Possible stoma complications

If you experience skin problems or complications, you should always consult your stoma care nurse straight away. However, spotting evidence of leakage early can help you catch a potential skin problem even before it develops.

Start by looking for any stoma output, either on your skin or on the back of the adhesive plate. Even if there is no direct visual sign of leakage, be aware of anything unusual, such as if the adhesive plate looks 'melted' (because the adhesive has reacted with the output).

If your skin is red, sore and moist, maybe even bleeding a little, but you have not had any leakage, the issue could be 'mechanical'. That means your skin is simply being irritated from removing the pouch too often, too vigorously, or from cleaning or scrubbing the skin to roughly.

To avoid mechanical irritation, try to be as gentle as possible, both when removing your adhesive baseplate and when cleaning the skin. Try to peel the plate off slowly, rather than ripping or tearing off. Using the other hand to hold the skin tight can help reduce stress on the skin. Adhesive removers may also help when removing the appliance.

If your skin is red and 'pimply'

If a rash seems to develop with small, painful pimples or pustules rather than a more diffuse irritation, it could be caused by an infection in the hair follicles in the skin around your stoma.

Infection in the hair follicles can develop if you shave the hair in the area around your ostomy too often or incorrectly (e.g. not using a clean, sharp razor, shaving against the direction of the hair growth etc.), or if you tear off the adhesive plate with force, tearing out hair as well. In most cases, scissors or an electric shaver will work better for the skin than a razor.

If your skin is wet and bumpy

Rashes (area of reddening, usually itchy) or with red or purple patches or with white substance over affected areas could be signs a fungal infection. If you have diabetes or lowered immune system, you could be especially at risk for this.

Dark and moist areas are particularly prone to fungal infections, so the most effective prevention is to keep the peristomal skin clean and dry when changing the pouch.

If your skin is bleeding

Start by carefully examining where the bleeding is coming from. Bleeding from the skin around your stoma could be a sign of a contact reaction, and may require treatment or preventive measures, and you must seek advice from your stoma care nurse.

However, a little bleeding from the ostomy itself is not necessarily alarming. The ostomy tissue bleeds easily, similar to gums when flossing or brushing.

First of all: An allergic reaction is a very rare reaction. However, if you do have one, the skin would likely be quite irritated or possibly itchy in the entire area exposed to the irritant.

Start by looking at the cleaning products you use. Do you ever use perfume, soaps with moisturisers, fragrances or oils? Perhaps alcohol-based cleansing products? Try avoiding these products completely, and wash the peristomal skin gently using water only for some time.

You could also be allergic to some of the supporting products you use, such as sprays, wipes or pastes, possibly even to components of your pouching system – so if the problem persists, talk to your stoma care nurse about alternatives.

Sore skin and detached baseplate

About five years ago when I first became the owner of an ostomy (which I named ‘It’) , I was really concerned about how my skin would cope with being covered by the adhesive layer and baseplate. I was careful to apply barrier cream and anything that was recommended to assist in the care of that area of skin.

The baseplate had a tendency to come detached in those days, which does cause us all so much stress and embarrassment. My skin was also very sore and patchy especially close to my ostomy.

On changing from a one piece bag to a two piece system I determined to start my regime again from scratch and see if I could establish the reason for the problems I was experiencing.

I determined to change my baseplate at the slightest sign of a tingle (I'm sure you know what I mean) even if the baseplate seemed fine. A good quality adhesive remover used copiously was always part of a careful removal of the baseplate. The emphasis being to be as gentle as possible to my skin by supporting it as the adhesive gave way.

Showering as nature intended

Secondly I only used soap and water to clean my skin and showered with old 'It' naked as nature intended when changing the baseplate.

Using an ostomy cup helps to get in and out of the shower without ' incidents' and only dry wipes to dry the skin before applying the baseplate ensures an additive free skin surface.

To my great delight that regime resulted in my skin healing really well and virtually no incidents of the baseplate 'letting go'. On the occasion when that happens now I can usually put it down to my mistake.

Having the baseplate on too long when I've been very active is mostly the reason. I have continued looking after my skin around my ostomy in this way for the past couple of years and I'm content with it.

I suspect we all have different skin types but for me this simple formula is perfect and keeps me free of 'ostomy worries'.

How to avoid flaky skin

One of my biggest skin problems generally since 'It' is that of dry flaky patches on my face and legs. I generally had put this down to inadequate hydration of my skin for whatever reason. Because we do not have the water, which would normally be extracted from food in our colon, there is a natural shortfall in our hydration, I'm informed.

It's been recommended to me that I should drink about 2 ½ to 3 litres of water a day. I'm able to achieve this by sipping often during the day. I find that when I do this, and also use a moisturiser on the effected parts, my skin returns to normal. I also take a good quality omega-3 fish oil capsule daily.

A recipe for healthy skin

I did think that because of my age my skin was having a hard time anyway so short of having a Ready Mix lorry load of anti ageing cream delivered I made use of Google to investigate solutions.

It turns out that wearing sunscreen above factor 30 when outdoors (I do), eating a healthy diet (I do my best) and not smoking (I don't) are the main contributors to a vibrant healthy skin. There are vitamin supplements of vitals C and E, which are meant to work so I will have to try those or just accept this craggy old face as it is.

Glass is definitely half full. Have fun.

Changes to the ostomy

After the operation, it may take a few weeks for your stoma to reach its final size. During this time, it may appear swollen. You may also experience that the length of your soma changes when you stand up or cough. Over time further changes can occur.

Your body changes over time and so will your ostomy. Exercise, as well as losing or gaining weight can influence the shape of your stoma, as well as the area around it. Some people may also develop an outward bulge and this can be caused by a hernia. This happens when a loop of the intestine pushes through a hole in the abdominal wall. If you think a hernia has developed you should contact your ostomy care nurse immediately. Find out more about hernias here

Why do changes happen?

Changes to your stoma and the area around it can be caused by changes in weight, changes in routine such as increased exercise or the natural effects of aging on the muscles and the skin. Bulges are often caused by weaknesses in the muscle of the abdominal wall.

How do I know if my area around the ostomy has changed?

Check your stoma and the area around it every time you change your appliance. It is also a good idea to use the BodyCheck tool to see if your appliance is still the right match for your body profile. Take me to the BodyCheck

Check also if the hole in your baseplate is still the right fit for the shape and diameter of your stoma. If not, you should cut the hole to the correct size to protect the skin from output.  

What do I do? When do I contact my nurse? 

If the area around your stoma changes, it is always a good idea to seek advice from your ostomy care nurse.

What causes ballooning?

When you swallow food or water, you also swallow a certain amount of air. Most stoma pouches have charcoal filters built into the bag. These allow the wind to be released. However, if the filter capacity cannot handle the amount of wind produced, or if the filter has become wet or blocked by the stoma output, ballooning can occur.

What can you do to reduce ballooning?

One of the main ways to reduce ballooning is to reduce the amount of air entering your digestive system.
Remember, we are all different and some foods that increase wind for one person is not the same for another.

Your lifestyle

Hints & Tips to reduce ballooning

• Eat regular meals throughout the day
• Sip drinks and try not to rush your meals
• Chew food thoroughly.
• Eating live yoghurt or taking pro-biotics daily can help to balance the bacteria in your digestive system, which in turn can reduce wind

You may find:

• Certain food types such as spicy or high fibre foods and some vegetables (e.g. onions, cabbage, beans) can increase the amount of wind produced.
• Fizzy (carbonated) drinks lead to an increased amount of air entering the intestine.
• Other activities such as drinking through straws, drinking from a bottle with a sports cap, chewing gum, smoking, shortness of breath and even snoring can increase the amount of air swallowed.

Hints & Tips in relation to your appliance...

• Check the contents of the bag have not soaked into the filter. If this is happening, you may need to change your pouch more often.
  Ensure your bag changes are within the recommendations provided by your stoma care nurse.
• If you use an open (drainable) bag or a two-piece pouch system, release the wind from the pouch regularly during the day.
• On some pouches, the filter can get wet from the outside, when swimming or showering. If this is happening, try covering with a ‘filter cover’ (which is found in your box of bags. Or contact our Customer Charter Team on 0800 783 1434 for further information.

At first I was innocent, and the word pancake remained pure. What I was experiencing was leakage. And nobody had warned me about leakage. Not the surgeon, not the ostomy nurse, not the other people I'd met with an ostomy; no, it was a big secret, apparently.

Accidents, as we call them, were one of the biggest things I had been looking forward to not having. No more running to the loo Mo Farah style, only to find that without his speed, making it on time was out of the question. And not making it in time meant serious washing and new underwear.

Sometimes it meant locking myself in a toilet, washing and drying my jeans and thanking the gods of technology for the invention of the hand blow dryer.

Knowing this was never to happen again once I'd been replumbed was a huge factor in my decision to have my colon whipped out in the first place. I couldn't wait to not have to worry about scoping out the nearest toilet, soiling my clothes, mortal embarrassment.

You’re not leaking, you’re pancaking

You can imagine my horror, then, when I woke up one morning covered in poo. A horror exacerbated by having to wake my husband, leaving him to strip the bed and change the sheets while I tore off my soiled clothes and jumped in a shower. I hadn't signed up for that. And it kept happening.

I went online to try to find what was causing it, to reassure myself I wasn't the only one experiencing it, and to try to find a way of stopping it. That's when I discovered I wasn't leaking, so much as pancaking.

Pancaking explained

A leak is when the output somehow finds a way to ooze out from under the bag, usually at a weak point, often down to user error. I was on top of those after my first few months.

Pancaking is different. When the output is thicker than usual and backs up really quickly, with nowhere to go because the person – in this case me – is busy not thinking about the fact that they have a pouch and not checking on things.

It clusters into a mound and pushes the pouch away from the body. When you look, there is a mass, a pancake like mass, of poo and the bag is all but free of your body. It's not nice. And golden syrup won't make it any better.

My solution to pancaking, for the first few years, was to remain vigilant.

To be aware of what I'd eaten and to keep checking on the bag, smooshing (maybe not a real word, but you know what I mean) the thicker output down into the bottom of the bag as soon as I could get somewhere private enough to do so, and mostly coping.

But messing about with your bag is not an easy thing to do in public, and I'm not always in a situation where I can find somewhere private.

I've actually turned towards a wall and tried to surreptitiously manipulate things before now. I can't imagine what anyone passing thought I was doing; if I was a bloke, at least I could pretend I was having a pee. So, whilst I had found a solution of sorts, it wasn't exactly ideal.

The solution: A bit of lubricant

And then somebody in the know suggested a deodorising lubricant. It wasn't someone in a sex shop in Soho; it was a person who works with ostomy products.

It's my own fault that I have the mind of a teenage boy when I hear the word lubricant, and if you're more mature than that, please accept my apologies.

The point is, said lube is swished around the inside of a fresh bag before you put it on. In my case, I take care to make sure the top of the pouch is completely covered in it, and then I proceed as normal.

No pancaking in six weeks and counting

I first did this about six weeks ago. Leaving aside the ridiculousness of my not having discovered this until I'd been pancaking for almost four years, my life has now been changed.

In those six weeks, I have not had one pancaking incident. My bag has stayed put and I am starting, daringly, to develop the confidence to not even think about it. Not always, but for more and more minutes every day. I'm optimistic. I think it's going to be okay from now on.

For most, a parastomal hernia will not cause any symptoms, some will experience a discomfort or dragging feeling particularly at the end of the day when your abdominal muscles get tired. The size or shape of the hernia varies in everyone, from a golf ball size to a grapefruit or larger, depending on the extent of the weakness around the stoma.

Are you worried you may have a hernia?

If you are concerned you may have developed a parastomal hernia, your stoma nurse will be able to assess the area and advise accordingly. The development of a hernia often changes the shape of your abdomen and the stoma, so the possibility of sore skin or leakages occurring as a result of the changes is likely – therefore, a review by a Stoma Nurse will be beneficial to talk through your stoma care routine and offer any alternative stoma bag options and check the template size of your stoma.

Please be reassured having a hernia around your stoma does not mean you will require further surgery. Surgery really would not only be indicated unless you are experiencing other stoma related issues for example: persistent stoma management issues due to the size of the stoma. If you have symptoms of severe pain, feel sick and your stoma changes colour or stops working, you should immediately seek medical advice from your GP or local A&E department.

There are several actions, big and small, you can take to reduce the impact the hernia has on your life. As mentioned earlier it is not uncommon to experience a discomfort/dragging feeling at the end of the day, however, making key life-style changes such as exercising more regularly or following a balanced diet to help manage your weight will have a significant and long-lasting effect.

Daily exercise and undertaking core exercises will contribute to strengthening your abdominal muscles as well as weight management to reduce undue pressure and strain around your stoma.

What causes a bulge to occur? 

When your stoma is formed, the end of your intestine is brought out through an opening in the abdominal wall.
This can weaken the muscle of the wall, allowing the bowel to push forward and form a bulge. The size of the bulge varies from person to person, but when a bulge first appears it is often the size of a lime.

A bulge can also occur if a segment of the intestine used to create the stoma, loops under skin. This is called a sliding hernia. When a loop of intestine pushes through the hole in the abdominal wall and embeds under the skin to form an additional bulge, it is known as a true hernia. If you suspect you have a true hernia, you should contact your stoma care nurse immediately as there is a risk of the bowel being squeezed between the muscle layers.

If the area around your stoma changes, it is always a good idea to seek advice from your stoma care nurse. If you have stomach pain it is crucial that you do so immediately.

Remember to use the BodyCheck!

Using it regularly will help you make sure that you are using the appliance that fits you best. Take me to the BodyCheck