If you have a stoma, skin care is the number one priority. It's essential to know exactly what causes discomfort on your skin, which products you tolerate best and how you can optimally care for your skin around the stoma. Sore skin is a common problem while wearing a stoma, but don't be too self-conscious about it. With the appropriate treatment, the skin will soothe and heal completely.
First things first: What is a stoma?
Basically the term comes from the Greek and simply means "mouth/opening", so a stoma is a surgically created opening in the abdominal wall.
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.
There is a misconception that a stoma is a wound - but it is not! Actually, it is "only" an opening in the abdomen through which faeces can leave the body instead of passing through the digestive system entirely.
What types of wounds will I have after stoma surgery?
After the stoma operation, you will of course have a wound. This wound occurs where the surgeon has created access to your bowel. The stoma itself is not a wound. There are different surgical techniques, which usually depend on whether the operation is urgent/life-saving or planned.
Laparotomy
In laparotomy, also known as open surgery, one long incision is usually made in the abdomen to enable access to the bowel. In some acute cases, open surgery is necessary because it is quite simply the quicker and therefore life-saving technique. At the end of the day, the surgeon in charge decides which method is safest for you. After a laparotomy, you may have one or max. two larger wounds in your abdomen. All wounds will be cared for by healthcare specialists immediately after the operation and checked by your Stoma Care Nurse as soon as you are back home.
Laparoscopic
In laparoscopic surgery, the surgeon makes several small incisions and uses a tiny camera and surgical instruments to enable access to the bowel. Planned operations are usually performed using this technique. Of course, any type of ostomy surgery will result in a wound - however, laparoscopic surgery has the advantage that there are no large open wounds or incisions. This means that there is less blood loss, pain and discomfort after the operation. In addition, the fine instruments used cause less tissue trauma.
How to care for your peristomal skin and wounds
Right after surgery
In the first few months after the operation, it is important to treat your abdominal wounds carefully. If you are unsure about this, speak to your stoma care nurse who will support you in caring that area. If your rectum has been removed, a wound will also remain in the area of your bottom. This should and will also be monitored by your Stoma Care Nurse. All wounds will be checked at your follow-up appointment with the surgeon treating you.
Allow yourself enough time to recover after the operation. Do not lift any heavy objects. As a general rule, avoid any heavy strain on your body during the first time following the operation. In order to slowly rebuild your muscles, your stoma care nurse will show you some gentle exercises that you can do every day.
You may well feel fit and strong quite quickly. However, it is important to take it slowly, as the muscles around the wound take much longer to heal than it sometimes may seem.
Read more about recovering after stoma surgery here.
Right after full recovery
The skin around your stoma must always be carefully cared for and cleaned during a pouch change. The skin often dries out more than usual in cold weather and when heated. In general, the weather should not affect the skin around your stoma too much, as it is protected by the baseplate. In fact, any damage to your skin around the stoma is not normal and should be treated immediately. If you have any difficulties with sore skin, please speak to your stoma care nurse.
Tips & Tricks:
Gently wash the stoma and surrounding skin with warm water.
Avoid using perfumed soaps, lotions and creams as these can irritate your skin and cause itching.
Gently dab your skin with fleece compresses when drying.
If your skin is already slightly sore, it can be helpful to use a special skin protection lotion.
When travelling: If you don't have access to a bathroom sink, pack unscented wet wipes for cleaning. Please only use these in an emergency!
Problems that might occure
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, 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.
Irritated peristomal skin
Skin irritation around the stoma can often occur for various reasons. If the skin is red, irritated and sore, it can quickly become ruptured, which in turn causes a lot of discomfort. Please contact your ostomy nurse for advice and support. It is essential to find out the underlying issue causing your sore skin and treat it appropriately. There are many products specifically for the skin around the stoma that have a soothing effect. Under no circumstances should you use creams, lotions or similar products that have not been specially prescribed by a healthcare specialist. In case of doubt, these will make the situation even worse.
Reasons the skin around your stoma might become irritated:
A poorly fitting appliance.
Uneven skin surfaces caused by skin folds or scars after an operation.
Excessive sweating can affect the adhesion of your appliance. This leads to leakage and subsequently to sore skin.
Excessive stoma discharge, which could attack the skin protection material of your baseplate and thus cause irritated skin.
A pre-existing skin irritation.
Contact dermatitis (allergy) caused by ingredients of your ostomy appliance.
You need more helpful information about how to treat sore skin? Discover here.
Pyoderma gangrenosum
Pyoderma gangrenosum is a rare but treatable skin disease. The symptoms can vary from person to person and usually lead to fragile, moist skin, painful wounds/ulcers around the stoma and directly on the stoma. These ulcers usually have a dark border. Although pyoderma gangrenosum can be treated, it is often difficult. More than one treatment may be necessary.
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).
Alginate Skin Protection – Harness the healing power
Our alginate products have been specially developed to care for and protect the skin around the stoma. They contain the healing properties of seaweed, which reduces irritation to sensitive skin, minimises inflammation and promotes skin resilience.
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The contents of this blog, including all text, graphics, images and information, are intended for informational purposes only. They are not a substitute for professional medical advice, diagnosis or treatment. Always consult a qualified healthcare professional if you have any questions about a medical condition or treatment, and before starting any new healthcare treatment. Reliance on any information provided on this website regarding health related decisions are solely at the reader's own risk.
