Stoma Care at Home — A Self Help Guide

If you are experiencing peristomal skin redness, irritation, itching, discomfort or leakage under the barrier, don’t panic. We’re here to help.

In this guide, we’ve outlined several potential stoma care issues that can be resolved while you’re at home during the COVID-19 pandemic.

Please remember, this page only contains general advice and is not intended to replace any specific advice given to you directly by a healthcare professional.

Sore skin

The area of skin around your stoma is called peristomal skin. While it might only be a small area, it can have a big impact on your quality of life and comfort if it is not cared for correctly.

Some studies show that up to 75 percent of people with an ostomy experience a peristomal skin condition. In many cases, this can result in pain, itching, soreness, odours or overall discomfort.

Consider using the Peristomal Skin Assessment Guide. It can help you identify common skin problems, things you should do, and when to visit your stoma care nurse or healthcare provider.

Poor-fitting ostomy skin barrier

Peristomal skin conditions are often caused by an incorrectly fitted ostomy skin barrier. This can also lead to leakage of stoma output underneath the barrier, which, in turn, can cause skin irritation.

Your stoma may get smaller during the first six weeks after surgery and can continue to change shape and size. As such, your ostomy skin barrier must fit where the skin and stoma meet. Verify there is no skin showing between the skin barrier and the stoma to prevent leakage.

We recommend remeasuring your stoma and cutting the correct-sized opening to ensure a good fit. Measure your stoma until it stops changing and remeasure if you are having problems or experience weight loss or gain. Fitting the ostomy skin barrier correctly will protect the skin.

You can find more information on appliance leakage below, or by reading our 6 tips for avoiding leakage.

Leakage under the skin barrier

Leakage of your stomal output under the ostomy skin barrier can happen for a variety of reasons. By having a skin barrier that fits well around your stoma, you will prevent leakage and can protect your skin from irritation or being damaged by the stoma output. Please remember you should always follow a regular peristomal skincare routine.

Need help with fitting your appliance? We have step-by-step fitting guides for one-piece pouching systems and two-piece pouching systems.

Body shapes

If you have abdominal creases, scarring, swelling behind the stoma, or any other changes to your abdominal contours, it’s possible that the pouching system may not fit correctly. Having a good seal around the stoma will help prevent leakage and promote comfort.

Make sure your skin is as flat as possible when applying products. If leakage issues continue or you’re experiencing any skin irritation, get in touch with a healthcare professional.

Our products are designed to conform to the body without compromising fit. You can assess your barrier fit needs by assessing your stoma and abdomen with the Fit Indicator Tool. You can also browse our latest product range.

Swelling behind/around the stoma

It can be normal to have swelling at the stoma site after surgery. It’s important, however, that during this time you monitor the area. If there is any pain, nausea, vomiting, inactivity or significant change in temperature, you should contact your stoma care nurse or healthcare professional.

Many people living with a stoma may experience what’s known as a parastomal hernia. This is a type of incisional hernia that occurs in the outer layer of the abdomen in the vicinity of a stoma. This forms a bulge around the stoma. The majority of hernias at the stoma site do not cause serious issues; however, you should contact a healthcare professional if you have any pouching system issues or any adverse side effects.

Stoma bleeding

While bleeding is uncommon for many people living with a stoma, there are different situations that you should be made aware of.

The most common scenario is when the stoma bleeds after making contact with it. This could happen during your cleaning and hygiene routine. In this situation, the bleeding should stop quickly. If it doesn’t, you should contact a stoma care nurse or healthcare professional.

Colostomy constipation

Constipation may occur when you have a colostomy. This could be caused by certain medications, such as some pain relievers and antacids. Other reasons for constipation include a diet lacking in fibre and inadequate fluid intake (more on dehydration below).

If you are experiencing constipation, you should increase your fluid, fruit, and fibre intake.. If there is no improvement or you’re experiencing pain, nausea or vomiting then contact stoma care nurse or health care professional.

To learn more about the additional causes of constipation and which foods to avoid, you can read our guide to dealing with gas and constipation after colostomy surgery.

Ileostomy: blockage or obstruction

If your ileostomy is not functioning properly, there may be a blockage or obstruction.

If an ileostomy has not worked for 6 hours and you are experiencing abdominal pain and nausea/vomiting, contact your stoma care nurse or healthcare professional.

High output stoma

A stoma producing more than 2 litres (2000 ml) per day is considered high output and increases the risk of dehydration and acute kidney injury.

The output from an ileostomy should be of a paste/porridge-like consistency – not watery. Watery output for longer than 12 hours should be investigated further, and some dietary changes should be considered. If there is a watery output for longer than 24 hours, you will require healthcare professional intervention.

A high watery output may be caused by:

• Infection (you may be asked to produce a sample)
• Obstruction
• Quickly stopping some medicines e.g. steroids or strong painkillers
• Taking some medicines e.g. laxatives or magnesium

You can read more about high output stomas here.

Dehydration

If you have a stoma, particularly an ileostomy, you are more vulnerable to dehydration. You should drink plenty of water, unless you have a fluid restriction.

Signs of dehydration:

• Feeling faint
• Dizziness
• Headache
• Feeling thirsty
• Dry mouth
• Feeling tired
• Muscle cramps/weakness
• Reduced/no urine output
• Dark, concentrated urine

If you need to re-hydrate your body, drinking water is always the best option. Sports drinks can help, as can special rehydrating solutions that are available from most pharmacies. Use these fluids until you are passing clear or straw-coloured urine through the day. Contact a health care professional if you continue to experience signs of dehydration.

Further advice

If you’re looking for more guidance on stoma care, you can find lots of useful information in our ostomy learning centre.

Please bear in mind that our learning centre only contains general advice and it is not intended to replace any specific guidelines given to you directly by a healthcare professional.

You can also use our guide to ostomy online communities for further advice about how to get support during the coronavirus lockdown.

Whether you're a patient, a carer, or a healthcare professional, we can help with any questions you have about Hollister products or services.

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Resources

1. Brighton and Sussex University Hospitals NHS Trust guide, endorsed by the Association of Stoma Care Nurses UK (ASCN): https://www.bedfordshirehospitals.nhs.uk/documents/stoma-care-self-help-guide/
2. Wound Ostomy and Continence Nurses Society: https://www.wocn.org/
3. Peristomal Skin Assessment Guide for Clinicians: https://psag.wocn.org/