Common Stoma Problems

There are common stoma problems that can arise when you have a stoma bag but if you are informed and prepared, complications can be countered or even prevented by following our helpful stoma advice.

Sore Skin Around the Stoma

A skin protection film can be used on sore skin before applying your stoma pouch and help the appliance adhere.

For very sore skin a ‘skin blanket’ can be applied onto the skin before putting on a new appliance which also acts as a skin barrier between the skin and the adhesive.

Large areas of skin that are red, sore, and weeping (always wet) may prevent you from getting a good seal around your stoma. It is therefore important to treat minor irritations before they worsen.

If you have any irritation or sore skin that does not clear up after a few days, contact your stoma care nurse.

Soreness around a stoma can often occur when:

• Base plates are changed too often – in some cases base plates do not need changing as often as pouches and it may be worth trying a two-piece system which allows you to change a pouch without always having to change a base plate.
• There is leakage of output onto the skin – to avoid leakage make sure that your stoma is measured on a regular basis and the base plate size changed accordingly. This is particularly important if you have experienced any kind of change in your weight which in turn may alter the size of your stoma. A belt can also be worn with two-piece and convex appliances to help prevent them leaking.
• Hair follicles become inflamed – this can be due to improper shaving of the area. If you do shave the area, make sure it is not too often and that adequate hygiene is maintained. A clean disposable razor must be used each time
• Soap is used to wash the area – instead of soap use water and dry wipes or a mild unperfumed soap. Fittleworth supplies complimentary dry wipes to help with this. Please note that many nurses recommend that you do not use wet wipes on or around the stoma as this can cause irritation. If you do use wet wipes and suffer from sore skin, try stopping for a while and only use dry wipes and water, to see if your skin improves.
• You are sensitive to the adhesive, other products or to certain foods – to help with this try some alternative appliances or use skin protectors such as protective wafers or wipes.
• Sweating occurs due to the plastic pouch sitting close to the skin – to stop sweating, particularly in hot weather, you can use a cotton pouch cover which is placed over the top of the plastic pouch. These are available on prescription through Fittleworth.

Stabbing Pain in a Stoma

Sometimes, intercostal nerves can be intertwined with scar tissue. If stitches are pulled too tight, this can also cause such pain. Irritation can cause inflammation within the stoma and around the general area. This type of pain usually recedes as oedema (a build-up of fluid) reduces within the stoma site. This type of stabbing pain, which occurs longer lengths of time after surgery, can be secondary to adhesions (scar tissue) becoming inflamed and has also been linked to constipation in Colostomy patients and obstruction (non-functioning ileostomy).

What causes blisters around a stoma and how can they be prevented?

Your stoma nurse should continually assess blisters around the stoma. These can most commonly be caused by parastomal stitches pulling tight due to post-operative abdominal swelling/oedema. Other common causes are incorrect stoma pouch aperture, which often needs altering a few times post-operatively due to changes in the post-operative abdominal topography and reduction of swelling in the actual stoma.

Alteration of the pouch aperture will immediately help prevent this occurrence, and ostomates need to observe any possible need for such changes. Also, stoma seals can promote comfort and act as an added guard against seepage of stool, which can irritate the skin in this area.

Stoma Bleeding

You may notice slight bleeding from the surface of your stoma. This is normal and can be caused by cleaning your stoma too harshly. It is also normal for some stomas to bleed when you change your pouch.

Take care when changing your pouch and cleaning the area. However, if the bleeding persists or you have any other concerns then you should contact your stoma care nurse for advice.

Bleeding can also be caused by friction from an ill-fitting appliance. To prevent this from occurring, regularly check that the site of the hole on the base plate or flange is correct. Your stoma nurse can assist with this. If there is blood in the contents of the pouch, seek medical advice.

Stoma Infection Signs

It is rare for a stoma to become infected. Usually, an infected stoma has puss and blood on its lumen. This would need assessment by your Stoma Nurse or GP, where antibiotic needs would be assessed. Infections of the skin around the stoma are more probable. This would present with itching skin, which can be wet or dry and also affect pouch adhesion. Blisters are usually visible, and this can lead to dermatitis symptoms and pain. It is important to remove pouches as advised and allow time for the pouch removal rather than being tempted to pull and possibly tear the skin.

Preventing Excessive Stoma Wind

The presence of excessive flatus (wind) can dislodge your pouch and cause leakage.

Different types of food and drink consumed could cause excessive wind, and will affect different people in different ways. It is helpful to keep a diary of your intake as this will allow you to see if there is a particular food or drink that is causing the problem.

Our stoma dietary advice contains further advice to ensure that you are eating a diet suitable for your needs. We also have a range of recipes for stoma patients if you need some culinary inspiration.

Remember that most people find that foods that have previously caused them upset and excessive wind will still generally have the same effect.

The best treatments for very painful trapped wind with a stoma

• Eat meals slowly and chew food well
• Avoid chewing gum
• Try to eat without talking
• Eat small/medium regular meals
• Try not to miss a meal
• Do not consume liquids during meals, avoid fizzy drinks
• Take peppermint oil, tablets or tea
• Try charcoal tablets which may also have a deodorising effect
• Once you have identified foods that give you wind gradually re-introduce them but eat them in moderation and in accord with your lifestyle.

Further dietary advice for ostomates is available from Fittleworth, or sign up for our stoma diet sheet and recipe book created by our team of experts.

Excessive wind can also cause ‘stoma ballooning’, where the pouch inflates. To avoid this, you can either change to a pouch with a double filter or obtain extra filters from Fittleworth free of charge.

Stoma Bag Smell /Odour or Leakage

If you notice any unpleasant odours from your pouch, it may be that you have developed a leak – you should check that the pouch is fitted correctly to avoid this. Remember that some foods will also increase odour, particularly if eaten in large quantities – these include:

• Baked beans
• Peas
• Onion
• Cabbage
• Egg
• Fish
• Certain cheeses
• Alcohol

There are many different odourisers available in the form of sprays or drops which are inserted into your pouch, all of which are available on prescription through Fittleworth.

Pancaking Stoma

‘Pancaking’ is caused by firmer stools sticking to the stoma and not moving down into the pouch correctly. It can cause problems often leading to leakage and sore skin.

How to Prevent Pancaking in a Stoma Bag

If your stoma bag keeps pancaking, then below are ways that will help prevent pancaking:

• Rub a small amount of baby oil into the top of the pouch, avoiding the filter, which will help the stools to slide into the bag
• Add a filter cover to the filter to prevent too much air from escaping and keep the sides of the pouch apart
• Place a small piece of screwed-up tissue or cotton wool inside the pouch, again to keep the sides apart
• Increase your fluid intake to help soften stools
• Try blowing some air into the pouch before applying it

There are specific accessories and products available on prescription which can help to prevent and stop stoma pancaking. For more information, please contact your stoma care nurse or speak to one of Fittleworth’s Customer Service team.

Diarrhoea with a Stoma

Possible causes of diarrhoea include certain foods such as:

• Spicy food
• Baked beans
• Peas
• Chocolate
• Prunes
• Spinach
• Raw fruit

Other factors could include excessive alcohol consumption, stress or an underlying medical condition. Some types of medication and food may alter the colour and consistency of your output.

Eating marshmallows, unripe bananas or smooth peanut butter may help to solidify the contents. It is also important to keep well-hydrated by increasing your fluid and salt intake.

‘Discharge Solidifying Agents’ are available on prescription which can be placed in a pouch to solidify the contents.

Speak to one of our Customer Service team for products available, or contact your stoma care nurse for advice.

If you have an ileostomy, generally your output will normally look loose and may resemble diarrhoea – this is nothing to worry about. If, however, you feel unwell, the output is watery and your pouch needs emptying more than 4 to 6 times a day and this continues for more than 24 hours it is advisable to seek medical help.

For more information, please see our ileostomy diet advice page, or one of our advice leaflets obtained through our Customer Service team, or contact your stoma care nurse.

General Stoma Care Advice

Ensure that your stoma appliance does not become too full as this can pull the pouch down and may pull it off. To avoid this, you should change or empty your pouch when the contents reach the half-way mark.

If your stoma changes colour, size or shape you should contact your stoma care nurse.
If your stoma stops working and you have abdominal pain/discomfort you may need medical assistance. Never stop taking any medication without consulting your GP.

Our advice page on exercising with a stoma is ideal for those who are looking to undertake physical activity and will provide guidance on the essential considerations required to exercise with peace of mind.

Our Simple Steps programme also contains core exercises for ostomy patients and takes new ostomates from surgery preparation through to recovery post-operation.