One concern a lot of new colostomy patients have is the proper way to care for their stoma. The idea of having an opening to internal organ, the colon in this instance, on the outside of the body raises all types of concern and worry over infection and how to maintain a clean and healthy stoma. It may seem like an impossible task to keep something clean when it routinely expels fecal and waste material. With just a few instructions and an understanding of when something may not be right with your stoma, the fright and worry should dissipate over time. It all becomes routine after a period of time. Healthy stoma care involves cleaning, changing the pouching system and skin barrier properly and regularly, watching out for signs of hernia and paying attention to the condition of the stoma itself.
Below are just some basic guidelines. Your ostomy nurse or doctor should provide you with detailed instructions and tips for maintaining a healthy stoma depending on your particular case and these should always be followed as closely as possible.
Basics of Stoma Care
Right after surgery, when one first gets a look at their stoma, it might seem alarming or disconcerting at the size and color of what has just been attached to the abdomen. This is normal. As time passes, and everything begins to heal, the stoma should go down in size and its color should change to eventually settle on a pink are light red tint. The stoma does not contain any nerve endings, so it will not hurt when it is touched. Once it settles into its final appearance, shape and color it is key to take notice of what your healthy stoma looks like. A sudden change in appearance from the norm can be the first sign that something may be wrong.
Cleaning: The stoma itself is basically the colon and is protected by mucus. The main area of attention to proper colostomy care is the condition of the skin that surrounds the stoma. Good hygiene for this section of skin involves proper changing of the pouching system and skin barrier and cleaning this area at regular intervals.
The use of warm water and a soft cloth is enough to clean the skin around the stoma in most cases. If you use soap it is advisable to avoid those containing any type of fragrance and oils since these can sometimes cause irritation or interfere with the skin barrier effectively sticking to the skin. Make sure to completely rinse off any soap if used. Before reapplying the skin barrier always make sure the area is dry by using a paper towels or a soft wash cloth. Avoid the use of skin irritating cleansers that contain alcohol or other harsh ingredients.
The Skin Barrier (Wafer): The skin barrier is probably the most important colostomy supply related to stoma care. It is placed over your stoma and has a opening cut out for waste material to pass through. It protects the skin around the stoma from contact with this fecal matter to help prevent irritation and possible skin infections.
It is usually recommended to change the skin barrier every 2 to 5 days. The opening should have a good fit around the edge of the stoma without being too tight. It should always have a snug fit to the the skin. Shaving the area around the stoma will help ensure a clean surface for the skin barrier to stick to. Optional pastes can be used as a sort of “caulking” around the edge of the stoma to fill in any areas wear skin may be exposed.
If any leaks occur it is best to remove the pouch and skin barrier, clean the area, and then reapply everything. Trying to fix the leak with tape or by other means may increase the risk of skin irritation.
Parastomal Hernia: The nature of colostomy surgery weakens the muscles in the abdominal wall and increases the risk of having a hernia. The small intestines may shift and push through an instable area of the muscle wall near the stoma. If this happens, a noticeable bulge may appear anywhere around the stoma. This is more prone in colostomies that happen closer to the small intestines such as an ascending colostomy. Certain colostomy belts may offer support and help prevent a parastomal hernia from occuring. Talk to your ostomy nurse about the risk of hernias and see if a support belt may help in your particular situation.
Stoma Care Problems
Certain problems, some rare, that may require you to seek immediate medical care or require you to call your doctor or ostomy nurse may include the following:
- Extensive bleeding from the stoma: While it is normal for the stoma to bleed a little while it is touched, prolonged bleeding that does not seem to stop is a definite cause for concern. If there is extensive blood in your pouch or you cannot control bleeding from the stoma, contact your doctor or nurse or seek immediate medical care right away.
- If you accidentally cut your stoma you should inform your doctor. If it is a deep cut with constantly bleeding then seek immediate medical care.
- Redness, red bumps, pain, white discharge and tenderness in the area around the stoma may be a sign of infection.
- Stoma retraction or prolapse: If your stoma seems to be shrinking or pulling back inside the hole in the abdomen or conversely, if it seems to sticking out further than usual then this is something you should inform your doctor about. As long is the stoma looks healthy then it should not be an emergency situation but it is something your physician should know about.
- Your stoma should be an area of activity. If you have gone longer than normal without anything being expelled from the stoma it may be a sign of a blockage. Your doctor should be informed of any prolonged periods of unusual inactivity from your stoma.
- If your stoma changes from its usual pink or red color to a darker red or purple shade then something might be affecting the supply of blood to your stoma.
- Non-stop nausea or vomiting may be a sign of something serious and medical care should be sought.
Proper use of the skin barrier, its application, maintenance and changing it regularly, can cut down on a lot of problems associated with skin irritation around the stoma. Always follow your doctor’s or nurses instructions regarding stoma care and make sure that you inform them if you are worried about any changes in the condition of your stoma. Once you get the hang of it, stoma care can become routine, like brushing your teeth.
Below is a video that further discusses stoma care.