Struggling with Skin Irritation After 6 Months with an Ileostomy

I'm 6 months into having an ileostomy. Adjusting pretty well, but baffled by skin issues. It wasn't too bad at first, but now I seem to have something or another every time I do a bag change. I have stoma powder, prescription Nystatin powder, and a prescription spray, but I'm never sure what to use for what. I just make it up every time, but that's not working. And the skin issues are causing poor adhesion of the flange, so then I have to add barriers or tape, and that makes the skin issues worse!

What I would love is a 1-page handout that has pictures of various skin issues and the corresponding solution. Does anyone know of anything like this? Then I could just match the pictures to what I'm seeing when I take the flange off, and know what to do. Help!

Have you tried the "crusting" technique? I use it at each bag change. It works well to clear up or prevent mild irritation.

I use 3M Cavilon swab, Hollister stoma powder, and 3M Cavilon spray.

Wash the peristomal skin with Cetaphil soap. Pat dry, let sit for a half hour. Tilt my stoma upwards, then using a 3M swab, wet the peristomal skin at the bottom of my stoma (my problem area). Sprinkle stoma powder on the skin. Carefully spread the powder with my finger. Use the swab and dab the powder to wet it. Put more powder on, use the swab. I do this 3 or 4 times. When done, brush off excess powder around the stoma with a finger. Then use 3M Cavilon spray. Spray all around the stoma. Use a wafer to fan it dry. Then I apply a moldable barrier ring, then install the wafer.

Contact your stoma nurse. They have seen it all and can advise you and will work with you to find a solution. It'll save you a lot of time and hassle trying to figure it out on your own!

Hi Pouch,

Yes, there's a reference book that every ostomate should own. Skin irritation can come from a lot of sources, and without knowing exactly what you're dealing with, most of the advice you get won't work. Once you've tried the normal basic techniques... like crusting, stoma powder, topical anti-fungals and anti-bacterials, and making sure your barrier isn't leaking... you have to identify exactly what's going on and treat it.

I've got to run right now, but the book you want to get is called "Abdominal Stomas and Their Skin Disorders," by Lyon and Smith. It's essentially a picture book showing every possible thing that can go wrong with your stoma, the skin around it, and how to treat it. It's available used from a variety of sources, and it's cheap. You'll mostly find the first edition, which is fine. The second edition isn't that old and hasn't made its way onto the used market much yet. To buy it will cost you hundreds of dollars, and it's not very different from the first edition.

The ISBN for the 1st edition is 1853178969. Abebooks.com and eBay usually have used copies for $20 or so, as do other online used book sites. If you strike out, just let me know... I can send you one of my copies until you can find one.

;O)

w30bob has a wealth of information. If you can describe what your peristomal skin is doing, we'd be better able to give advice. Is it just red and inflamed looking? Is it damp and weepy? There are a few things that could be happening: fungal infection, allergies to your products, skin breakdown from output contact, to name some. Anything other than normal, healthy-looking skin around your stoma is a sign something needs attention. What that attention is depends on what the issue is. That being said, it's not unusual to have an issue come up once in a while.

Years ago, I was hesitant to listen to advice from my WOCN. The simpler your routine, the better. If you need a barrier wipe or spray, great, but if you don't, pass on it. It truly is a 'trial and error' situation sometimes, especially within the first year. Once you understand what your body needs, you'll be more confident. Seasonal changes (fall to winter/spring to summer) affected my skin greatly during the first year. Myself, when I change, I have a strict routine.

1. Set up the change supplies in a dry area. I use my bedroom, TV tray table with everything I need next to the bed.
2. Set up the bathroom, towels, and washcloths all in place.
3. Strip the old bag in the bathroom right before a shower and clean the stoma and skin. I use a damp paper towel to start, then clean the skin with Witch Hazel. After that, immediately shower. If I need some kind of cream to heal the skin or moisturize, I do it BEFORE the shower and give it a little time to absorb. I also use a soap that doesn't leave any residue; most sensitive skin soap rinses clean (I use Dove).
4. Dry the skin well, and ensure it stays that way before the wafer goes on. If there are any weepy spots on the skin that won't dry up, I use a powder on them (stoma powder, Nystatin powder, Anti-Fungal powder will all work). Apply and dust off the excess until the dampness in the skin is gone (this is where you might want a barrier wipe or spray; apply these in alternating layers until the skin remains dry, crusting technique).
5. Make sure the wafer fits properly. A hole cut too small won't seal well around the stoma; cut too large, and you risk irritating the skin directly around the stoma. Warming the wafer before you apply it can also help adhesion. Once I have mine sized, I tuck it under the small of my back for a few minutes, let the body heat do it.
6. Apply the wafer and give it some light pressure with a paper towel on it. This will help retain the warmth you applied to it and help it adhere better. After that, I snap on the pouch, dress, and go about my day.

This is just my routine; it may not work for you, but I thought I'd take the time to share. Good luck, and let us know if you need advice.

How to Manage Emotions with LeeAnne Hayden | Hollister

Thanks! I didn't know this book existed. Gonna get a copy.

Just ordered it, Amazon. Used, first edition. Nasty-looking cover photos. 🙃

There is also a skin assessment guide provided by the Wound Ostomy Nurses Society and Hollister. If you have multiple skin issues, it would go through the questions for each one.

http://psag-consumer.wocn.org/ 

Hi Beacher,

Yeah, I just got the second edition the other day. Really not much difference and not worth the extra cost, but I got lucky and found a rare used copy in the UK. If you think the cover of the first edition is bad... I'd suggest you read your book before you eat. You'll be absolutely amazed at all the things that can go wrong with a stoma and peristomal skin. And be grateful those things haven't happened to you. I gave a copy to my ostomy nurse friend and she was blown away! Knowledge is power!

;O)

I used to have occasional seepage into a small diameter around my stoma when I was using the wafers that you have to cut with scissors to size. It caused perpetual irritation to my skin because my stoma used to change shape constantly, and the hole I had cut would sometimes be too big.

I then tried the ConvaTec Natura SUR-FIT moldable skin barrier instead. You stretch it out, and after it's around your stoma, it then shrinks back a little to ensure a snug (but not too tight) fit. What a game-changer for me. There are no jagged edges, no fussing with scissors, and the opening always fits perfectly. Nowadays, when I do a bag change, there is only a slightly more pinkish hue around the immediate stoma area, but that is caused by the Eakin Cohesive seal that I use before applying the skin barrier (flange).

I can easily go a week or more without a bag change, even with frequent showering. Everything dries quickly, and the adhesives don't bother my skin. The only thing that ever irritated my skin was the output from leakage, which was resolved.

As individuals, we all have different needs for our stoma care, and I hope you can find your perfect solution. Yes, it can be as confusing as heck in the beginning, but there is no problem that can't be solved... eventually. Let your body be your guide—it will tell you what it likes and doesn't like. For example, my husband's skin is uber sensitive to every chemical, so if he had a stoma, he might be bothered by the actual adhesives themselves.

Please let us know what you find out!

So do you use both the moldable skin barrier and the Eakin seal? Just curious as I just ordered a sample from ConvaTec and they didn't mention anything about the Eakin seal.

Hi Rancher,

Yes, I use both. The ConvaTec convex flange adheres really well to the Eakin seal, and it gives an extra layer of protection for one's skin. I tried using only the convex flange, but it didn't prevent leaks well. With the two of them, I am super protected, and it's quite comfortable. It only takes an extra minute or two to adhere the Eakin seal. Then again, everyone's body is different, so you might need to sample a few to get the right combination for you—for example, some folks prefer flat flanges. And some prefer the one-piece system (where the bag is already attached to the flange), but I like the two-piece system.

You'll be successful; it'll just take a bit of time to find out what works best for you. :)

M

xo

Thanks for the reply, I'll try both.

A week would be a dream for me. What products do you use to get a week out of the bag? Myself, I am lucky to go 2 days without leakage. I currently use a 1-piece bag with that moldable ring that looks like one of those jelly ring candies. If I could go a week, that would re-open the door for me. Right now, since I keep having leakage issues, I am afraid to go that far from home as I get leakage. Needless to say, the leakage has caused skin irritation that worsens the issue.

Stomahesive wafers under my bag heal my skin. I cut an opening for the stoma to fit through. Every time I change the bag, I put on another Stomahesive wafer until my skin is healed. I use Convatec bags too, as they have Stomahesive backing. I've been using this method for 50 years. All the best.

Talk with a stoma nurse. I've never heard of the stuff that you are putting on your skin. Call Hollister and tell them what you are using and get their opinion also.

I also can only go two days before changing my bag because of a small leak at the bottom of my stoma. I'm working on it and so far concluded that I need a larger barrier ring than two inches. I'm going to contact Hollister tomorrow. They make a barrier ring #507806 that is 4 inches. It can be trimmed down to fit the back of the pouch, probably about 3 inches, and the hole stretched to fit the hole in my bag. I'm currently using a Coloplast barrier ring #120427, which is 4.2mm thick. I put the ring between parchment paper and roll it out like you would bread dough to make it larger and thinner. It's not easy to peel off the paper, but it can be done. Then I stretch the hole to fit the 1 1/8" hole that I have cut in my pouch. So far, using this method, I have not had any leaks, so I feel that the larger ring might solve my problem. I am also using a Hollister Convex Pouch #8868, which is relatively new and seems to be working with the rolled-out ring. If it works out for me, it might work for you. I will post the results. Edgepark prints a catalog of all ostomy supplies from all the different companies, and that is how I found out about the larger rings.

 I use the ConvaTec Natura SUR-FIT moldable skin barrier (convex flange) and eakin Cohesive slims (barrier seal). And for extra protection, I use a bit of medical adhesive tape to reinforce the perimeter of the entire unit.

Just as a quick note, if I eat an excessive amount of fibre without enough liquid to offset/dilute it, I still have to be alert to leakage from "pancaking." Even the best barriers and seals can only do so much before the sheer force of the thick, pasty output (which pools around the stoma opening and doesn't migrate/flow to the bottom of the bag as it should) lifts them clear away from one's skin. 

I understand your fear about venturing any distance from home base until you feel more confident that your leakage situation has been resolved. And it ain't no fun suffering from skin irritation either! I'm sure you'll find the answers to both of these dilemmas from this wonderful group of wise folks.

M

xo