Skin Irritation with an Ostomy

Overcoming skin irritation around the stoma

Skin irritation around the stoma is often caused by leaking from the ostomy pouch. As a result, stoma output gets under the adhesive of your baseplate and onto the skin. Not only is this uncomfortable, but it can prevent your ostomy appliance from working well. 

Usually the skin around the stoma should look like the rest of the skin on your body. It's normal for the skin to be a little pink immediately after the adhesive is removed. If this colour doesn't fade, or if the skin is broken or damaged, this can be an indicator that the skin may be irritated.

What should I do?

• Remove the baseplate and check the back. Are there any signs of stool or urine that could have caused irritation?
• Is there any irritation or damage around the stoma that matches what you see on the adhesive baseplate?
• How well does your ostomy appliance fit around your stoma? If your appliance isn't fitting correctly, the skin may be exposed to the output. 
• Assess the diameter and shape of your stoma to determine if your size guide has the correct size and shape. If using a cut-to-fit product, cut the hole to match your stoma's exact diameter and shape.
• What is the position of the stoma opening relative to the surface of your skin? Is it above, level or below the surface of the skin? 
• If the stoma is at or below the skin's surface, you may need a different type of pouch or accessory for your body profile. Speak to your ostomy nurse about convex products. 
• Has the adhesive eroded? If so, you may need to change your ostomy appliance more frequently. You could also consider an erosion-resistant adhesive baseplate if you're not already using one.

When experiencing skin irritation or skin integrity issues, it's crucial to consult your ostomy nurse or doctor. 

Skin irritations & What to Do:

If your skin is red and "pimply."

Rashes with small, painful pimples or pustules may be due to an infection of the hair follicles around the stoma. 

You may have seen this type of irritation before from shaving; the same applies if you shave the hair around the stoma. Irritation can occur when the area is shaved too often or incorrectly (e.g. not using a clean and sharp razor, shaving against the direction of hair growth, etc.) or if you pluck the hair. Your adhesive baseplate can also pull out the hair if removed forcefully. Using scissors or an electric shaver is recommended, as they work better on the skin than a razor blade.

If your skin is wet and bumpy

A rash (an area of ​​redness, usually itchy), accompanied by red/purple spots or a white substance on the affected areas, can be a sign of a fungal infection. Risk factors include diabetes, weakened immune systems, and dark/moist areas. 

You can prevent fungal infections by keeping the peristomal skin clean and dry.

If your skin is bleeding

Start by carefully examining and determining where the bleeding is originating. Bleeding from the skin around the stoma may be a sign of a contact reaction and may require treatment or other measures. You should seek advice from your ostomy nurse.

A slight amount of bleeding from the stoma itself is not necessarily troublesome. Ostomy tissue bleeds easily, similar to gums when flossing or brushing.

Are you having an allergic reaction?

Allergic reactions are not common; as a matter of fact, they are relatively rare. However, if you are experiencing one, the skin is likely to be very aggravated and itchy throughout the area exposed to the irritant.

Start by skimming through the products you're using. Products that contain perfumes, soaps with moisturizers, fragrances, or oils should be avoided. Some ostomates are more sensitive to alcohol-based products and find they dry or irritate the skin. Instead, try to wash the peristomal skin gently using only water and determine if the skin is improving. You can also find alcohol-free accessories. 

It is possible to be allergic to some of the accessory products you use, such as sprays, wipes or pastes, or even components of your pouch system. If the problem persists, talk to your ostomy nurse about other options.