Management

The area around your stoma, where your stoma bag is attached, is called the peristomal area. The sticky area of your stoma bag/flange/wafer, called the skin barrier, is designed to protect the peristomal skin whilst allowing it to breathe. It is important that this area is kept clean and protected from stoma output.

It is the ileostomy output that may cause soreness of the peristomal skin and not the continuous use and removal of the skin barrier. If the peristomal skin becomes uncomfortable, itchy and painful, your stoma bag needs to be taken off, the area washed, rinsed and dried and a new stoma bag re-applied.

The area around your stoma, where your stoma bag is attached, is called the peristomal area. The sticky area of your stoma bag/flange/wafer, called the skin barrier, is designed to protect the peristomal skin whilst allowing it to breathe. It is important that this area is kept clean and protected from stoma output.

It is the ileostomy output that may cause soreness of the peristomal skin and not the continuous use and removal of the skin barrier. If the peristomal skin becomes uncomfortable, itchy and painful, your stoma bag needs to be taken off, the area washed, rinsed and dried and a new stoma bag re-applied.

Hints and tips

• Many stomas are not round, therefore make sure the skin barrier fits as snuggly as possible.
• The easiest way to measure your stoma is by using the backing paper of the skin barrier as a pattern. You may want to stand in front of the mirror to do this.
• During the first 3 months you may want to check the size of your stoma on a weekly basis, as your stoma may change in size.
• If your skin is damp you may find it useful to dry the peristomal skin with a hair dryer on a low setting before you apply the new skin barrier.
• To aid adhesion of your flange/wafer/stoma bag, you may find it helps to place your new clean flange/wafer/stoma bag in a warm place (e.g. sit on it, put it under your arm) prior to application.
• Excessive sweating may reduce the skin barrier’s ability to stick to the skin. The use of a non-perfumed antiperspirant underneath the skin barrier helps solve the problem.
• Care must be taken when applying peristomal skin creams. They are often greasy and may prevent the skin barrier from sticking to your skin. The amount needed is no more than the size of a match head and should be well rubbed in before applying the new skin barrier.
• A bulge around the stoma may indicate a hernia, contact your stoma nurse for advice.
• A prolapse is an increased protrusion/lengthening of the stoma.
• Do not worry if your stoma bleeds when washed – this is normal, because it has the same delicate texture as the inside of your mouth.

Try to get into a routine when changing your stoma pouch.

You will need:

• Disposal bag
• Non-woven wipes for washing/drying
• Warm water for washing
• Fragrance free mild soap (if required)
• New pouch and/or flange
• Scissors for cutting flange/wafer (if required)
• Any accessories you may use

Changing the bag

• Secure clothing out of the way (pegs and safety pins may help to hold clothes out of the way).
• Empty your stoma bag.
• Dampen a few non–woven wipes to help release the adhesive barrier.
• Remove the used stoma bag carefully, from top to bottom supporting the skin with the dampened non-woven wipes.
• Clean any stools on the stoma and skin with toilet paper.
• Wash the stoma and surrounding skin with your dampened non-woven wipes/paper kitchen towels.
• Dry skin thoroughly.
• Do not apply anything to the skin unless recommended by your stoma care nurse or health care professional.
• Remember to remove the backing paper before applying the new stoma bag/flange/wafer.
• Do not forget to carry your spare kit with you when leaving home
  

When washing the peristomal area, it is not advisable to use baby wipes/wet wipes, disinfectants or antiseptic fluids – they may cause skin reactions around the stoma.

Hair removal around the stoma

Some people find it necessary to remove hair from the skin around the stoma. The best way to do this is either by shaving or cutting long hairs with scissors. Dry shaving is uncomfortable, so it is preferable to wet shave the area with a clean disposable safety razor each time. Shave gently and carefully in the direction of hair growth once a week. Do not use or share family razors. It is not advisable to use hair removing creams or gels.

If you need to shave the stoma area: use the cylinder from an empty toilet roll to protect your stoma and shave safely around the stoma.

Disposal of products

All stoma bags should be emptied before disposal. The empty stoma bag should be placed in a disposal bag and sealed before disposing of in a rubbish bin. When away from home you may wish to double wrap the used stoma bag before placing in the appropriate bin.

Disposal of used appliance

• Empty pouch contents into the toilet.
• Do not dispose/flush the stoma bag down the toilet.
• Place used stoma bag and wipes in disposal bag and tie a knot before placing it in household rubbish

Nappy sacks make good disposal bags for used stoma bags

Odour/Smell Hints and tips

• If the stoma bag is correctly applied there should not be any smell.
• When you have finished your stoma bag change and everything is cleared away and the toilet is flushed, strike a match and blow it out straight away. The sulphur tip of the match will reduce/eliminate the smell.
• There are some foods that may increase smell, like onions, garlic, cauliflower and cabbage. You may want to avoid the ones that affect you.
• A few drops of vanilla essence or proprietary ostomy deodorizer in the stoma bag may help with odour.
• Proprietary odour absorbers to spray towards the bathroom ceiling.
• Buttermilk to drink.
• Place a Tic tac in the pouch
  

When changing the stoma bag in the toilet/bathroom there will be a smell different to before your stoma surgery. The difference is due to the bypassing of the large bowel. Odour may also indicate leakage. This can be leakage from the pouch sealing or underneath the skin barrier. It is important that you change your stoma bag immediately – both to eliminate the odour but more importantly to clean and protect the skin around the stoma.