I am 4 weeks post-ileostomy surgery and have developed a nasty infection around my stoma. I have pus coming out from under the stoma and angry cracked red skin around that. I saw my doctor on Friday, and she put me on oral antibiotics and gave me hydrocortisone cream to put on my skin.
I am looking for some tips on how best to manage my skin as it heals. I am using the Coloplast Sensura Mio wafer and bag and the Coloplast barrier ring.
When I changed my bag tonight, I saw I had a lot of output under the ring, which was irritating my skin, so I now put a piece of Coloplast protective sheet under the ring. I am not sure if this is recommended or not.
I think I remember someone saying to use the elastic barrier strips on the wound, but wasn't sure if I remembered correctly and don't want to hurt my skin even more.
Any advice would be appreciated!
Thank you
Thank you, Shamrock
I want to clarify that I only started using the cream tonight and I put the protective sheet over it. Output was getting under the barrier ring before I had put the cream on my skin.
I did wait for the cream to fully dry before putting the protective sheet on it.
About the paste, I have very flat smooth skin around my stoma. Does the paste do anything other than smooth out the skin? Does it help heal the skin?
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It'll sting for a second because I believe there's an alcohol component to the paste. It should protect the area for a few days though and can be very helpful. I recommend wetting your fingers before smoothing it out, as it makes things go much easier.
I'm not sure if this will help, but every once in a while, if I remove my flange too soon, it rips some skin off with it. The last time this happened, the area got a little inflamed. I applied Neosporin to the skin, then applied a waterproof band-aid to cover the skin, then applied my new flange. It seemed to work really well. I'm not sure if you could get a band-aid over the area you're talking about, but you could try cutting it to form if necessary. It might help to keep the cream on for a longer duration.
The good news is that you can avoid them with some small changes in your diet.
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I've used hydrocortisone cream in the past around my stoma and for my eczema. It's really good; it clears skin problems up fast. I'm sure the doctor warned you to use it sparingly and for as short a time as possible, as long-term use would thin your skin. After applying any cream, wipe over the skin with a tissue.
It's not that unusual for output to leak under the barrier, especially in the early days. If it did continue to be a daily or regular problem, speak to your stoma nurse to find a bag that's more suitable for you.
I have dry skin, so I always wash around my stoma with Dermol 500 lotion and very rarely have any skin problems.
Hi there,
For cleaning around the skin, I recommend the Dial antibacterial soap, the gold bar. It isn't harsh like dishwashing liquid soap, which is also hard to rinse off the skin completely. The gold bar is an antibacterial soap and doesn't leave a residue of soap, which causes problems with adhesion and won't strip your skin, nor does it contain anything that will compromise your wafer. Regarding the issue with the output coming around the base of your stoma, is it in one spot or is it all the way around?
Hi Clara, You've gotten some good advice here about dealing with your infection. Going forward, you may still have skin irritation issues, as is common with ileostomies. I also have an ileo, and I had a pretty bad problem with raw irritated skin. What worked for me to clear it up and keep my skin healthy, is Salts brand 'aloe rings'. They are barrier rings infused with aloe and are very kind to your skin. They were the only thing that worked to clear up my skin and I continue to use them to keep it healthy. They also increased my wear time by a couple of days. Good luck.
Terry
Check this out:
https://nightingalemedical.ca/product/medline-marathon-liquid-skin-protectant-0-5g/
Crusting (as Shamrock mentioned) and use of a skin prep spray/wipe will also help
I agree with the marathon, and they also have a 3M Advanced Skin Protectant. And no, it's not excessive when you're leaking. If you're leaking, actually, this stuff is going to be the best when it comes to protecting the skin from output, and your wafer will stick to it, so there's no problem with adhesion at all.
Follow our simple and practical guidelines for eating healthy with an ostomy.
It is difficult to determine what is too expensive. Each person's expense tolerance is different based on income, insurance, etc. Sometimes when you are in pain, your expense tolerance may rise. It may be more appropriate to state that a given treatment is more expensive. I am no fan of Hydrocortisone ointment/cream (0.5 or 1%). I'd rather pay for a more expensive solution.
For example, a very effective but more expensive solution, for me, is to use a beclometasone dry powder aerosol inhaler. Aerosol steroids are a quick, easy-to-apply method that reduces both the systemic side effects of oral steroids and the problems of stoma bag leakage seen with oil-based preparations. The aerosol steroid works well with broken peristomal skin — a steroid inhaler is used to decrease the peristomal inflammation without affecting the adhesion of the stoma bag which could be caused by creams.
The dosage of beclometasone dipropionate aerosol inhaler for peristomal skin differs from its use for asthma or COPD. For peristomal inflammation, the typical application is to use two puffs directly to the affected area at each stoma bag change. This is different from its use for respiratory conditions, where it is usually administered as 1 or 2 puffs twice a day.
The recommended steps for using a beclometasone dipropionate aerosol inhaler on peristomal skin are as follows:
• Clean and Dry the Area: Ensure the peristomal skin is clean and dry before application to maximize effectiveness and adherence.
• Application: Spray two puffs directly onto the inflamed peristomal area during each stoma bag change. This method reduces inflammation without affecting stoma bag adhesion, unlike creams.
• Duration: Treatment typically leads to improvement within a week, with complete healing observed in about four weeks.
IMPORTANT: Once the skin has improved, gradually reduce applying the treatment, rather than stopping completely — apply on alternate days for a couple of weeks, then stop the treatment. This may prevent recurrence of the inflammation. Generally, it is preferable not to use topical steroid treatment for a prolonged amount of time, though sometimes this can be necessary.
Brands like Clenil Modulite and Becloforte are commonly used for this purpose. Becloforte may be preferred for its higher potency, requiring lower doses to achieve similar effects compared to Clenil Modulite. Clenil Modulite and Becloforte are primarily available in the UK. They are not commonly found in the United States, Canada, or India under these brand names. In India, similar formulations such as Beclate are available. Since I am in the U.S., I order the Beclate 200 Inhaler from AK PHARMA International in India.
A less expensive solution is the use of an inexpensive over-the-counter spray, Nasacort Allergy 24-hour is a 0.039% triamcinolone nasal spray. Nasacort is pretty good despite lower potency than the prescription steroid sprays. If using Nasacort for peristomal skin, apply it sparingly and directly to the affected area using a fingertip, rather than spraying directly.
I saw on this site someone that stated that their WOC nurse recommended the use of fluconase — I have not had the opportunity to try this out yet, although I have used fluconase for my allergies.😊
For those that prefer not to use topical steroids, another alternative is to use an inexpensive prescription topical anesthetic, Lidocaine 2% gel. The recommended steps to using Lidocaine are:
• First apply Lidocaine 2% gel to the desired treatment area during a bag change, allow it to sit for 5 minutes to facilitate anesthesia, then wipe it off.
• The gel can be removed easily without greasy residue, so it does not interfere with appliance adhesion.
• The skin anesthesia permits thorough cleaning of the site with adhesive remover, followed by a warm water rinse.
• The skin is then dried with a low-temperature hair dryer.
Lidocaine's anti-inflammatory effect decreases skin weepiness. This method enables improved bag adherence and therefore reduces leaking that can prolong and worsen the problem.
For those that prefer herbal solutions, I read a report advocating for the use of chamomile. The report stated that chamomile has been shown to have anti-inflammatory, antibacterial, and bacteriostatic properties and was found to "facilitate granulation tissue formation and epithelialization of ulcers." 🙄
Two types of chamomile generally are used in traditional herbalism: German or Hungarian chamomile and Roman or English chamomile. German chamomile is considered more potent and medically superior to Roman chamomile because it contains a higher proportion of the active chemical ingredient chamazulene. This compound is a potent anti-inflammatory agent. Roman chamomile has less chamazulene and a higher alcohol content than its German counterpart. A study was conducted to compare the effect of a German chamomile solution to topical steroids on peristomal skin lesions in colostomy patients. The results of the study suggested that chamomile-treated peristomal lesions heal more expediently than those managed with 1% hydrocortisone ointment. Based on the results of the study, German chamomile can be recommended to relieve itching and inflammation and that twice-daily application facilitates healing of peristomal skin.
Other things, which I have not tried, include witch hazel, waterproof skin protectant barrier films, Marathon liquid skin protectant, 3-M Cavilon Advanced Skin Protectant, and Domeboro Solution compresses which are sold over the counter.
As you can see, there are many different approaches, some more expensive/less expensive than others. Also, what works for one person may not work for another (site mantra 😉).
I've always enjoyed solving problems and finding solutions. Luckily, I don't view my stoma as a hindrance but rather as a source of constant challenges — easier to accept this than lament over something that saved my life. 😉 I am constantly seeking and trying out new products/solutions.
It's not 25 dollars per application. You can actually buy them individually on Medical Monks and also buy the 3M Advanced Skin Protectant individually as well. And if you are constantly leaking or even have a tendency to leak, yes, it is necessary. You want to protect the skin; once that skin gets eaten away, you're in big trouble for many reasons. Infection is one, your bag not sticking which results in more leaking and more eaten away skin. When you leak, there is nothing besides one of these two skin protectants to protect the skin. The output will eat away the crust method which isn't even a true skin protectant. Pepto doesn't work, placing the barrier extenders doesn't work, Tegaderm doesn't work, Calamine lotion, Aloe Vera doesn't. I have had 6 ileostomies and every last one of them retracted to where they were almost inside my stomach, so I had contrast output hitting my skin and eating it away all day long; a bag wouldn't even last 5 minutes. And I tried everything and then some. These skin protectants were the only thing that would even help get me through a day and protect the skin. And if the skin gets that bad in the picture you sent, the stoma needs to be fixed ASAP, and that dark purple on the skin looks like a deep bruise from a convex wafer.
Thank you Beth
I just googled the 3m cavilon and see it comes in a paste and spray. Which do you recommend?
Hey Clara, it's neither one of those; it's 3m advanced skin protectant. And there are places like Medical Monks, Vitality Medical, and others where you can buy it individually.
Hi Clara, I had a colostomy bag fitted on November 16th, 2024, so I am new to this really. I had skin irritation for a period and also leakage every day. My stoma nurse suggested that I persevere in cleaning around the stoma with the special wipes you should have been supplied with, warm water, then finish off with refresh adhesive remover with barrier film within. She then changed me to a convex colostomy bag with cohesion rings to stop the output from getting to my skin. I followed her instructions to the letter; my irritation cleared up within 3 days, and I now have no problems with irritation or leakage. Your stoma nurse should be consulted ASAP. I found 3 or 4 medical suppliers online who will gladly send you FREE samples of the spray very quickly. I'm in the UK and use COLOPLAST for my medics. Superb, very caring suppliers. Good luck.
Sorry this is so late in response. I have been using benzoin tincture as a protective barrier under my colostomy appliance for years. It was recommended by a pharmacist when I was having skin problems. I have found it works better than the wipes from Coloplast or Smith and Nephew. It is alcohol-based, so it will really sting for a minute when applied to inflamed skin. It comes in a small bottle, and I use a Q-tip to apply it. It also comes in swabs or ampoules. It's pretty cheap from online suppliers or some pharmacies that sell ostomy supplies. Hope you have been able to resolve your issues and are doing well now.