 |
 |
| Caring for Your Skin to Treat Problems or to Prevent Them from Occuring |
|
| The Importance of Skin |
| Prevention is Better Than Cure |
| Routine Skin Care |
| Protecting Your Skin |
| Treating Simple Skin Problems |
|
| The Importance of Skin |
| With a stoma, it's vital to care for the peristomal skin — the skin around the stoma. The condition of this skin can affect not only your overall general well-being, but also the skin barrier, how the pouch is fitted and how long it can be worn. Learning how to take good care of the skin around the stoma can bring great rewards in the form of both physical comfort and peace of mind. |
|
| If a skin problem develops, it will usually be easily treatable. However, the process can take time and may cause stress. Remember, though, if at any time skin problems persist, or you've tried several treatments without success, it may be time to visit a stoma care nurse or doctor for some help and advice. |
|
| The skin is the body's largest organ. It does many things that most people may not even be aware of. It helps make some vitamins, controls body temperature, protects against harmful germs, provides waterproofing, provides information to the brain about what's happening in the outside world, and gets rid of wastes. No wonder looking after skin is so important. It looks after us. |
|
| At some point in life, everyone experiences a painful break in the skin. Most of us have endured blisters and sore feet caused by new shoes, bad sunburn, or the cuts and scrapes that happen with everyday living. Skin breakdown is not only uncomfortable but can also be messy. |
|
| Remember, everyone's skin is unique. What works for one person may not work for another. |
|
| ^ top |
|
| Prevention is Better Than Cure |
| The best course of action is to prevent skin problems from starting in the first place. A correctly fitted pouching system - that is, one which is snug to the stoma, but not too tight - is a good start. If there's any visibly exposed skin on the inner circle of the skin barrier when applied, chances are the hole in the barrier is too big. If in doubt, use a stoma measuring guide and double check to make sure of the correct fit. This is of particular importance especially in the early days following surgery, when stomas can change both shape and size. It's always a good idea to re-measure frequently in the beginning. |
|
| With a loss or gain in weight, the peristomal skin may change size or shape and affect the pouch seal. Check to see if there are any skin dips or gullies around the stoma. If there are, adding a small amount of stoma paste as filler to smooth the surface may fix the issue. Stoma paste is a caulking agent, not an adhesive. It's used as a gap filler. There are other choices such as barrier rings and strips which are easy to apply. |
|
| There are skin barriers that fit an outward curve of the skin around the stoma. These are called convex skin barriers and they are different from flat backed barriers: the back of the barrier is curved outwards along with the skin. This fills in places where the skin is folded or the stoma is recessed, and gives the stoma a little push forward to assist drainage into the pouch. It also helps flatten out any peristomal folds and creases which might be interfering with a good skin barrier seal. It's generally a good idea to speak with a stoma care nurse about using these kinds of products as they vary from brand to brand in terms of depth and style. |
|
| If there's a small amount of broken skin, stoma powder can be applied to protect these areas from further breakdown. Be sure to brush off the excess powder before applying any other pastes or skin barriers. Once the skin has healed, stop using the powder. It's not used for prevention but simply to help treat an existing problem. |
|
| Also, when changing the skin barrier, be gentle. Don't pull the skin barrier straight off the skin. Instead, gently press the skin away from the barrier. This will help prevent what's commonly known as skin stripping. |
|
| If the pouch adhesive or tapes are difficult to remove, or if there are concerns about residue, you may find a remover helpful. These are often available in either an aerosol or a wipe form as an accessory product. |
|
| Make sure to empty the pouch when it's one-third to one-half full. This ensures the adhesive is not carrying too much weight and maintains a good skin seal. If the pouch gets too full, the contents can leak and wash back over the adhesive. This can dissolve the barrier, which weakens the seal between skin and pouch. |
|
| ^ top |
|
| Routine Skin Care |
| Many people feel that they need to keep the peristomal skin spotless at all times. This can reach a point where cleaning, scrubbing and disinfection become excessive. This can be very harsh on skin since it removes the protective layers of the skin around the stoma. There's no need to use harsh cleansers or disinfectants. |
|
| The solution is simple. Carefully remove the skin barrier adhesive and cleanse the skin with warm water. Many people like to remove everything in the shower and rinse everything. This is fine and won't harm the stoma. |
|
| Remover wipes are useful if there's a build up of residue from either tape or skin barriers. Be sure to cleanse the skin after using them though. If using soap, select a brand that's not oil-based and doesn't leave a residue. Specially designed skin cleansers are available which are soap and fragrance-free for extra gentle cleansing. Once the skin is clean, simply pat it dry. Then reapply the pouch or skin barrier. Some people recommend methylated spirits and hairdryers. This is not a good idea as the stoma can get burned with the dryer on too high a setting and the methylated spirits are flammable. These products are designed to adhere to the skin with nothing in between. Adding other remedies may cause skin reactions. |
|
| If the peristomal skin shows signs of redness or mild irritation, sometimes conditioning the skin helps. Taking quick action at this stage can help keep skin in good shape. Many skin care products are oil-based, which can interfere with pouch adhesion. If there's problem, such as dry/flaky skin or even just some mild redness and irritation, a non oil-based cream can be used that will not interfere with pouch adhesion. Some of the aloe vera gels or aloe vera-based lotions are useful. Again, ensure a correctly fitted skin barrier to prevent skin irritation from leakage. |
|
| ^ top |
|
| Protecting Your Skin |
| There are many accessory products designed to protect the skin that are specifically designed for people with stomas. These include pastes, stoma powders, and protective wipes, as well as rings (washers) and strips. |
|
| There are various types of stoma pastes which are used as fillers or caulks. Pastes can be applied directly around the stoma or onto the skin barrier. Either way, there should be a firm seal between the pouch and skin. Be sure to use stoma paste only as a filler and not adhesive. Pastes contain varying amounts of alcohol, and they can sting on broken skin. When they are applied to unbroken skin, there should be no sensation. |
|
| Stoma powder (not talcum) is a good skin protector for broken skin. It absorbs moisture and protects the skin. Stoma paste can be applied over powder to seal the powder in. This may reduce the stinging sensation that can be experienced with pastes. When using powder, make sure to brush off the excess before applying any other pastes or skin barriers. Paste, skin protective wipes or rings can be applied directly over the powder once the excess has been removed. Be sure to stop using the powder once the skin has healed. |
|
| Protective wipes offer a protective film to the skin. This can serve a dual purpose by firstly helping shield the skin against discharge and secondly allowing easier removal of skin barriers. A lot of skin protective wipes also contain alcohol (like pastes), so using them on broken skin is probably going to sting. There are some alcohol-free wipes available for this. If the skin is not broken, any protective wipe should be fine to use. |
|
| If it's difficult to remove either the skin barriers or tapes, or if skin stripping is an issue, these wipes may be of some help. |
|
| ^ top |
|
| Treating Simple Skin Problems |
| No matter how careful you are, at some point, a problem might develop. If the skin around the stoma is damaged, it will look irritated and feel sore. It's important to place a skin barrier over it to prevent further damage. When there is a problem, it's important to learn what caused the irritation. |
|
Improperly Fitted Skin Barrier
If the opening on the skin barrier is too large or does not adhere well, the drainage from the stoma can damage your skin. This is of particular risk for people with an ileostomy where a lot of enzymes can damage the skin quickly. A good way to handle this is to start by measuring the stoma periodically to make sure the size is right. Then select a product that fits closely around it. |
|
| Apply stoma powder to any open or broken skin before applying the new skin barrier. Discontinue powder use after the skin has healed. Contact a stoma care nurse if the skin doesn't improve. |
|
Leakages Causing Skin Irritation
Stoma discharge can be irritating to the skin, causing redness that can lead to open, raw skin that weeps or even bleeds. This type of irritation is often very painful. (People with ileostomies are at the highest risk for this kind of skin damage.) A change in the size or shape of the stoma or the shape of the abdomen can change the fit of any pouching system, leading to leakage. |
|
| Change your pouch promptly if drainage is leaking under the skin barrier. Change the pouch on a regular schedule before it leaks. |
|
| Contact a stoma care nurse if there are any difficulties keeping the skin barrier stuck to the skin. Sometimes using accessories can help, or products such as convex skin barriers, paste, and rings/seals, may help prevent leakage under the skin barrier. |
|
Skin Irritation Under Tape
Irritated skin that develops only under the tape of the skin barrier can occur for a variety of reasons. The skin may be itchy, blistered or open and weeping. This problem can develop at any time, even if the same type of product has been used for months or years. In this case, a sensitivity may have developed to an ingredient in the tape, or the skin may have become damaged when the tape was removed. |
|
| Try a pouching system without tape. These products still stick to your body but use an all skin barrier instead of a tape border. Apply stoma powder to any open skin before applying a new pouching system. Contact a stoma care nurse if there are difficulties keeping the skin barrier on. |
|
Rash Under a Stoma Product
Sometimes a rash is caused by a skin infection, sensitivity or even from leakage. The area may be red, or red with bumps. Itching also may be a symptom. It's important to get assistance in determining the cause, since treatments will vary. Contact your stoma care nurse if there are difficulties keeping the skin barrier on. If an anti-fungal agent is recommended for treatment, make sure it's in powder form or a non oil-based cream. |
|
| ^ top |