Evaluating the skin around the stoma to identify any potential problems
Managing the peristomal skin, or the skin around the stoma is probably the most important thing to ensure you have a good stoma care routine for the person you are caring for.
What is good peristomal skin?
The skin around the stoma should look like the rest of the skin on the abdomen, there shouldn’t be any breaks, rash or discomfort experienced.
Skin breaking down.
One of the most common problems that people complain about is that the skin around the stoma breaks down and/or feels itchy or painful. Whenever you do experience this contact the stoma care nurse or doctor to ask for advice. It is important to identify the cause.
Skin surrounding the stoma
The peristomal skin is the skin immediately next to the stoma and underneath the entire pouch adhesive. It is common for this area of skin to become red, sore, or itchy particularly within the early days or weeks however with the appropriate assessment this can be rectified.
Here are a few reasons why this could happen:
- Pouch has been cut too big
One of the main reasons is that the pouch hole has been cut too big and the some of the skin has been exposed to the effluent which causes this area of skin to breakdown. The stoma usually decreases in size over the initial 6-8 weeks after surgery and it is important to measure the stoma and cut the pouch hole accordingly at this early stage.
How to prevent this from happening: Make sure the size of the pouch hole is cut out to exactly the shape and size of the stoma. Most manufacturers will provide a measuring guide inside the box of pouches. If you have difficulty doing that, contact the stoma care nurse and ask to have the stoma measured and sized. There are certain pharmacies or certain deliveries services that will cut the pouch out to the exact shape and size. Many of the manufacturer companies have pre-cut pouches that might suit you and the local stoma care nurse can help with appropriate code number for ordering these.
2. Pouch leakage
If leakage or broken skin is an ongoing problem, it is important to speak to the local stoma care nurse. Perhaps the stoma is retracted or coming in and back out again, maybe that is what is causing irritation on the skin. You might need to think about an accessory product or even an alternative pouch.
How to prevent this from happening:
- If the ostomate has uneven skin or creases around their stoma then paste or a seal/ washer works well.
- If a flat bag is currently being used and the stoma is flush or retracted, you might need to talk to the stoma care nurse about trying a convex pouch which helps to create a better seal between the stoma and peristomal skin.
3. Surrounding peristomal skin
Another common complaint would be about the area underneath the flange where the pouch is stuck onto the skin can start to deteriorate. The technical term for that is called skin stripping.
How to prevent this from happening: A remedy to prevent this from happening is to use an adhesive remover spray, which allows you to remove the pouch without any trauma. There are some countries that do not prescribe an adhesive remover spray therefore you may have to buy it and perhaps that is not possible for you. If that is the case, use warm water and hold the pouch away from the skin and very gently wash the pouch off the skin.
Another problem for some men particularly if there is a lot of hair on their abdomen, they can develop irritation/inflammation within the hair follicles. A remedy is to try and shave once every fortnight or three weeks to reduce the inflammation. It is important to protect the stoma when shaving the peristomal skin.
4. Underlying skin problems
A small percentage of people have an underlying history of eczema or psoriasis before their surgery and therefore may be at risk of developing this on their peristomal skin.
If the person you are caring for has psoriasis or eczema, it is important to speak to your local stoma nurse, GP or perhaps a dermatologist. There are some remedies for helping with a larger area of peristomal skin problems, the use of a steroid cream might be prescribed if needed. If that is what has been recommended, the way you would use it is to take off the appliance and try to apply at a time when the stoma is quiet and isn’t functioning. You apply a small pea sized amount of the cream on to the irritated area, wrap a tissue around the stoma to catch any effluent that is coming out, allow the steroid cream to seep into the skin and then wipe any excess away and that shouldn’t interfere with how the pouch will adhere onto the skin. If you are having difficulty applying prescribed creams or ointments, seek help and advice from your local stoma nurse.
It is also important to be aware that some ostomates may have pre-existing skin conditions, such as eczema and psoriasis, or they may have an allergy and may therefore require a dermatology referral (Burch, 2011).
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