as it is protected by the baseplate.

However, if changes or impairments to the skin occur, these are not normal and should be treated immediately. If you have problems with irritated or sore skin, please contact your stoma care nurse, who will be able to support you in providing the right care.

Potential problems

Mucosal detachment
Mucosal detachment occurs when the sutured connection between the stoma and the surrounding skin separates. This complication usually occurs within the first 30 days after stoma placement and mainly affects people whose wound healing is impaired by other health factors, such as diabetes, malnutrition or infections.

Even if the appearance may seem unsettling at first, a mucosal detachment usually heals quickly and without complications. Your stoma nurse will instruct you on how to care for the affected area. Above all, it is important to keep the area clean and dry. Special stoma pastes or powders are often used to fill the wound and support healing in a targeted manner. With the right care and a little patience, this complication can usually be managed well.

Irritated peristomal skin
Skin irritation in the area of the stoma is common and can have various causes. If the skin is reddened, sensitive or even open, small tears can occur, which are associated with pain and considerable discomfort. In such cases, it is crucial to contact your ostomy nurse at an early stage. Together you can determine the exact cause of the skin problems and take the necessary steps for treatment to alleviate the discomfort and promote healing.

Specially developed medical products are available for the care of the skin around the stoma, which have a soothing effect and provide optimum protection for the skin. Please do not use any commercially available creams or lotions that are not specifically recommended for stoma care or prescribed by a doctor. Such products can increase skin discomfort under certain circumstances and have a negative effect on the adhesion of the ostomy appliance.

Causes of irritated skin

A poorly fitting ostomy appliance.
Uneven skin surfaces caused by skin folds or scars after an operation.
Excessive sweating or increased moisture can impair the adhesion of your supply. This leads to leakage and subsequently to sore skin.
Changing the pouch too frequently, which causes stress on the skin.
Excessive stoma discharge, which attacks the skin protection material of your supply and thus causes irritated skin.
A pre-existing skin irritation.
Contact dermatitis (allergy) caused by ingredients in your ostomy appliance.

First aid for sore skin
Here are some ways you can treat your sore skin:

Measure your stoma opening to determine the perfect size of your appliance to ensure that your pouch fits perfectly.
Use a band-aid remover spray (e.g. STOMCOUR® EmplaSectal) for a safe removal of your ostomy appliance.
Apply skin protection powder (e.g. STOMOCUR® Skin Protection Powder) or Skin protection lotion (z.B. STOMOCUR® Safety) on moist, irritated skin to relieve discomfort.
Barrier creams can also be used for a short period of time.
Use non-irritating stoma pastes to help the skin protection adhere to the skin.
A supply with alginate could help to soothe irritated skin.
If you already suffer from a skin condition such as psoriasis or eczema, using small amounts of your usual prescription cream may be a solution.

Pyoderma gangraenosum
Pyoderma gangrenosum is a rare but treatable skin disease that can take different forms. It usually leads to brittle, weeping skin as well as painful wounds or ulcers around the stoma and directly on the stoma. These ulcers are often surrounded by a dark border.

The skin changes can be triggered by an injury to the skin, e.g. trauma caused by a stoma that is too tight or an operation. In some cases, pyoderma gangraenosum can also occur in connection with other diseases, such as inflammatory bowel disease or arthritis. In most cases, however, the exact cause remains unknown.

Although pyoderma gangrenosum is treatable, therapy is often challenging. In many cases, several treatment steps are required to bring the disease under control. It is therefore important to seek medical support at an early stage in order to provide the best possible care and prevent the disease from progressing.

Fungal infections (mycosis)
In the case of mycosis, whitish-yellow coatings develop on the mucous membrane and/or individual, small red papules and pustules on the skin. These changes are often accompanied by itching, burning or pain under the skin protection plate. Causes can include moisture under the supply, a disturbed acid mantle of the skin, excessive wearing time or inadequate stoma hygiene.

If a fungal infection is suspected, a doctor should be consulted promptly. The doctor will usually take a swab to confirm the diagnosis. The affected skin is then treated with an aqueous-based antifungal suspension. It is also important to maintain careful stoma hygiene and an optimally fitting appliance to prevent re-infection.

Optimal skin protection with alginate for protection and regeneration

Our alginate-based skin protection promotes skin integrity, absorbs moisture and is ideal for sensitive skin.

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Conclusion

Appropriate skin care after a stoma surgery is a key part of your new life situation. With a little routine, the right products and support from specialist staff, you can keep your skin healthy in the long term – and feel confident and comfortable in everyday life.

After all, healthy skin is the best basis for safe ostomy care.

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