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Cleaning Stomas


If possible, clean stoma while showering. Have your supplies set out an ready before you remove your bag. Wash around stoma with warm water. Try to stay away from soaps and baby wipes, they leave a residue on the skin that can obstruct the adhesion of the barrier, or cause dermatitis. If soap is necessary, use soap without oils in it and make sure to thoroughly rinse the area. If you are insistent on using more than just water to clean the peristomal area, only use products that are made specific for ostomy care (such as skin wipes). If the area around your stoma has excess hair, shaving around the area can help, especially during barrier removal. This also can help prevent folliculitis (inflammation of the hair follicles).

Equation for keeping peristomal area healthy: FIT + FORMULATION = HEALTHY PERISTOMAL SKIN. This is where using the correct device for your body and making sure the wafer has been measured to your stoma will protect your skin and reduce the risk of leakage.

Crusting Technique

1. Start with a clean and dry peristomal area. If you have residue from stoma paste or barrier rings, use an ostomy adhesive remover to remove it- do not scrub. Scrubbing will aggravate the already irritated skin.

2. Lightly dust the peristomal area with stoma powder, making sure to especially cover the irritated skin. You do not put powder on the stoma itself, but if some get on your stoma, it will not hurt it. Brush off the extra powder.

3. Use an ostomy-specific skin barrier wipe or spray and gently pat it on the powder. The skin barrier is what adheres the powder to the skin. Wait around 10-15 seconds (or until dry) and repeat steps 1 & 2. This will form a protective "crust" to help shield the irritated areas. Do this for about 4 layers to ensure you are creating a safeguard for your skin. Once completely dry, proceed to attach your device as normal.

If you are dealing with a rash and the crusting method is not working, you may be dealing with a yeast infection and you should contact your ostomy nurse/medical team.

Skin Irritation

This is usually due to leakage from the ostomy device. This is when output from the stoma seeps under the adhesive part of the wafer and output is now touching the skin. This can be painful as well as damaging to your skin and your ostomy device. The skin surrounding the stoma should look close to the skin on the rest of your body. When removing the device, the skin might have a slight pink tint, but this will fade. If it does not fade, or the skin around the stoma is damaged, you are dealing with irritation.

What should I do?

Remove your wafer to see if the adhesive has any feces that have seeped out. Look to see if the irritated skin correlates with the feces on the wafer. Make sure you are fitting your wafer correctly to your stoma by measuring each time you change your bag (most ostomy supplies come with a paper stencil to do so) by leaving 1/8" of room between stoma and wafer. This allows room for the stoma to expand without getting suffocated by a wafer that is too tight. If you have a stoma that does not go above the surface of the skin, and it is more level with, or below the surface, you might need to use different ostomy products (such as the concave device). If the adhesive has deteriorated, this means that your device should have been changed sooner. You should change your bag every 3-5 days for the best results.

Irritant Dermatitis

When the skin around the stoma is very red and wet. There might even be blood and pain. This is due to irritated skin from feces or certain ostomy products like pastes or solvents. To avoid this, make sure to measure your stoma and cut your barrier to the correct size (1/8" bigger than the stoma). If the skin looks weepy/wet, use the crusting method (see Cleaning Stoma) to create a seal to protect the skin as well as help seal the wafer to the skin. Be sure to regularly change your bag to avoid irritation. If having reoccurring issues with getting the bag to stay adhered, try different products, such as powders, concave wafers, pastes, and/or moldable barrier rings.

Mechanical Irritation

Mechanical Irritation is another possibility of irritated skin around the stoma. The signs of mechanical irritation are similar to those of irritant dermatitis: red, weepy skin around the stoma that might be painful and bloody. This is caused by the device getting removed too forcefully or washing the skin too aggressively. Try the crusting technique (under Cleaning Stoma) or use a barrier ring if the skin is wet and weepy. When removing the bag, be gentle and use slow movements. Try to hold your skin tight with one hand while carefully peeling the adhesive wafer in a downward motion.

Contact and Allergic Dermatitis

Allergies can also be a cause of irritated skin around the stoma. 'Contact dermatitis' happens when the skin is damaged or cut and is now easily irritated. 'Allergic dermatitis' happens when the products you are using are causing an allergic reaction. This can be from the pouch itself, soaps, powders, barrier rings, or wipes. Discuss options with the medical team (there are hypoallergenic ostomy products made, you will just need to find the right product for you) to see what is causing the issue as well as what is available for you.

Peristomal fungal infection

This is when fungus or yeast (mixed with bacteria) is in your digestive tract and on your skin. Fungus grows in dark, moist, warm environments (like the skin under your ostomy device) and can especially be infectious when the skin is already damaged. To avoid: make sure your skin is completely dry before replacing your device. Some people like to use a hairdryer to ensure this. If doing so, make sure to set the hair dryer to a "cool" setting and cover the stoma with toilet paper. This will also warm your skin, helping the adhesive to stick more efficiently.

Blockages

Signs of blockage: output is a clear, thin liquid with repugnant odor; feelings of cramping near the stoma; swelling of the stoma/abdomin; and lighter urine/decrease in darker urine.

STEP 1: AT HOME

1. Create a larger opening in your pouch for your stoma to be able to expand without barriers.
2. If you are still having an output and you are not experiencing nausea or vomiting, only drink liquids such as sports drinks or tea.
3. Taking a warm bath can help relax the muscles around the stoma.
4. Try moving around, using positions like knee-to-chest, possibly moving the blockage.
5. Gently massage the area around the stoma and abdomen. Try pulling your knees to your chest, as it helps to increase the pressure behind the blockage. Most blockages from food happen just below the stoma.

STEP 2: IF STILL BLOCKED, DEALING WITH NO OUTPUT, OR VOMITING FOR SEVERAL HOURS: STOP ALL FLUIDS AND FOODS.

1. Call your medical team (doctor or WOC Nurse). Let them know what is happening and what you've tried to alle and report what is happening and what you tried at home to ease the problem. They will give you instructions on what to do next. If ER is necessary, your doctor can call in your care orders.
2. If you are unable to reach your medical team and your stoma is not outputting anything, go to ER immediately.
3. It is important that you take your ostomy supplies with you.

WHEN TO GO TO THE ER:

If you are dealing with an ileostomy obstruction you will have no output from your stoma, pain/cramping of the abdomen, nausea/vomiting, swelling of the stoma, swelling in the abdomen, and faint or absent sounds of the bowel.

Nausea/Vomiting

Electrolyte imbalance is common for those who have had their large intestine removed. This risk can also increase when sweating, vomiting, or dealing with diarrhea. Keeping electrolytes balanced are very important. Try Oral Rehydration Solution recipes to keep hydrated and balanced.

Sodium loss can also be an issue. Signs are: loss of appetite, leg cramping, and drowsiness. If low on potassium, signs are: fatigue, short breath, and muscle weakness. Being dehydrated and having low sodium and/or low potassium needs immediate attention. Keeping hydrated with electrolytes is important to avoid these issues.

To reduce ballooning

Try to control the amount of air going into your digestive system. As individuals, what causes more wind for one person might not be the same as for another.

Helpful tips to reduce ballooning

Eat and drink slowly, trying not to hurry or rush while doing so. Make sure to chew your food completely. Adding daily probiotics to your routine can help to balance bacteria in your system, diminishing wind in the system.

Some foods cause more gas and wind production.

These are foods high in fiber, spicy foods, some vegetables (mainly beans, cabbage, onions, and cucumbers), dairy products, and soy products. Carbonated drinks also cause more air in the intestines. Certain activities can also create more wind in the digestive tract: drinking through a straw, drinking from a sports cap bottle, chewing gum, smoking, snoring, and shortness of breath. These can increase the air that is getting swallowed, creating more wind in the digestive tract.

If ballooning does happen, it is possible to release the air from your pouch.

If you are using a two-piece system, you can "burp" the bag by partially unclipping the wafer from the bag at the very top and gently pushing out the excess air. If using a 1-piece system, you can tilt the bag up (if anything is in the bag it will slide up towards the stoma) to prevent spilling and slowly guide the air through your bag, exiting through the drain/spout. This should be done in a bathroom, or well-ventilated area- it will have a strong odor.

Other Complications

Phantom rectum is similar to the feeling of a "phantom limb" that an amputee experiences. The feeling of need to empty your bowels (like it felt presurgery) may continue for years after surgery. If you still have your rectum, you may still pass mucus while having this feeling. That is completely normal since the rectum is still alive. Some say it can be helpful to sit on the toilet and help move the mucus by acting like it is a bowel movement. Another way to release this pain is by self-administering (or having a loved one assist) a saline enema. Enemas help hydration, helping to pass the mucus while relieving the pain/pressure.

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