On this page you can read about the inconveniences you can have with a stoma, and the associated stoma aids which can reduce, correct or help with the problem. As there are more than 1000 stoma products from 15 different manufacturers, there are enough potential solutions! If you see no improvement after trying the tips beneath, then do not experiment any further but consult your doctor or stoma nurse.
Skin problems and
aids
Leakage en
aids
Smells and gasses
Faeces and urine splashes
Pan caking/vacuum
Sweating in warm weather and during sport
Hernia and solutions
The stoma changing colour and/or shape
Retraction
Prolapse
Blockage
Diarreah
Narrowing stoma
Crystal formation by a urostomy
Sitting pain/ phantom pain
Leakage from the anus
Skin problems
People with a stoma may regularly encounter skin problems. Problems with the skin can have various causes. First a piece of biology:
The skin consists of three layers: the outer skin (epidermis), the middle section (dermis) and the subcutaneous tissue. The top layer, the epidermis, consists mainly of skin cells (keratins). These cells are continuously created in the lowest level of the upper skin (the basal layer). The newly formed skin cells push bit by bit their way to the outer surface of the skin, so that the continuous production of new cells is pushed upwards. The outer skin renews itself roughly once a month.
Picture source:
Medicinenet.com
Whenever you peel a base plate off the skin, then the outer layer of skin cells goes with it, giving it a ‘peeling’. Hereby more skin cells are removed than are added and so the skin becomes thinner. It is therefore very important to remove your base plate as carefully as possible. If you are too heavy handed and a red, irritated skin occurs, then this is known as the “stripe effect”. Therefore if you have a very sensitive skin it is better to use a two piece system, so that you do not have to remove the base plate every day. People, who use prednisone, can often have problems with a thin and fragile skin. We speak of real irritation if the skin itches, hurts and becomes damp.
During an investigation
(Ostomy skin study) it appears that 45% of people with a stoma have skin problems.
Source:
Coloplast
Many people are unaware of this, because they think it is a normal occurrence with a stoma. More than 80% of the people from the survey had not sought help from for example a stoma nurse. Meanwhile there are a large number of aids and solutions which can reduce or cure the skin problems. Leakage from under the base plate is one of the most prevalent causes.
Source:
Coloplast
Keep it in mind that the new stoma patient must adapt to the base plate because the skin is suddenly covered over with the stoma products. The normal regulatory system of the skin becomes disturbed and can cause skin irritation. You can imagine that the skin under the base plate does not allow the sweat to evaporate. The skin can be irritated (maceration). Sometimes small pimples or blisters develop which are very itchy. Do not be afraid of this, the skin needs time to adapt to the new situation! There are also enough people who have no skin problems caused by the permanent covering.
The causes of skin problems can be:
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Skin irritation can also be the result of leakage or from a too large or too small cut opening, so the faeces or urine can irritate the skin. During the formation of a stoma, you lay the intestine very close to the skin surface. Also the skin is not prepared for the aggressive intestinal juices or urine. The skin around the anus and urinary tract is made to resist moisture. Therefore be careful in the cutting of the opening that it is a maximum of 2mm larger than the size of your stoma.
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It can also develop through the use of irritating products used to clean the skin such as adhesive remover or perfumed/disinfectant soaps. Try to use adhesive remover products as little as possible and clean your skin with warm water and gauze.
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You can also have problems with folliculitis, which is an infection of the hair follicle. You see then a pimple about as large as a pea filled with pus, often pierced by a hair and surrounded by a red top. Sometimes it remains a large pimple, sometimes known as a papel. Mostly these heal spontaneously; they burst or are absorbed by the skin and vanish.
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What happens rarely is a material allergy. You can test this by placing a small piece on the arm for example. If the same irritation develops, then it is likely you have a skin sensitivity of allergy. Hereby it is advisory to contact your stoma nurse. There are people who cannot tolerate plasters on the skin. If you get irritation under and around the plaster, then it is better to choose a base plate that is completely made of hydrocolloid.
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You can also suffer from a skin irritation caused by a bacterial infection, a fungus or a virus. The result of an infection is always an inflammation, and there could also be a fever. This does not happen very often and you are advised to seek contact with your stoma nurse or doctor, as it could be the result of another problem in your body.
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Occasionally you can get eczema or warts around the stoma. People with a predisposition towards eczema can get problems around the stoma quicker, than people with less sensitive skin.
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Some food stuffs can also cause skin problems.
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If you have inflammatory disease and ulcers around the stoma, then it can mean a return of the inflammatory disease.
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Adhesions can be formed if sutures are left in place for too long (strictures/granulated tissue). Irritation can also occur around the stoma, under the base plate, if incisions have to be performed. Certainly if you use a convex base plate a form of a pressure point can occur. Your stoma nurse is the best person to help you with this.
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Finally, you can also have problems with keloids (over growth). This forms bubbles around the stoma. It is not harmful, but can be difficult with your base plate and cause leakages. Following advice from your doctor you have to carefully strip them with silver nitrate.
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Assistance for skin problems
With a slight irritation or redness of the skin, or the prevention thereof, you can use a barrier cream. This sort of cream promotes recovery and protects the skin. It does no harm to use this daily. It is vital that the cream is very sparingly applied (a matchstick head’s worth), then massage around the stoma until the cream has been totally absorbed. You have the choice of various manufacturers when using this cream.
Brand: Coloplast,
Hollister, Dansac
and
Pelican
If you have a moist irritated skin, then powder could offer a solution. The powder is sprinkled lightly over the wet skin parts and inflamed areas and forms a protective layer. In some powders there are also active ingredients such as Aloe Vera, which aids healing. Blow the excess immediately away from the surrounding skin. Excess powder on the healthy skin can cause a poorer adhesion of the base plate. Before attaching the base plate which will come in contact with the powder, first dampen it slightly. This is important for the optimal adhesion.
Brand: Hollister,
Convatec,
Hollister
and Wellform Medical
If you wish to prevent the skin being pulled, then you can use a skin protector. Following the evaporation of this product it leaves behind on the skin a thin plastic layer. When the base plate is removed this plastic layer is removed rather than the skin cells, whereby skin irritation and thinning of the skin can be prevented. This product can increase the adhesive strength and is available in the form of protective films (wet wipes) and sprays.
Brand:
Coloplast,
Smith & nephew,
Welland and
Ambiance Healthcare
If for any reason a small hole develops which pushes out, for example on a pressure point on a scar by the stoma, or through a fistula, then naturally you must contact your doctor or stoma nurse. Hereby often the daily application of Aquacel, under a protective layer of Hydrocolloid (for example Varimate Thin Strips from Eurotec), can be a good solution. There are also methods of rinsing with a saline solution.
If you use convexity and (temporarily) you may not use this in order to allow the spot to heal, but you cannot do without because you have leakages with a standard base plate, then you can use a foam tape under the base plate. A tip is the Versiva gelling foam tape from ConvaTec. It absorbs the moisture from the wound, and ensures that there is less pressure on the wound so that it has the chance to heal. It comes in a piece 10 by 10 centimetres, with an adhesive edge. Cut to the size you require, a tad larger than the wound itself to distribute pressure. Leave the adhesive edge on one side, so that the foam cannot shift under the base plate. If there is a lot of moisture from the wound, then it is best to replace the foam twice a day. Later you can reduce this to once a day, when the wound is quieter.
With specific problems such as infection and eczema may sometimes be also monitored by a dermatologist, for example using a special cream.
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Leakage
A leak is very annoying. You feel uncertain, and sometimes dirty. You have your nose rubbed in it that you cannot control your faeces or urine yourself. It is important to find the reason for the leak, as often there is then a solution to be found. Leaks can have many different causes. Firstly you can have a leak because you have not placed the base plate on correctly, or cut the opening incorrectly. It is therefore very important to take the time to care for your stoma. Leaks can also occur because of surface imperfections of the skin, such as pimples, wrinkles or scars. The faeces or urine then creeps via this channels under the base plate and damages it. Furthermore you can have a leak if your stoma is at or under the skin level (sunken/withdrawn stoma), such as the example you can see in the photograph beneath. Chemotherapy can also dry the skin and make it more vulnerable, causing the base plate to release earlier. Finally weight gain or loss can be the cause, or skin irritations under the base plate.
Helping aids for leakage
You can use a protective paste to fill in bumps and dips of the skin around the stoma, so that no faeces or urine can escape under the base plate. You can get these in various forms. You have a filling paste, this is a knead able paste, a sort of filler, from a tube. Some contain alcohol, and can therefore irritate the broken skin. But there are also some pastes without alcohol. You can put the paste directly onto the skin, but it is also possible to put the paste of the reverse of the base plate. Whenever you wish to remodel or press the paste further, then you should use a wet finger or spatula.
Brand:
Coloplast,
Hollister, Dansac
and
Convatec
For whoever finds paste from a tube inconvenient, there are paste strips and paste rings. These are sticks/ rings of mould able material where a hole or ridge can be filled. You can use this to raise an area than has sunken. The material sticks on both sides and can be torn/cut to size.
Brand:
Coloplast,
Hollister,
Dansac and
Welland
Then you have the convex base plate. You can use this with a stoma that is sunken or lies in a hollow. A convex base plate is a stoma flange with a bulge on the reverse (adhesive layer). This bulge presses the stoma upwards a bit, whereby the faeces or urine has less chance of seeping under the base plate. The bulge comes in various depths.
Brand:
Dansac,
Welland and
Hollister
Nowadays there are also convex rings, which you can secure under the base plate.
Brand:
Hollister
To prevent a leak, for example during swimming, you can secure the rim of the base plate with special tape. For example you can use Circleplast from NuHope; these are water proof, available in different sizes and with a rubber top layer. You can also use Circlemate from Eurotec, these are available in different diameters and with a soft top layer. Eurotec also has Varimate thin strips, these strips are made from a thin and see through hydrocolloid and are also a solution for people with a plaster allergy. Welland had semi circular hydrocolloid plasters for extra fixing around the base plate. But the old trusty Leukoper also works well.
Brand: Circleplast from
NuHope, Circlemate from
Eurotec Hydrofame strips from
Welland and Varimate thin strips from
Eurotec
If your base plate does not stick well, you can use an adhesive strengthener, such as by Hollister. These are only available on prescription from the stoma nurse or doctor. You also have wipes which protect the adhesive strength, for example Conveen prep from Coloplast.
Brand:
Hollister
and
Coloplast
For extra security you can use a stoma belt. This is an elastic belt which is attached to the flange. Therefore you need a stoma bag with attachments points. The belt can give you an extra feeling of security and ensures that your stoma material sits well.
Brand:
Eakin
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Smells and gasses
Many people with a stoma are afraid of smells. Fortunately the containment materials nowadays are odor proof, but it still remains a sensitive point. Everyone’s faeces smells, therefore this also applies for ostomists. However if you consider that the distance between nose and stoma when placing or changing a stoma bag, is approximately 30cm, and the distance between anus and nose is much longer, surely it is understandable that ostomists consider their faeces smells more. What can you do about this? Firstly you should watch your diet, certain foodstuffs, such as fish and strong herbs, can cause a strong smell. There are also anti-odor capsules, powders, gels and drops on the market. You should put these in your bag when attaching it, and then after emptying. They absorb the smell in the bag. What also absorbs the smell is a paracetamol in the stoma bag.
Brand:
BBraun,
Hollister and
Dansac
Gas is a normal result of digestion and occurs with everyone. It is also not completely preventable. It can however be reduced. The largest part of the gas (70%) consists of ingested air. This is predominately cause by talking and eating too quickly. Also by chewing gum, drinking through a straw, smoking, nervousness and badly fitting teeth a lot of air can be ingested. You can count on this. You can also count on food stuffs that can cause gas. An empty stomach also causes gas. Missing meals to prevent gas, is therefore pointless. Nowadays the filters on stoma bags continuously improve, and there are now even bags with two filters which allow gas to escape odorless. Unfortunately therefore gas is not preventable.
Brand:
Coloplast
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Faeces and urine splashes
If you find the splashing of faces or urine annoying, you can thicken the contents of the bag with special thickening agents. This also means less chance of leakage and skin problems. This sort of product is available as tablets, capsules, sachets and absorption strips. The faeces or urine is hereby transformed into a gel-like substance.
Brand from the left to the right:
BBraun,
Eurotec and the last two from Laprolan.
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Pancaking/vacuum
If you have a thicker output, it can be that the faeces remain hanging at the top of the bag (pancaking), very annoying. It can occur because the bag creates a vacuum, and then seals off the filter. You can also blow some air into the bag before you attach the system. There are also products that make the faeces slide downwards easier. Some people use olive oil, but there are also special products available on the market.
Brand:
Hollister
and
Wellform Medical
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Sweating in warm weather and during sport
If it is very hot weather, or if you sport often, then it is logical that you sweat. But it can be very annoying with a stoma. A base plate often attaches itself to the skin even better due to the warmth, but by excessive sweating it can also lead to the base plate not sticking well. The use of an unperfumed deodorant under the base plate can solve this problem. It can also get sweaty and sticky between the stoma bag and the skin. A tip hereby is to wear a material cover on the bag, to absorb the moisture. This could be a cut out wash cloth, but there are also special stoma covers.
Picture source:
Design your stoma
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Hernia
A hernia can occur by an operation scar (wound fracture) or by a stoma (also known as a parastomal hernia). This occurs because there is a weak spot around the stoma in the abdomen or near a scar. The abdomen is surrounded by a strong layer of muscles and covered with peritoneum which holds everything in place. By creating a stoma there exists a weak spot in the abdomen, and there is talk of a too large opening in the abdomen muscle layer. Due to this too large opening, the abdominal contents can shove against the stoma, and a part of the intestines then is pushed in front of rather than behind the abdomen muscles. The result is a large or small swelling or curvature of the abdomen.
Almost a third of all ostomists develop a hernia (predominately this happens within the first year of construction). Sometimes you only see this hernia during effort; others walk around with a huge bulge on the abdomen. This sort of hernia normally occurs after too much pressure on the abdomen, such as by heavy lifting or a coughing fit. In some instants the doctor will decide to help operatively, for example by moving the stoma to the other side of the abdomen or by strengthening the abdomen wall with pads. In many cases this is not possible and only people with serious problems, such as heavy leaks, are considered for this. A new operation will always weaken the abdomen, meaning the chance of a return of the hernia is large. Therefore it is best to prevent a hernia.
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Solutions by a hernia
Prevention may include wearing a support or truss during sport of heavy effort. However even if a hernia already exists, a truss is a good idea. The truss then pushes the bulge away ensuring the stoma material will sit better, and it prevents the hernia from becoming larger. It is not wise to continuously wear such a truss, otherwise the abdomen muscles weaken. There are various types of truss. You have them without and with stoma openings. There are standard sizes but you can also be measured for one by the stoma nurse. There are also bandages available in different widths. The support band is applied lying down, so that when you stand up again there is sufficient pressure. Lay the band on the bed, lie on it (whereby the hernia sinks back into the abdomen), bring the support around your abdomen and stoma and pull the stoma bag (if applicable) through the opening. Close the support with the Velcro and stand up again. Hopefully now the truss will give sufficient support and the hernia (in most cases) remains in the abdomen cavity.
Beneath are a few examples of support bandages:
Brand:
Basko,
Bort,
Eakin and
Nuhope
Since recently there is also a stoma support bandage in the form of underwear. For example Corsinel from Coloplast (see picture beneath). The underwear is made from 50% elastan, a very elastic material. Hereby it is much more flexible than the current support material for a parastomal hernia. It is easy to pull on and you can move easily.
There are also vests with a good support for the abdomen and back. For example the Sensi for women.
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The stoma changing colour and/or shape
If a stoma changes colour or shape, it can have various causes. Is the stoma not working correctly and has it moved? Then you could have a blockage. Has your stoma shrunk back, is it bulging outwards? Then look beneath under retraction and prolapse. A stoma must have a good blood flow and be a clear pink colour. Has the colour changed or is there a grey glaze? Then talk to your doctor or stoma nurse. The stoma can also move if it is damaged or has difficulty getting the food out. So long as the stoma keeps on producing well, then there is nothing wrong. An ice cube can sometimes help to reduce the swelling.
Also the stoma can first be sprinkled with icing sugar or caster sugar; this absorbs moisture on the intestine, whereby the swelling normally reduces within a half hour. Yet another aid to reduce the stoma swelling is nose drops (for example Otrivine).
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Retraction
A retraction is when the stoma recedes inwards. This can happen through a large weight gain, also as a complication of stitches releasing, if the stitches are removed too early or through a badly made stoma. The solution hereby is to use a base plate with convexity so that the bulge pushes the stoma outwards and so prevents leaks. Another solution is surgical correction.
Picture source:
uzleuven
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Prolapse
A prolapse is if the stoma pushes outwards abnormally. This used to happen a lot more with a double looped stoma than with a single stoma. It can happen for example if it is badly place, if the stitches are loosed or removed too soon after the operation, with too much exertion on the abdomen through coughing, pressing or heavy lifting, and by strong peristaltic through large or hard faeces.
Picture source:
at the left thanks Karin!
A prolapse can be treated. In most cases the stoma nurse can help you. You can try to replace the stoma with soft, continuous pressure and ice cubes. When there is serious oedema (swelling), the stoma can first be sprinkled with icing sugar or caster sugar; this absorbs moisture on the intestine, whereby the swelling normally reduces within a half hour. Yet another aid to reduce the stoma swelling is nose drops (for example Otrivine). With a regularly occurring prolapse the surgeon must intervene. When an acute occurrence of a stoma prolapse occurs and no faeces exits, then the surgeon must intervene immediately. A relatively small operation will solve the problem in both cases. To avoid a prolapse you have bandages with an anti-prolapse flap which you wear during heavy effort.
Brand:
Basko
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Blockage
An obstruction, also known as ileus, can have various causes. With an obstruction, which happens mostly with an ileostomy, for various reasons no faeces comes out of the stoma or a minimal watery output. This can happen for example as a result of strictures (see under for more information), inflammation, adhesions or an impassable wad that sits in the opening of your stoma. The first symptoms are a distended stoma and stomach, stomach cramps, nausea and later, if the blockage is not resolved in time, also sickness.
What to do? Drink a lot and massaging the abdomen around the stoma can help propel the food wad through the opening. You can also irrigate your stoma with water, in the hope of loosening the wad. You can do this for example with a feminine catheter with a syringe. If it does not work with water, you can also insert a laxative. If you cannot release it yourself quickly, then call your stoma nurse or go to casualty! Because if you do throw up then you can quickly dehydrate. In other causes of an ileus the doctor will determine how further to handle it. If the cause is a food wad, this can occur through the inadequate chewing or small enough cutting up of certain food stuffs.
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Diarreah
Diarreah is, certainly with an ileostomy, very difficult. You lose an extra amount of fluids replace this or you will dehydrate. You can do this through drinking at least 1 litre of ORS (oral rehydration solution, a solution of salts and (grape) sugar or starch in water) or drinks which can be well absorbed by the intestine such as bouillon, tomato juice and others. Add to this with water and other drinks up to 2 to 2.5 litres. Eat easily digested food. Think also about your salt and potassium intake. If you show the signs of dehydration (very thirsty, nauseous, drowsy, dark coloured urine, weight loss etc) then warn your doctor. If you cannot drink enough yourself you will need to have an infusion in the hospital.
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Narrowing stoma
Sometimes over a long time a narrowing (stenosis) of the stoma can occur. Such a narrowing can occur through connective tissue (stricture) for example. It gets more difficult for the output to come out of the stoma, it becomes painful, and obstructions can occur. Stretching (dilation) of the stoma can sometimes help. You can do this (after consultation with your stoma nurse or doctor) every day with your finger, or with dilators (plastic sticks in various thicknesses). Unfortunately this is often insufficient, and a new stoma has to be formed (revised).
Source:
Wikipedia
With a narrowing of the opening of a stoma you have to catheterise, with an Indian pouch and a mitrofanoff stoma for example, you can use a stopper. This is a sort of nail made of soft silicon. You put this in the opening, with a special plaster above it. They only stick once, so after each time you have catheterised you have to use a new plaster.
Brand:
Medicina
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Crystal formation by a urostomy
You can recognise crystal formation by the typical, glistening flakes on and around the stoma. Crystal formation is caused by too highly concentrated urine. Hereby the acidity (pH) is too high, also called ‘alkaline urine’. It is vital hereby to drink sufficiently, at least 2 liters a day. You can remove the crystal formation around the stoma through daily laying gauze soaked in a mixture of equal parts of water and vinegar on the stoma. You can repeat this 2 or 3 times daily for a week. If your problem is not solved in this way, then you should contact your stoma nurse. Often alkaline urine goes hand in hand with a urine infection; therefore it is important to get your urine tested. You can test the acidity (pH) of the urine yourself with a dipstick, which you can buy at the chemists.
It is important to test the urine that has just come out of the stoma, and not the urine that is in the bag. If the test shows that the acidity is too high (7 or 8), then you should discuss the treatment with your doctor, specialist or stoma nurse. There are medicines for the acidification of urine, but you should not experiment with them yourself. A much heard tip to acidify the urine is to take vitamin C tablets. Investigations show that this does not help. An aspirin in the stoma bag lowers the acidity of the urine, but it also affects the lining of the stoma. Cranberry juice seems to have good results. The American National Institute for Health (NIH) has officially declared that cranberries perform a role in the prevention of urine infections. Cranberry products seem particularly effective in the prevention of recurrent infections. Cranberry juice is however not a product to cure a bladder infection. You can buy it in juice form, or in capsules from the pharmacy.
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Sitting pain/ phantom pain
Just after the operation when the rectum has been removed, many people have problems with sitting pains. This is logical because the anal wound needs time to heal. However if the pain remains for months or longer, then there is something wrong. People, who have to undergo an amputation, are often not prepared for it and they, after the operation, feel the amputated body part as if it was still there. This is a normal occurrence by more than half the patients. This is called phantom feelings/pain. If you have a feeling of urgency, it can help if you just sit upon the toilet. If you have serious phantom pain, then it is best to take these complaints to a pain clinic, where attention will be given to the various aspects of the pain. They will try to trace the factors and to find a suitable treatment for your pain. One person is helped by medicine, another by muscle and connective tissue massage and yet another by biofeedback. Many people find out for themselves small aids such as a warm bath, a gel seat, a fitted cushion or just a simple neck cushion. As you can see there is no singular piece of advice that can given as a solution to stop the pain.
Brand:
left
Tempur and at the right:
Roho
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Leakage from the anus
There are various reasons for having leakage from the anus when you have a stoma. It can be because you have a fistula, or because you cannot hold onto the mucus that the remaining piece of intestines still produces. Of course you can use panty liners, but it’s not nice to use them long term. Another solution is anal tampons. This is a tampon that in placed in the anus and seals it, so that no more faeces or mucus can come out. There are various sizes and types. It is possible to begin with a starter set with the smallest size, so that you get used to the anal tampon. You can compare the tampon with a sort of foam suppository, except that it has a string on it, which can be stuck to the buttocks. When the anal tampon is inserted, the film layer around the tampon is dissolved by the moisture and body warmth creating a good seal. In the beginning it can feel strange sitting down. You can use the tampon day and night, the advisory wear time per tampon is maximum 8 to 12 hours
Brand: first two
Coloplast, the third from Curion
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