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Patient education handout (download)
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What is a Healthy Stoma?
A healthy stoma should look pink or red, moist, smooth, and not swollen or bleeding. The skin around it should be clean, dry, and free of redness, rashes, or sores (Figure 1).
Fig. 1. Healthy stoma
What Causes Irritation of the Skin Around a Stoma?
Leakage
If your ostomy pouch leaks, it can make your skin sore. Here's how to prevent and fix leaks:
- Check where and why it is leaking.
- Make sure your ostomy pouch fits well.
- Use moldable seals or paste around the stoma before attaching the wafer.
- Change your pouch regularly, and empty it when it’s no more than halfway full.
- Keep your skin clean and dry before sticking on a new pouch.
- After changing the wafer, limit activity for about 30 minutes so it can stick well and last longer.
- Tip: change pouch on a regular schedule so you do not have leaks in between changes. Do not wait for a leak to change your pouch.
Dermatitis
It happens when your skin is in prolonged contact with the stool or urine or if bacteria or fungus infect the skin. Signs include redness, bumps, wetness, and itching or pain (Figure 2). To treat it, you can use the "crusting technique"
- Apply ostomy powder to absorb moisture (some powders may be medicated). Let it dry.
- Apply no-sting skin protectant on top.
- Repeat these steps up to three times until a dry “crust” forms.
- Then attach the wafer.
Fig. 2. Dermatitis of the skin surrounding the stoma
Mechanical Injury
Sometimes, the skin can get sore or tear when you remove the ostomy wafer. This happens because the wafer is not removed correctly. To prevent injury:
- Be gentle when taking off the wafer - press skin away from the adhesive instead of pulling the adhesive from your skin.
- Use an alcohol-free adhesive remover to make it easier and less painful.
Allergy to Wafer
This allergic reaction appears as redness, itching, or swelling around the stoma in the same shape as the wafer.
- Remove the wafer. Clean with warm water.
- Apply a soothing cream or barrier film.
- Try a different wafer or adhesive.
Fig. 3. Allergy to wafer
What If My Stoma Changes Appearance?
If your stoma looks longer, more sunken, bulging, black, waste is not moving through, or a new sore appears, it may be due to one of the following. Make sure to contact your ostomy health provider:
- Prolapse: The stoma sticks out further than usual, which may cause discomfort or difficulty with the pouch fitting properly.
- Necrosis: The stoma looks dark or black, which can indicate a lack of blood flow and may require medical attention.
- Retraction: The stoma sinks below the skin level, making it harder to attach the pouch and sometimes leading to leakage.
- Parastomal Hernia: A bulge appears around the stoma, often caused by a weakness in the abdominal wall, which may cause pain or pouch issues.
- Mucocutaneous Separation: The skin around the stoma separates from the stoma itself, which can lead to leaks and requires treatment to heal.
- Stoma Stenosis: Stoma stenosis is when your stoma becomes narrow, making it harder for waste to pass through and sometimes causing blockages.
What If It’s Hard to Keep My Ostomy Pouch in Place?
If your ostomy pouch won’t stay on, there are products that can help (Figure 4). Ask your clinician about:
- Stoma adhesives: they create a strong seal around your stoma to stop leaks.
- Moldable skin barrier: can be shaped to fit your stoma, giving extra protection and comfort.
- Different pouch sizes and shapes: options are available to fit your body better and stay in place more securely.
- Stoma paste: soft, flexible paste that helps create a better seal between your skin and the ostomy pouch, preventing leaks and irritation around the stoma; to use it, simply apply a thin layer around the stoma before attaching the pouch, ensuring the paste does not touch the stoma itself.
Fig. 4. Sample products to help keep ostomy pouch in place
What Health Problems Can Happen With a Stoma?
- Dehydration: If your body loses too much fluid, you might feel tired, dizzy, or weak. To stay hydrated, drink plenty of water throughout the day.
- Bowel Blockage from Food (Ileostomy): Some foods can block your stoma, causing cramping, bloating, or trouble passing waste. To avoid this, follow the diet your healthcare provider gave you.
- Infection or Abscess: An infection around your stoma or the nearby skin can cause redness, swelling, pain, or pus. If this happens, get medical help right away for treatment.
When Should I Contact My Healthcare Provider?
If you have a colostomy or ileostomy, call your ostomy care nurse if you notice any of the following:
- You are changing your pouching system more often than expected
- Skin irritation
- Pain
- Leaks under your pouching system or skin barrier
- Excessive bleeding from your stoma
- Blood in your stool
- A bulge around your stoma
- Persistent diarrhea
- Diarrhea with pain or vomiting
- A stoma that seems to be getting longer
- No output from stoma
If you have a urostomy, call your ostomy care nurse if you notice:
- Any signs of a urinary tract infection
- Skin irritation
- Urine crystals around your stoma
- Leaks under your pouching system or skin barrier
- Warty or discolored skin around your stoma
- Excessive bleeding from your stoma
- Blood in your urine
