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.

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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.