You may have a stoma because you’ve had bowel, rectal or bladder surgery. When you have a stoma, it’s important to take care of the skin in the area. This will help to prevent problems managing your stoma and bag.
Why does having a stoma affect your skin?
A stoma is a surgically-made opening of the body onto the skin. You can have a stoma because you’ve had surgery to remove part of your bowel, your rectum (back passage) or bladder. Your bowel movement or urine then comes out of the stoma and collects in a bag that you need to regularly empty or change. The bag attaches to a base plate, which fits over the stoma. In a two-piece system, the bag clips on to the base plate. In a one-piece system, the bag comes already attached to the base plate so you change the whole thing every time you need to empty the bag.
The fit of the base plate determines whether your bag is secure and the skin around your stoma is protected. If they fit well enough, you can use pre-cut base plates. Or you may need to cut the plate to fit neatly over your stoma.
How does having a stoma affect your skin?
When you have a stoma, urine or stool can affect the skin around it. Both are acidic and will cause the skin to become sore or even break down if it’s in prolonged contact with it. Although the base plate helps to protect the skin around the stoma, inevitably some skin will come into contact with the contents of the bag. Having a well fixed base plate that fits neatly around the stoma can minimise skin contact but it’s very difficult to prevent this completely.
The skin where you stick on your base plate is also at risk of damage. Having to repeatedly stick on and remove the plate can make it sore or even tear it. Once the skin is broken, there is a risk that it will become infected.
Choosing a stoma appliance
There are different types of stoma bags. Some you remove and throw away each time it needs changing. Others you can leave in place and just empty when you need to. There are also bags that clip on to the base plate so you can leave that in place and just clip on a new bag. They are generally used for ileostomies (when you’ve had your complete lower bowel removed) or urostomies (after having your bladder removed). The base plate of these types of bag only need to be changed every few days.
To some extent, the type of appliance you use will be dictated by the type of stoma you have. But if you’re having skin problems, changing the base plate less often may help. Talk to your stoma nurse. They know about all the different types of stoma bag and will be best placed to help you find the one that suits you best.
How to care for your skin
There are two main aspects to skin care with a stoma:
- Avoiding damage when changing the base plate
- Preventing or minimising contact with the bag contents
Having to repeatedly remove and stick on new bags or base plates can tear your skin. Have everything you need ready to hand and take your time. To avoid tears, you will need to ease the old base plate away gently. It may help to use an adhesive remover. You should be able to get a sample to try from your bag supplier or ask your stoma nurse.
Clean the skin around the stoma with warm water only. Even baby products can contain perfume and irritate the skin. Once your skin is clean, check for signs of irritation or rashes. Tell your stoma nurse as soon as you spot any problems. Getting help early will stop them getting worse.
Make sure your skin is completely dry before you try and attach a new bag. Dab with a clean towel (don’t rub or drag the skin) and leave it open to the air for a few minutes. Some people use a hairdryer on a cool setting.
If your skin is prone to damage, ask your stoma nurse about barrier sprays or wipes that will help protect it. You apply these before positioning the base plate of your next bag.
If you’re just changing a bag and leaving the base plate in place, check for any leakage that could have seeped behind the base plate. If there is any, change the base plate too so that you can clean your skin properly.
Your stoma can change shape and size over time. It may shrink naturally after surgery or it may change shape if you lose or put on weight. If it changes, the hole in your base plate will not fit snugly. So it’s a good idea to check it every few months. Ask your stoma nurse to help or use the stoma guide that comes with your appliances.
Your stoma may also leak if your skin is uneven because of old scars, wrinkles or blemishes. There are pastes you can get that fill in any gaps and help the base plate to fit neatly. There are also washers that are made of paste that you can mould to fit. Again, ask your stoma nurse for advice.
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