Most people living with a stoma experience irritated skin now and again. However, irritated skin is not a ‘normal’ skin condition. For your stoma pouch to be comfortable and worry-free, it’s important to prevent skin irritation and maintain healthy skin in the area.

The cycle of irritation

Leakage leads to contact between output from the stoma and the skin, which causes irritation. The problem is that once your skin becomes irritated, the adhesive on your pouch won’t attach properly, leading to more leaking of output. A vicious cycle of leakage and skin irritation can develop.

Six steps to healthy skin around your stoma:

1. Make sure your skin is clean and completely dry before applying the adhesive part of the pouch
2. Adjust the hole in the adhesive so that it fits exactly the diameter of your stoma. After surgery it’s normal that you body shape will change. It’s important that you keep checking to see if your template is the right size and shape for your stoma. Check this by positioning your cutting template over your stoma to see if the hole fits perfectly.
3. Regularly check the size of the stoma, especially if you have a hernia
4. Ensure full contact between the adhesive and your skin by exerting light pressure with your hand
5. Change your appliance as soon as you feel any itching or discomfort
6. Make sure to use the stoma appliance and accessories most appropriate for your body profile

In the months and years following your operation, you may notice certain changes to your body. These changes can include: 

• Weight gain or loss as you recover from the illness that caused the operation
• Fold or scarring of the skin around your stoma
• Hernia development connected to your stoma

As these changes occur, it’s important that you make sure your stoma pouch continues to provide the right fit.

A tight seal between the pouch and your skin is essential to good stoma care. If, for example, the area around your stoma changes from being regular to being more inwards, it may be time to switch to a convex pouch. You may also need to use additional accessories.

It’s a good idea to consult with your stoma care nurse about pouch fit and accessories.

Ballooning happens when there’s a build-up of gas in the stoma pouch, making it inflate like a balloon. Pouches have charcoal filters that help deal with wind by deodorizing and releasing it from the pouch. But if the filter capacity cannot handle the gas produced, or if it has become moist or blocked by solid output from the stoma, gas build-up can occur.

What can you do to prevent ballooning?
One of the main ways to prevent ballooning is to minimise the amount of gas your digestive system produces. Chewing food thoroughly really helps, as can avoiding food and drinks that you know make you produce a lot of gas. These could be nuts, beans, fizzy drinks or sparkling wine.

If ballooning does occur, you can release the gas from the pouch in the privacy of a toilet, if you use an open bag or use a two-piece system. Changing the pouch when needed can also help prevent ballooning. Finally, it may be worth trying another type of stoma pouch and filter type.

Pancaking happens when there is a vacuum in the stoma bag and the bag sticks together. This stops the output from dropping to the bottom of the bag and can block the filter. There is then a risk that the pouch will be pushed off the abdomen.

What can you do to prevent pancaking?
Blowing air into the pouch before putting it on will help stop a vacuum from occurring. In addition, a drop of oil or lubricant in the pouch will help the output to get to the bottom of the bag.

The skin around your stoma should look similar to the skin on the rest of your body. Immediately after you take off the adhesive, it may be a little pink, but if this doesn’t fade or if the skin is broken or damaged, your skin may be irritated.

What should I do? 

• Remove the adhesive and check the back. Is there any sign of faeces or urine that could have caused the irritation?
• Is there any irritation or damage around your stoma that corresponds to what you see on the adhesive?
• How well does your pouch fit around your stoma? Is your skin exposed to the output from the stoma due to poor fitting? Assess the diameter and shape of your stoma to see if your template has the right size and shape. Use the release liner from the pouch as a guide and if needed, adjust the hole in the adhesive so that it exactly fits the diameter and shape.
• What is the position of the stoma opening in relation to the surface of your skin? Is it above the skin surface, level with the skin surface or below the skin surface? If the stoma is level with or below the skin surface, or if it is situated in a deep fold, you may need a different type of pouch or accessories for your body profile. Try the Coloplast BodyCheck tool to check fit.
• Has the adhesive eroded? If so, the pouch may have needed to be changed earlier. Try more frequent changes or consider an erosion-resistant adhesive if you’re not already using one.

If your skin irritation is caused by other reasons, consult your stoma care nurse or doctor.