How to prevent skin issues with your ostomy

Finding out that you have a health condition which requires a temporary or permanent ostomy creation is a life altering conversation. Chances are that you know little to nothing about what to expect, and after the ringing in your ears subsides, you have many questions.

This blog will discuss some of the common causes of peristomal skin irritation and how to prevent them. But first let's talk about the different types of ostomies.

The term ostomy refers to any internal organ or body structure having a surgically created external opening. Trachea, your digestive tract, bladder and kidneys are some common sites. Tracheostomies are created for patients diagnosed with throat or oral cancer, impaired neurological function or for patients that will need long term mechanical ventilation. We won't spend as much time on these outcomes, but many of the principles discussed may apply. Your DME supplier can provide more specific information on trachs.

Colostomies are what most people automatically think of when hearing the term ostomy. A colostomy is created in the large intestine and allows patients to eliminate formed stool to an external pouch. Depending on the location of the ostomy, patients may be able to "train" their gut to eliminate at certain times. However this is not common. Colostomies being lower down the GI tract make formed, mostly non liquid stool, similar to what you would see with normal defecation from the rectum.

One common issue that lead to skin irritation is when the stool pancakes between the stoma and the pouch, leading to the surrounding skin getting macerated and sore. Using an adhesive paste to ensure a proper fit against the skin as well as accurately measuring the wafer before application can mitigate most of these occurrences.

Another common problem is wafer detachment and slippage. Cleansing the stoma with warm soapy water, then patting completely dry and using a skin prep wipe will allow the adhesive to seal more effectively.

Some manufacturers also offer ostomy appliance belts to help keep it placed without pancaking.

Ileostomies and jejunostomies are placed in the small intestine at either either ileum or jejunum. The stools produced at these sites are much more liquid and far more likely to cause significant skin breakdown because of their acid and enzyme content. Frequently emptying the pouch, as well as the techniques described above with colostomies are the best prevention. Should skin breakdown occur, asking the doctor to insert a catheter temporarily may allow your ostomy to function and drain to gravity without causing a blockage. They may also recommend the use of a medication such as Lomotil or Immodium if the stooling is severely compromising your quality of life. Use of the skin prep wipes will keep the stoma free of acid induced maceration and irritation.

Urostomies and nephrostomies involve draining the bladder or kidney of urine. These appliances are generally accessed through a Foley catheter or a nephrostomy tube. Urine drains to a gravity pouch and can be dumped with a simple clamp release. Urostomoy care focuses on minimizing mucous irritating the surrounding skin. Again, warm soapy water and complete drying will help prevent irritation. Alcohol wipes should be used daily to disinfect the catheter to 2 inches above the insertion. This prevents infection and helps reduce mucous buildup. Applying and frequently changing a clean 4 by 4 gauze pad will prevent spoilage of clothing and wick away excess mucous. Nephrostomies generally require a nurse to come and perform a dressing change weekly at the home due to their location and the need for sterile technique.

We hope that this brief overview has been helpful to you and your family. Check out our website for additional information on your specific DME needs.

User Avatar

I hope this wasn't TMI for the client but with my nursing background I thought this was appropriate to address these topics here. Especially if they are selling multiple products.

Stoma Differences

There are lots of differences between the types of stoma’s people have.  They also have them for lots of different medical reasons and each has its own specific purpose and philosophy of how to live and work with them. There is a lot of confusion on the differences and the terminology is just crazy. So I want to go through and maybe clear up a few things about the placement of Stoma and what that means for the person who has it.

The first stoma we will talk about is a Colostomy. A colostomy is an operation that creates an opening for the colon, or large intestine, through the abdomen. A colostomy may be temporary or permanent If you have a colostomy and irrigate your bowels, you might not need to empty your bag for a day or two! Now it does depend on the size of the bag and I like the variety that ostomy supplies carries.  That’s pretty convenient! But if you aren’t irrigating your bowel then you may be emptying 1-3 times a day or however often you would have been going to the bathroom before your surgery. Now this is different from having an ileostomy.

Wickipedea describes this as this: “Ileostomy is a stoma constructed by bringing the end or loop of the small intestine out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an artificial external pouching system which is adhered to the skin” Most ileostomates will empty their bag 4-10 times per day, but some may need to empty more often if they have liquid output. I find myself emptying around seven or more times per day, but I also let my bag fill up past the 1/3 mark.   Then there is also a urostomy.

A urostomy is a surgical procedure that creates a stoma (artificial opening) for the urinary system.  There are specialty bags for each of these ostomy situations and I still would say to check out ostomy supplies to see which ones work best for your situation. A urostomy bag may need to be drained several times a day depending on the capacity. The volume of urine collected throughout the day should be closely matted with the volume of liquids you consume. 

A urostomate who drinks several liters of water should expect several liters of output in a 24h span. So now you hopefully are a little more informed about what is out there and the differences between stomas and placements!

Convexity in Ostomy Appliances

For many ostomy appliances, the convexity of it matters. This is the outward shape of the faceplate, which is like the top of the bell, that’s used to reach into the peristomal skin in order to create the best seal possible. This exists to provide the optimal seal. The stoma can have a shape that’s uneven, unusual in size, and other irregularities that make the non-convex applies ineffective. Convex ostomy bag systems curve outwards, and with that, it can press into the peristomal skin in order to protrude to the stoma long enough for the ostomy bag to attach in a firm and secure manner.

One of the key parts of ostomy care is to provide a secure and have a predictable seal. Having the convexity in place is important for achieving this. convex products are usually the preferred means for flat and retracted stomas, and will help compensate for the peristomal planes, and it helps with reducing the creases and the folds. While there are many products available with a lot of depths and shapes, there is little supporting evidence to guide the use and selection.

The origin of this is not known. There are limitations in early product availability and the need to cope with the wrongfully constricted stomas or irregular body contours that were historically addressed by the creative use of the belts, rings, and other medical adhesives. During the 80s and the 90s, there were many ostomy product manufacturers that were made to release the convex skin barriers that were made for the different systems.  There is also the new accessories such as the barrier rings and the convex skin barriers. While these are used consistently to describe the curvature of the adhesive sides of the barriers and accessories, there are still undefined descriptors.  There are no industry standards for the ability to determine the different flexibility and other aspects of this feature.  There is still research which needs to be done on this,which does leave the determination of the matching stomal protrusion and the peristomal contours to approximate the barriers of the different systems, and right now, only really the clinicians can help with showing you the correct way to have something such as this.

You might wonder what a convex pouching system is.  These are differing in how they sit around the stoma.  The flat one will sit flat around the stoma, whereas the convex ones are different, since they will curve around the skin. The outward curve will then press down on the skin, and from there, it will help push the stoma out more, and will offer a better emptying means for the pouching system.

This might be used if you need to stop the stool or leakage, offer a comfier and secure means to hold al of this in, stop skin irritation, improve the wear time, and also help save you some time and money.

You might end up suing this to help with preventing frequent leakage that’s caused by a stoma that empties either below or at the skin surface, any wrinkles and scars or creases in the skin, or if there is soft abdomen around the stoma. This will help with wearing in many cases, especially when compared to a pouching system. While this isn’t for everyone, and it might be a bit uncomfortable at first, it’s a good option for those who have trouble with the flat options for your stoma products.

What is an Ileostomy Surgery? – Types of an Ileostomy

In an ileostomy surgery, doctors detach the small intestine of a patient from the large intestine. In this operation, surgeons remove whether an entire colon and rectum or a small portion of the small intestine. The ileostomy operation could be permanent and temporary. It depends on the condition of the rectum and colon in a patient. If the procedure can preserve the colon and rectum, then the surgery will be temporary. Otherwise, an ileostomy operation is permanent.

Most of the digestion of food takes place in the small intestine. It is a six-meter-long tube. The absorption of vitamins, proteins, minerals, fats, and carbohydrates takes place in the small intestine. Any food which a small intestine cannot absorb goes into the large intestine. The undigested food which goes into the large intestine is waster matter of the body (stool and liquid).

In the ileostomy surgery process, doctors attach ileum to the wall of the abdomen and make a stoma (an artificial opening) in the lower belly wall. The stoma collects the waste of the body which discharges after the digestion process.

Causes of an Ileostomy Surgery

The following are the various causes of ileostomy surgery:

•      Ulcerative colitis (an inflammatory bowel disease).
•      Crohn’s disease (gastrointestinal tract disease).
•      Congenital bowel defects (esophageal atresia and fistula disease).
•      Uncontrolled bleeding (from the large intestine, a severe infection).
•     Any injury in the intestine (damages intestinal tract).
•     Ischemic bowel disease.
•     Carcinoma urinary bladder.
•     Spinal cord injury.

Types of Ileostomy

The following are the two primary types of ileostomy:

•      Conventional ileostomy surgery. 
•      Continent ileostomy surgery.
•      Surgeons remove the large bowel downstream no caudal viscus anastomoses from the ileum, which is a permanent device.

Conventional Ileostomy or Brooke Ileostomy

In conventional ileostomy surgery, doctors remove sphincter from the intestine. Because of the surgery, a patient loses the natural process of discharging feces. After the operation, patients excrete their stool through the artificial opening stoma, which is made by doctors on the lower abdomen wall. A stoma is the small opening to evacuate the urine and stool from the body. Stoma collects the waste matter of the human body in a pouch called stoma bag.

When a patient has ulcerative colitis, doctors perform conventional ileostomy. In ulcerative colitis, a patient has inflammatory bowel disease. When a person has ulcer or inflammation in a digestive tract, he needs conventional ileostomy operation. The conventional ileostomy is preferred when a patient is Crohn’s colitis. When a person has familial adenomatous polyposis and extensive colonic resection for ischemia, he may need proctocolectomy and end ileostomy.

Continent Ileostomy or Barnett Continent Intestinal Reservoir

In this type of surgery, doctors make an internal container and a valve from the lower end of the ileum. However, the stoma is outside the wall of the abdomen. The stoma collects the cavity and mucus flow from the small intestine. Surgeons insert a small narrow tube in the valve, it excretes the waste two to three times a day. The stoma covered by a simple and single band-aid.

J-Pouch

What is J-Pouch in conventional ileostomy?

There is one more option to the conventional ileostomy surgery, called J-Pouch or Ileoanal Pouch.

This is an advanced procedure of conventional ileostomy. It has better options for quick recovery and tolerance in a patient. The procedure has advance technical changes to make a patient comfortable.

Temporary Ileostomy

A temporary ileostomy is a partial dissection of the colon. In the temporary ileostomy operation, half of the colon removes, and when the remaining colon gets to heal, surgeons restore the connection of colon to the anus.

Permanent Ileostomy

Permanent ileostomy surgery occurs when a patient has chronic ulcerative colitis, bowel obstructions, colon cancer, rectal cancer, Crohn’s disease, congenital conditions, or trauma. In the permanent ileostomy, the patient will have stoma for the rest of his life.

What is a Urostomy Surgery? – Types of Urostomy

Urostomy Surgery

Urostomy is a surgical process that allows the urine to come out through an artificial opening stoma. The operation allows the urine the go pass the bladder and urethra.

Causes of Urostomy Surgery

The following are the causes of urostomy:

•  Bladder cancer.
•  Chronic inflammation.
•  Neurological bladder dysfunction.
• Malfunction of the kidney.
•  Infection in the kidney.
• Injury in the bladder or urethra.
•  Defect in the ureter or urethra.

The procedure of a Urostomy Surgery

In the urostomy operation, the doctors have to remove the ureters from the bladder. During the surgery, surgeons make an opening in the abdomen. After the operation, the stoma (opening) collects the urine. The process of the flowing of the urine does not change. It remains to evacuate through the ureter and collects in a bag which affixes to the opening (stoma). During the operation, doctors can remove the bladder, it depends on the type of disease.

Urostomy surgery is the least common type of the three primary kinds of stoma. The only purpose of the urostomy is to pass the urine from the body, through an artificial process. the urine collects in the stoma bag which attaches to the abdomen wall. In the operation, a small section of the bowel uses as a conduit (a path), sometimes the ileum (an ileum conduit). Usually, doctors put stents in situ to prevent the anastomosis between the ureter and bowel through a process called stenosis. The sensing occurs during the urostomy surgery. The urostomy operation is al usually permanent end stoma.

When it comes to appropriate appliances for the urostomy stoma. Doctors and nurses always recommend a drainable pouch. You can clean and wash the stoma bag through normal tap water. A patient should empty and clean the pouch five to six times daily. If you do not empty your stoma bag on time, it may leak and release the bad odor. The stoma pouch has a maximum capacity of 400ml, it cannot collect the liquid more than it. Therefore, it starts leaking and makes you embarrassed in public.

Types of Urostomy Surgery

The following are the three main types of urostomy surgery:

•  Ileal conduit.
•  Colon conduit.
• Ureterostomy.

Ileostomy Conduit

In the ileostomy conduit, procedure doctors resect the minor segment of the ileum and create a small opening in the belly wall called a stoma. In the operation, surgeons attach only one segment of the ileum (small intestine) to the stoma and connect the remaining portion of the small intestine by sewing to the two ureters. The surgery stops the passage between the ureter and the bladder. After the operation, urine can flow directly from the kidney and collects it into the stoma. The urine passes to the stoma through the ileal conduit which has created by the doctors. The ileal conduit only allows the urine to pass, the remaining undigested material pass through the sewed intestine.

Colon Conduit

The surgery procedure and purpose are the same in the colon conduit. The only difference is doctors create the conduit in the colon segment. In the colon conduit, surgeons have to make a larger stoma in the lower abdomen wall. Therefore, the size of the stoma pouch is larger in diameters than the ileal conduit.

Ureterostomy

In the ureterostomy operation, the doctors have to create one or two stomas in the belly wall. Surgeons have to connect each ureter to the abdomen. When a doctor links the ureters with each other internally, it is called transureteroureterostomy. One ureter creates the stoma on the outer wall of the patient. Therefore, it requires one stoma pouch which attaches to the outer stoma that collects the urine and liquid fluid. When doctors create two stomas on the outside of the abdomen, it is called bilateral ureterostomy, and it requires two stoma bags to collect the waste fluid from the body.

Running and being prepared with a stoma

There is nothing better than feeling the freedom of the outdoors.  Many people feel this on a motorcycle, some when running, and others simply by hiking in the woods.  Being outside is a passion of mine and something that has given me joy my entire life.  I love the outdoors and the joy that comes from being in nature.  When I found out I would need an ostomy surgery and would end up with a stoma I was worried about the effect it would have on what I look forward to every season.  I look forward to being outdoors.  After lots of reading, and listening to the doctors and nurses I gleaned enough information to know that I would still be able to do all those things.  I was originally super worried about living a normal active lifestyle and I had nothing to worry about.  Being a little more prepared and taking a little more gear with me was all that was going to be needed to enjoy my life.  I was given good advice to try lots of different ostomy supplies and see what works best for my body.  I highly suggest getting online and shopping around and working on finding what works best for your body. 

I wanted a good attachment system so I could be active and I landed on giving a few different major manufacturers a try and I was not disappointed.  After googling, they came up as one of the first companies.  They had a good knowledgeable website and most importantly to me the ability to try products before buying a bunch of them in bulk.  This was huge to me because I am going to be testing in lots of different environments.  I need a bag and belt that will work in the winter.  Where I am going to be bundled up and needing moisture wicked very efficiently.  I need a spring bag that will need to deal with lots of water on the outside due to the weather.  For summer I need gear that will be very efficient at being breathable.  I want to be comfortable in lighter clothing.  So these are the reasons that I like the free samples from the big companies.  I literally tried lots of different items until I found what worked best for me! The last thing I wanted was an item that gave a bad seal and leaked when I am outside and maybe far away from items or a sink. 

So are there any limitations to being outside? Honestly, not really. I find myself being active and biking, hiking, fishing, and hunting.  I am able to do all the things I normally did.  I must say I was most worried about hunting. Animals generally have an amazing sense of smell vs humans and this I knew was going to be hard. But there are lots of good scent-blocking items out there that I am able to utilize to enjoy and be successful at hunting still. There is nothing better than being able to provide for your own family and still be able to do it with a medical condition.  Each year my family eats lean venison for the whole year and I get hundreds of pounds for a minimal cost. It only takes wisdom, will power, and skill. 

Running, Jogging, Athletic, and with a stoma?

We all know that things are a bit crazy now.  But that is all the fun of living and that is that each year things go a little more bonkers.  The year is now 2021 and no it's not the distant future where the world is being taken over by robots.  Instead, we are still being told to stay at our home and live by the rules of social distancing and told to fear being outside and enjoying life like normal.  This does not mean that you should not be going outside and staying active.  Instead, it is suggested that since most people are being forced to work from home if they still have jobs that they should be getting outside.  The fact is that even if you have a medical condition you still need to do what you can to live your best life. 

When the weather allows it is paramount for your health to get in the sun and get moving.  Being active with a stoma can indeed be a little bit more work than the average person has to deal with.  It really is not all that bad though.  Some people go all the way sedentary for no good reason in 2021 just because they have a stoma.  It should in no way hinder what you are doing and how you are able to be active outside.  It simply means you need to plan a little more or have a few extra ostomy supplies with you. This is a normal thing to me because I am an active person and a gear guy.  I almost always have a backpack with me or an extra set of gear in my car for the worst-case scenario.  

What do I enjoy doing in teh outdoors and what am I capable of doing with a stoma? Well, I like to jog.  So if you really enjoy jogging then go out and jog.  Now a caveat to that is that if you just had an ostomy surgery then you do indeed need to be a little more careful.  Your abdomen is weaker than normal most likely due to the surgery.  It also means you may be more apt to hernias in general. I am sure you heard all about this from your ostomy nurse or surgeon, but it is always good to keep that in the back of your mind.  So if you just had surgery then you do need to start slow.  Don’t jump back into jogging right away. Instead, use this as your learning time to get the right ostomy supplies that work for your outdoor or active lifestyle.  Test out the right bags and make sure the adhesives work for you.  

Don't give up on what you live. Instead, make sure you are getting the right tools that will help with your active life. So try and get bags and bands that are more comfortable and sweat resistant.  You want them to breathe just like your clothing does.  Under Armour took the world by storm due to its breathable materials and now most places have learned a thing or two about it and invested in using them for their products.  Know also that some bags have loops for belts.  Get a good elastic belt or protector for your stoma and enjoy the great outdoors.