A Guide to Caring for Your Stoma at Home

We understand that many people living with a stoma may be feeling anxious about what the global health crisis means for their ostomy care. Whether you have recently had surgery or you have had a stoma for some time, it is essential to have all the facts at your fingertips.

To help make life a little more comfortable during the Covid-19 pandemic, we have compiled a list of stoma care resources, hints, and tips. Please bear in mind that this page only contains general support and is not intended to replace any specific advice given to you directly by a healthcare professional.

Skin irritation
Your skin serves as a protective barrier from outside elements, so it’s important that you keep good care of it. The skin around the stoma is especially at risk as it may come into contact with stoma output which can cause skin irritation.

When you experience an issue with the skin around your stoma (also known as a peristomal skin complication or PSC), it has the potential to result in mild discomfort and may lead to other problems. To help prevent these complications, you should take care of your peristomal skin regularly.

You can refer to our articles on ‘understanding your skin’ and ‘avoiding peristomal skin problems’ for some essential hygiene tips.

Getting the right fit
If you have recently had surgery, it is normal to expect the shape and size of your stoma to change in the first few weeks. What it does mean, however, is that you must always check and make sure your skin barrier has a good seal around the stoma. Your skin barrier should fit where the skin and stoma meet – with no skin showing in-between.

If you haven’t correctly fitted the skin barrier, it can cause the stoma output to leak underneath. By exposing your skin to stoma output repeatedly, your peristomal skin can become sore and irritated. Also, irritated skin may result in poor skin barrier adhesion, causing you to change your barrier too-frequently, which may damage your skin further.

If you’re having problems with getting the skin barrier to stick to your body or experiencing leakage, speak to a stoma care nurse.

Leakage under the skin barrier
If the output from your stoma leaks under the skin barrier and comes into contact with your skin, it may lead to itching, soreness, redness, and a whole host of other problems that may require medical attention. The fluid from your stoma is corrosive by nature, and any contact with the skin is likely to lead to damage.

Leakage of your stomal output under the ostomy skin barrier can happen for one of many reasons, but a likely cause is not achieving the right fit. By correctly fitting the barrier around your stoma, you can prevent ostomy output from getting trapped underneath and causing irritation. Likewise, over-filling your pouch can cause the barrier system to pull away from the skin and potentially cause leakage under the barrier onto your skin.

You can read more about the effects of leakages by reading our article on how your skin works. If you’re still struggling with consistent leakages, however, you should talk to a stoma care nurse directly.

Different body shapes
You need only to look around you to realise that everyone’s body is different. Some people have abdominal creases while others have folds and different shaped abdomens. The key to minimising leakages and irritation is to make sure your barrier conforms to the contours of your abdomen.

Many of the ostomy products at Dansac have convexity designed to conform to your body without compromising fit. That means whether you have abdominal creases or folds, your stoma appliance should still produce a good seal. To avoid any potential leakages or skin irritation, try and make sure your skin is as flat as possible before applying the new skin barrier.

If any problems persist and you are struggling to obtain a good seal around your stoma with the barrier, speak to a stoma care nurse.

Swelling behind/around the stoma
Some people might experience swelling behind their stoma. Swelling is very common at the stoma site after surgery but this should resolve within six to eight weeks. If swelling around the stoma persists, it may be a parastomal hernia. A parastomal hernia is simply an abnormal protrusion of bowel through a weakened area in the abdominal wall.

A hernia around the stoma (parastomal hernia) occurs in about 5-10% of people with colostomies, and about 3-10% of people with ileostomies. How significant the swelling is will depend on how much bowel protrudes through the abdomen wall and how big that weakened area is. For many people, this results in a slight bulge around the stoma.

While parastomal hernias are pretty common for people who have had ostomy surgery, you should pay close attention to any side effects. If, for instance, you experience any of the following responses, you should contact your stoma care nurse or healthcare professional immediately:

• Pain
• Nausea
• Vomiting
• Inactivity of the stoma (output)
• A significant change in temperature

You should also seek medical attention if swelling behind the stoma is causing any difficulty with fitting your pouching system.

For more information about parastomal hernias please refer to the Dansac Hernia Hints and Tips Educational Booklet.

High output stoma
If your large bowel is removed, the small intestine is not as efficient at absorbing fluid. This procedure can result in what’s known as ‘high output’ from your stoma – that is, large amounts of fluid and electrolytes.

In the first three weeks following surgery, almost 16% of patients with a small bowel stoma have problems with high stomal output. So, it’s more common than you might think. However, losing a large volume of liquid in your output should always be monitored and checked by a healthcare professional, as it can result in dehydration, a loss of weight, and even acute kidney injury.

The ostomy guide produced by Brighton and Sussex University Hospitals NHS Trust states that a stoma producing more than 1,5 litres (1500 ml) per day is considered high risk. You should investigate any watery output that continues for longer than 12 hours. If there is a watery output for longer than 24 hours, you must seek professional medical intervention.

Common causes of a high watery output include:

• Infection (you may be asked to produce a sample).
• Obstruction.
• Quickly stopping some medicines e.g., steroids or strong painkillers.
• Taking some medicines e.g., laxatives or magnesium.

When in doubt, always speak to a healthcare professional.

Dehydration
Unless you have a fluid restriction, you should keep your body hydrated by drinking plenty of water. As we discussed above, having a stoma makes you particularly vulnerable to dehydration, so you should make a conscious effort to drink fluids regularly.

If you notice that your urine is dark in colour or there is a reduced volume of output, it could be a sign you are dehydrated. Other symptoms include having headaches, feeling tired, faint, or dizzy.

Depending on the cause, water may be the best option when rehydrating. Contact a healthcare professional if you continue to experience signs of dehydration, or if you’re worried.

Stoma bleeding
Your stoma has many blood vessels, which means that it may bleed through touch or irritation. If bleeding does occur during your cleaning and hygiene routine, it should stop on its own within a few minutes.

Any bleeding that lasts longer than 5 to 10 minutes requires medical assistance. Likewise, if you notice any blood coming from the inside of your stoma or in your bowel movement, you need to call a healthcare professional immediately.

Gas, constipation, and odour
If you’ve had colostomy, ileostomy, or urostomy surgery, certain foods may increase the odour of your output. Everyone is different, and certain foods may or may not affect you negatively.

You can read our guide to preventing odour and gas after stoma surgery for more tips.

If you’re struggling with constipation, it could suggest your diet is lacking in fibre, or you’re not taking in enough fluids. Similarly, some people experience constipation after taking certain medications, such as pain relievers and antacids. If there is no improvement or you’re experiencing pain, nausea, or vomiting, contact a healthcare professional.

Further advice
Need more advice about managing your stoma at home? You can find lots of useful information in our Ostomy Learning Centre.

Please bear in mind that our learning centre only contains general advice, and it is not intended to replace any specific guidelines given to you directly by a healthcare professional.

1. Brighton and Sussex University Hospitals NHS Trust guide, endorsed by the Association of Stoma Care Nurses UK (ASCN): https://www.bedfordshirehospitals.nhs.uk/documents/stoma-care-self-help-guide/
2. Wound Ostomy and Continence Nurses Society: https://www.wocn.org/
3. Canadian Society of Intestinal Research: https://badgut.org/information-centre/ostomies/parastomal-hernias/
4. A systematic approach in the management of a high output ileostomy resulting in a favorable clinical outcome: https://www.pulsus.com/scholarly-articles/a-systematic-approach-in-the-management-of-a-high-output-ileostomy-resulting-in-a-favorable-clinical-outcome.pdf