Stoma and Skin Care

Introduction

This blog aims to provide information regarding the care of the stoma and peristomal skin. Caring for your stoma and the skin around the stoma (peristomal skin) includes multiple factors. The proper selection of an ostomy appliance helps prevent leaking and peristomal skin problems. Regular maintenance includes consistent changing intervals and emptying of the pouch. Allowing the appliance to become overfilled will shorten its wear time. When changing an appliance, it is a good time to examine the stoma and peristomal skin. Additionally, it is critical to understand the normal appearance of the stoma and peristomal skin in order to recognize abnormalities.

 

Stoma Care Management

  • Appliance Emptying: Throughout the day, feel the pouch to assess if it is full and needs to be emptied when it is ⅓ – ½ full of gas and or stool. The pouch assessment will differ depending on whether it has a filter and the type of ostomy. Overfilling the pouch interferes with the wear time of the pouch.
  • Appliance Changing: Proper changing technique, regular changing intervals, and a well-fitting appliance prevent leaking and skin problems. The usual interval for changing the appliance is twice a week. Or sooner if the appliance is leaking or if there is a feeling of skin irritation beneath the appliance. A two-inch flat skin surface around the stoma ensures adequate appliance seal. 
  • Frequent Appliance change: If the appliance needs to be changed more than every three days, it is necessary to see an ostomy nurse. The ostomy nurse will provide recommendations for appliances and skin irritation.

 

Stoma Color and Appearance

  • Stoma Color: The overall health of an individual can have an effect on the stoma color and is not considered a stoma problem.  The stoma is constructed of bowel mucosa and contains blood vessels. The normal stoma color ranges from dark pink to red. The stoma color will appear dull and light pink for a severely anemic individual. Low oxygen levels can change the color to a bluish tint. When the underlying health issues resolve, the stoma color will return to normal. 
  • Stoma Appearance: The stoma produces mucus, and the stoma is warm and moist. Small amounts of bleeding are normal if rubbed and will resolve quickly.
  • Abnormalities:  Stoma colors are yellow/brown/black, burgundy to deep red, and active bleeding internally or externally is abnormal. Any stoma abnormalities require immediate physician notification.

Stoma Size

Stoma size can vary for different reasons. Therefore, periodically check the stoma size with a stoma measuring guide. 

  • Postoperative Edema: Edema after surgery can cause changes in the stoma. The size decreases over six to eight weeks. During this time, measure the stoma before changing the appliance. The stoma appearance is a light pink translucent color and changes to a dark pink or red when the edema subsides.
  • Parastomal hernia: bump or bulge can affect the stoma size. The size will increase and decrease with body position. The bulge will reduce while laying down and increase sitting and standing positions. Cut the opening in the skin barrier with the largest measurement and protect the exposed skin with a barrier ring seal.
  • Stoma Budding: Budding is the protrusion of the stoma from the skin level. The ideal protrusion is 2-3 cm above the skin level. Less than 1 cm height may cause problems with leaking and skin problems.
  • Size Abnormalities: Notify a physician of hernia formation, stoma retraction greater than 0.5 cm, and prolapsed (telescoping) stoma. Abdominal pain and no output require immediate medical attention.

Peristomal Skin

The peristomal skin should look the same as the other side. Individuals with lightly pigmented skin should not be red, and dark pigmentation should not have darker skin tones. The peristomal skin should be free of rashes and open areas. Any abnormalities require a properly fitting appliance, rashes, and open skin treatment.

 

Conclusion

Stoma and skin abnormalities are not typical. The stoma should be dark pink or red in color, with a protrusion above the skin level (2-3 cm). The skin will be protected if the appliance is applied, maintained, and fitted correctly. Knowing what is typical will aid in determining what is abnormal.   

 

Further Reading and References

Colwell JC, McNichol L, Boarini J. North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues. J Wound Ostomy Continence Nurs. 2017 May/Jun;44(3):257-261. doi: 10.1097/WON.0000000000000324. PMID: 28362656; PMCID: PMC5417579.

 

Kirkland-Kyhn, Holly PhD, FNP-BC, GNP-BC; Martin, Sanaz MS, RN; Zaratkiewicz, Sunniva PhD, RN, CWCN; Whitmore, Morgan MSN, RN; Young, Heather M. PhD, RN, FAAN Ostomy Care at Home, AJN, American Journal of Nursing: April 2018 – Volume 118 – Issue 4 – p 63-68 doi: 10.1097/01.NAJ.0000532079.49501.ce 

 

Murken, D. R., & Bleier, J. (2019). Ostomy-Related Complications. Clinics in colon and rectal surgery, 32(3), 176–182. https://doi.org/10.1055/s-0038-1676995

 

McTigue T, Lei J, Kowalski MO, Prestera S, Chiu S, Shehebar JA. Stoma Bridge Types and Their Impact on Patient Outcomes: A Retrospective Analysis and Prospective Global Survey of Surgical Practice. J Wound Ostomy Continence Nurs. 2019 Jul/Aug;46(4):309-313. doi: 10.1097/WON.0000000000000543. PMID: 31274861.

 

Stelton, Susan MSN, RN, ACNS-BC, CWOCN CE: Stoma and Peristomal Skin Care: A Clinical Review, AJN, American Journal of Nursing: June 2019 – Volume 119 – Issue 6 – p 38-45 doi: 10.1097/01.NAJ.0000559781.86311.64 

 

Disclaimer

The views and opinions expressed in this blog are solely those of the author and do not represent the views of iWound, its affiliates, or subsidiary companies.

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