After surgery, taking good care of your stoma and peristomal skin (i.e. the skin around your stoma that is covered by the barrier) is one of the best things you can do to keep your ostomy healthy. Peristomal skin health impacts how well your ostomy supplies work and how often you need to change your barrier plate.

In this article, we’ll explain why a healthy stoma and peristomal skin are important, how to take care of your skin, and how to solve some common problems you might run into.

Why peristomal skin health is important

The simple truth is that barriers work best on healthy, unbroken skin. Ostomy barriers need healthy skin to create a good seal and to provide the best protection. 

If your skin becomes irritated, weepy, denuded (the skin layers are rubbed away), or macerated (the skin is breaking down), you may have trouble getting the barrier to adhere to the skin. That may lead to more frequent barrier changes, which can cause the skin to break down further and increase risk factors for stoma complications.

Factors that affect skin and stoma health

For ostomy patients, your activity level, your stoma location, body shape, and how much you sweat impact wear time between barrier changes and can result in skin problems.

Common causes for peristomal skin and stoma complications

As in real estate, it’s all about location for managing stoma care. In a perfect world, your stoma would be located in a spot with no problems. Surgical procedures sometimes dictate a change in plans and our stoma placement ends up being tricky to work with.

Your stoma might: 

• Be located in a skin fold
• Retracts into the skin
• Have a parastomal hernia
• Be next to scar tissue or bellybutton, you might experience additional challenges.

The number one thing you can do to prevent and treat skin issues is to ensure your barrier fits correctly.

Keys to the right barrier fit

Regardless of whether you have a colostomy, ileostomy, or urostomy, you should minimize the amount of output that can reach the skin.

• Ensure your barrier fits closely around your stoma.
  The less skin showing between the barrier opening and the stoma, the lower the chance for output to reach the skin surface. 
• But don’t choke your stoma
  Your stoma needs to room to expand and contract, which is a normal part of the way intestines function. Your stoma also needs adequate blood supply.

What can I do to solve peristomal skin irritation?

First, evaluate your skin’s condition. You or your caregiver can assess your skin just by looking at it.

• Your stoma should be pinkish-red and moist.
• Your peristomal skin should be intact and unbroken. Peristomal skin should look the same as the rest of the skin on your abdomen.
• Check the stoma and skin each time you change the ostomy system.
• Observe the old barrier for potential leaks around the stoma.

Next, describe the issue to yourself. What are you seeing? Are there papules (small bumps) or vesicles (small sacks that look like pimples)? Do you notice discoloration, redness, weeping, crusting, oozing, or dryness? The presence of these symptoms can indicate several specific types of problems.

As always, consult your wound care nurse or  medical care provider before you begin treatment.

Common types of peristomal skin complications

Allergic contact dermatitis

Allergic contact dermatitis is when the skin becomes inflamed due to direct contact with a certain substance. It is a fancy way of saying your skin is allergic to something you’re applying on it. It could be caused by the barrier or the skin prep products you use. 

Contact dermatitis produces a red, itchy and sometimes painful rash. Unfortunately, you usually can’t know you’re allergic to something until you use it and have a reaction. 

If you think you might be having an allergic reaction:

• Remove the irritant or allergen.
  Try cleaning and thoroughly drying skin before reapplying your ostomy system.
• You may need to try switching to a different type of barrier
  Not all barriers use the same type of adhesive. Barriers typically have an acrylic (like medical tape) or hydrocolloid (gel-based) formulation.
• Eliminate unnecessary ostomy products
  Or, if you’ve found a product that is particularly effective for you, try re-introducing it after a break.
  If several products help, try reintroducing them one barrier change at a time. The combination of certain products may be causing your reaction.
• Most, but not all, ostomy products are latex-free.
  If you have a latex allergy, verify that the products you’re using are latex-free.
• If the skin is denuded, try the crusting method. Barriers won’t adhere well to denuded skin, in which layers of skin have been worn away. 

Irritant dermatitis

Irritant dermatitis (sometimes called contact irritant dermatitis) is skin damage caused when the skin is exposed to fecal or urinary drainage or chemical preparations. A skin barrier that is cut too large is a common cause of irritant dermatitis because it can expose skin to stool or urine. To improve barrier sealing, you may need to modify the pouching system or add accessories.

Irritant dermatitis looks similar to allergic dermatitis. You might see small red bumps or pustules, redness, discoloration, and oozing or dryness.

To manage irritant dermatitis:

• Use the correct size opening for the pouching system. Your barrier opening should be no larger than a few millimeters or a quarter-inch around the base of your stoma.
• Modify the pouching system by using an ostomy belt or a convex skin barrier instead of a flat one.
• Try using a convex or flat barrier ring. Barrier rings help create better seals by filling in gaps or creases where output can accumulate.
• Use a skin barrier spray or wipe as a protective layer over the skin.
• Use the crusting method to create a dry surface for pouch adhesion.

Candidiasis Infection

A candidiasis infection is more commonly known as yeast rash. Yeast cells live all over the body but they thrive in warm, dark, moist places – just like the area an ostomy barrier covers. Fungal infections, like yeast, can stem from body perspiration, denuded skin, or a leaking pouch system.

Candidiasis infections can appear as skin discoloration with small bumps or pustules. Contact your medical provider right away if you believe you have a candidiasis infection, as they can prescribe an antifungal cream or powder.

The following actions can help prevent fungal skin infection:

• Ensure skin is completely dry before applying a new pouching system 
• Use a pouch cover or a pouch with a cloth backing. This will help absorb moisture.
• Dry the pouching system well after swimming, bathing, showering, or contact with water or steam. A blow dryer on low heat is a great way to dry the pouch system.
• If you have a history of fungal infections—for example, you often develop a fungal rash during antibiotic therapy — consult with your medical provider. They may prescribe a prophylactic treatment to help manage the infections.

If you need additional help identifying causes or symptoms not covered in this article, this Peristomal Skin Assessment tool developed by the Wound, Ostomy and Continence Nurses Society is a great resource.

How do I clean around my stoma and skin?

The stoma itself does not need to be cleaned, although it can be helpful to wipe away output during a barrier change. Here’s a step-by-step guide to cleaning around your stoma:

• Gather and set up all equipment and materials you will need in a clean environment.
• Wash your hands before and after caring for your stoma.
• The best way to clean the skin around your stoma is to use warm water and a washcloth, or soft paper towels. You do not need to use gauze or gloves. It is not necessary to use soap to clean around your stoma. If you prefer to use soap, use a mild soap and rinse well. 
• Avoid using soaps and cleansers with oils, perfumes, or deodorants. These products may cause skin problems or keep your pouching system from sticking.
• Do not use pre-moistened wipes, baby wipes, or towelettes not made for cleaning the skin around a stoma. While wipes can be used in an emergency, many of these products contain ingredients that can interfere with the pouching system adhesives. They also may irritate your skin.
• If paste is part of your pouching system, don’t be concerned if a little bit of paste is left on your skin after cleaning. It will not harm your skin or keep the new pouching system from sticking.
• Unless recommended by WOC or health care provider, do not apply powders or creams (except for special ostomy powders) to the skin around your stoma as they can keep your pouching system from sticking.
• Always dry your skin well before you put on a new pouching system.

Shaving peristomal skin

Shaving or clipping excess hair around the stoma in the direction of hair growth may limit skin irritation. Carefully shave the skin outward away from the stoma to avoid accidental injury.

• Use an electric razor
• Dry shave with a safety razor and an ostomy skin barrier powder
• Wet shave with mild soap and water.
• If you use shaving foam, avoid foam that has moisturizers or perfumes that may irritate the skin or interfere with the barrier’s adhesive. 
• Always rinse the skin well with water after shaving.
• Assess for any injury to the stoma or bleeding as you may necessarily feel it if there is an accidental injury.

When cleaning, keep in mind that:

• Sometimes you may see a small amount of blood when you are cleaning around the stoma.
  The stoma has small blood vessels that may bleed for a short time when cleansed. Any bleeding that does not stop should be reported to your health care provider.
• Be gentle when cleaning around the stoma.
  The stoma does not have nerve endings so you usually are not able to feel if you are rubbing too hard. 

How can I prevent skin irritation and other problems?

It’s very common for ostomates to experience irritation or problems with peristomal skin. The skin in that area experiences a lot of stress, from barrier changes to exposure to output. Here are some ways to prevent or reduce skin irritation.

• The best skin protection is a well-fitted and comfortable pouching system. Your wound care nurse (WOC nurse) should help you choose the system that works best for you. Better Health can also guide you in selecting your products. Call us at 1-415-475-8444.
• The opening of the barrier on your pouching system should be the size of the stoma unless otherwise your WOC nurse directs you otherwise. 
• Measure your stoma each time you change your pouching system for the first six to eight weeks after your ostomy surgery.
• Re-measure your stoma occasionally if you notice that your stoma has changed shape or size. If your stoma changes, you will need to change the size of the opening in your barrier.
• Hold your skin smooth as you put your pouching system on to avoid wrinkles in the skin that may lead to leakage.
• Each time you remove your pouching system, check your skin for signs of irritation. Check the sticky backing of your pouching system for signs of moisture leakage.
• Use a mirror to check your skin around the stoma. Look for any places where stool or urine may have leaked under the pouching system and onto your skin. When you apply your next pouching system, these areas may need extra reinforcement with skin barrier strips, rings or paste.

There are many great ostomy products available that are well-designed and do an excellent job of protecting your skin and stoma. Want to try something new? Better Health’s team of experts can help you with samples and recommendations. Call us at 1-415-475-8444 for a free consultation!