Problem with skin under stoma

And how close to the stoma do you put the hydrocolloid skin barrier strip?

I recommend switching from the paste to a flexible ring like an Eakin seal. My skin cannot handle the paste. Also stop any prep sprays or wipes and any adhesive removers till you get this worked out.

Is it extemely painful? Sounds like possible Peristomal Pyoderma Gangreosum. That would require a trip to the doc/stoma nurse.

When you remove the pouch has output been leaking onto this area? If so that is probably what is causing the problem and you need to get a better seal around the stoma. A seal, Eakins or the like typically would be the next step. You just warm them up a bit and form the seal around the stoma. You should not need paste with the seal but the skin has to be dry and clean or they dont stick. That said, are you using a convex pouch? If not that would be the first thing I would try. Do not let the wound go too long without medical attention typically a wound /stoma nurse

We did go to a wound care nurse and she switched us to a convex bag. Also gave us a nonalcolhol barrier wipe to use with the stoma powder to create a thin skin cover over the raw area. She did this on Tuesday morning at 9:30. It is now Saturday morning 9:30 and he has had some burning off and on for the past couple of days. The nurse told us to leave it on as long as possible for healing and that there may be some minor burning as the skin tried to heal. The problem now is knowing how to tell it's time to change the bag! It doesn't look like it's leaking but there is some burning at times. Should we wait and try to draw this out to at least 5 days or go ahead and change it this am?

Is there a way to look at the stoma site through the clear opening and tell if the seal is breaking up????? The slight burning, according to the wound care nurse, may be a sign of some healing. HELP! We are still new to this. We want to keep the bag on as long as possible for healing but we don't want to allow any leakage to keep the skin raw. How many days would you go?

And another issue we have is that his stoma has 'dipped'. The opening for the output has dipped down and is flush with the bottom of the stoma at the skin line! If anybody has this issue, please let us know how you deal with it so that skin isn't raw there.

wow that seems like totally contradictory advice to anything I have ever heard. There is no way you can tell it is leaking by looking through the bag. I have always been told that if its burning, itching, etc.. change the bag. Even with perfect skin.. most people do not get five days wear time.

Also did she show you how to crust up the area with the powder, barrier wipe, poweder, barrier wipe, powder barrier wipe.

Where the skin is dipped but not raw yet, you can proactively prevent rawness by using the powder barrier wipe thing.

Also is he using a belt. If not, get him one ASAP.

Seriously.. change that bag NOW. And I would definitely be changing things about every 2-3 days until he is healed up. If things are not improved he needs more drastic means like a hydrocolloid barrier. I can help you describing how to use that if you need it because I just went through 2months of that last fall.

But for now... CHANGE THAT BAG.

The convex appliance is supposed to deal with the flush stoma. I don't know if there is any way to see if there is leaking under the wafer through the bag. You might want to try adding an ostomy belt to help prevent loss of the seal from gravity.

I've never had an ostomy so I don't know, but is there a different quality in sensation between the irritation of the already raw skin, as opposed to getting the ostomy drainage on it? Does it burn or tingle all the time? Most people say that if it burns, it is leaking.

Jan

Totally agree with Liz. I was told to change the bag at the first sign of discomfort, usually itching but burning especially. In my experience that is the right thing to do. My "sign" of healing is that I feel nothing. I will wait until it is convenient to change if I can. The output actually burns the skin due to the level of acidity, we have to keep the output off the skin. There is no way to see what is going on without removing the pouch and skin barrier.

Five days pouch ware with an ileostomy without skin irritation is possible but most people with a good stoma get about 3 or 4. This is completely an individual thing it may be 1-2 days for others 5-7, dont try to "break records" it is not a competition, be comfortable.

[quote]The opening for the output has dipped down and is flush with the bottom of the stoma at the skin line! If anybody has this issue,[/quote

This makes it very difficult to pouch. I would say you need to use an separate hydo colloid seal and or need a pouch with high convexity.
Frankly this is a bummer. I had a flush stoma for about 6 months before it was revised and 2 days per pouch was all I ever got. A flush stoma is hard to pouch successfully.

Burning is not healing, its usually that effluent is hitting raw skin. I would change asap. I NEVER get 5 days of wear. I change every 3-4 days and find it keeps my skin better. If I have a raw skin area, I change every day till its gone because it gives the skin full protection from the eakin for several days.

I would skip the wipe - all those preps irritate my skin more than they help. I use a convex wafer with an eakin, stoma powder when needed and that's it. No wipes, preps, pastes, etc...

What helps with a flush stoma is to apply the eakin first; while applying, pull up on the skin above the stoma to help pull it up and out. Place the eakin then the wafer (I know lots of advice is to put the eakin on the wafer and then the whole thing on but I find this give you a lot less control. Since the eakin is soft you can place it closer to the stoma than you can the wafer opening.

PM me if you want to chat.