Living with a stoma is a very personal thing, the way that you maintain hygiene, manage your skin and avoid leaks can be very individual. However, there are some tried and tested methods of managing your stoma that can be shared by the many people who have lived with a stoma for a number of years.
One of those people is Mike H. who shares his experience and insights to help others who have their own struggles. As always, however, what works for one person might not for another, but we hope that Mike’s tips and tricks might help you with certain aspects of stoma care. If you need any support managing hygiene or changing your stoma bag, please ask your stoma nurse who will be able to help.
I’m exceptionally fortunate, now well into the second half of my ninety-third year, not to have any recurrent problems arising from my ileostomy of six years ago – not because I’m a genius but because I ran a whole gamut of disasters during my first few months and learnt from those. Having moved house, lost contact with any stoma nurse, and now seeking independent information I found the Bladder & Bowel Community.
What time of day should you change your stoma bag?
It would be natural to think that today’s lunch produces this evening’s bag contents. What we know is that the digestive processes carry on during our day’s activities and in periods of sleep too. So the best chance of catching the stoma flow at a minimum is on waking from sleep, normally before breakfast. Such a timing is also likely to be convenient for a morning shower. This can provide an opportunity to remove the bag, and pay close attention to cleansing the whole stoma area during your shower. You can then dry thoroughly and apply the new bag.
This is likely to work well 95% or more of the time. But owing perhaps to the unpredictability of the microbiome (trillions of microorganisms which are essential for the process of digestion), you may get caught out with drops of discharge falling to the shower floor. These can easily be washed away. But I suggest avoiding stepping out onto any fluffy bathmat or similar before the new bag has been fitted.
Adhesion and preventing stoma bag leaks
The one and only safeguard as regards convenience and continence is the leak-proof union between skin and attachment maintained by the bag-base glue. Adhesion depends entirely on the glue gripping the skin. Any water in between will spell disaster, and even worse is oil, grease, or lubricant.
- Cleaning the skin around your stoma can be achieved with just water and a soft flannel.
- If something more is required (or is inevitable, when showering for example) use only a simple (cheap!) toilet soap followed by thorough rinsing.
- NEVER use any sophisticated (expensive) solid soap or liquid soap of any kind since such products almost certainly include lubricants to improve the ‘feel’ of the product in normal use.
- I would advise you NEVER to experiment with wet-wipes anywhere near your tummy/belly/trunk area of skin. Any attachment is likely to fall off, almost literally, within minutes!
- Make sure the skin around your stoma is as dry as you can get it. After towelling you might dab the area with soft absorbent toilet paper, paying particular attention to the skin close up to the stoma itself (if some flakes of paper stick to the stoma they will be carried away at the next emptying). The actual stoma will always be moist – it can never be dried, and the moisture may even include traces of blood.
To maintain Adhesion
- Once firmly attached, your appliance should ideally remain in place for a convenient number of days, or up to a week if that suits you and your lifestyle.
- You will be relying on adhesion to bear the weight of your attachment and its contents whenever you are vertical, and to withstand any internal pressure at all times so it’s important to get that right first. Your bag should be emptied frequently enough to avoid contents becoming too heavy.
Other Considerations
Ballooning
The night-time accumulation of gas, sometimes known in this context as ballooning, can be alarming when you wake to find yourself attached to what seems to be a hard rugby ball!
When emptying such a bag there is a huge temptation, after releasing the drain flap, simply to squeeze the bag and force the contents – semi-solid and gas – down and out for disposal.
With a ballooned bag there seems to be little option. But as well as operating downwards, any squeeze pressure would also be trying to pull the attachment away from your skin, straining the adhesion and increasing the chances of leakage. This is best prevented by initially manipulating the lowest section of the bag to open the flap and start the flow, and then using a gentle downward massaging action to encourage the desired flow of the remainder.
Pancaking
A difficult case, sometimes known as pancaking, is when the bag contents are unusually stiff, bordering on solid and refusing to flow at all. Assuming it is not felt appropriate to change the bag in desperation, and depending how much space is available around your bag, it may be best to insert something rigid behind the bag to make it easier to knead the material in the desired direction. It can be helpful to retain a backer board to match your particular bag type for this purpose. This image shows how to make one, using the stiffest cardboard you can find – perhaps even a suitable semi-rigid plastic.
If you find this works, you may find it preferable to use your backing board at every emptying.
Apply / Remove / Check Procedures
Maintaining healthy skin is often simply about checking you are applying and removing your stoma appliance correctly and with the right frequency. The length of time between changes will vary for each individual and their routine. Exceptional activities may disturb the positioning of the appliance, leading to irritation of skin around the stoma or even to leakage beyond the edge of the plastic.
Unfortunately, hard and fast rules can’t be suggested, at least partly because of the situation with nerves in and around the stoma. Of course we don’t normally feel the passage of food through any part of our digestive system, and this is mostly the case with a stoma too. But occasionally there can be feelings bordering on pains as any lumpy food residue is squeezed through by the peristaltic motion. Perhaps some change in the microbiome due to recent changes in diet has resulted in temporary unusual dryness leading to stiff output instead of a liquid flow. This usually lasts two or three hours and doesn’t usually relate to the need to renew the bag.
Any irritation lasting from one meal to the next requires investigation. Just think for a moment – why doesn’t the digestive system digest itself? The answer is that the internal surfaces are protected against the strong chemicals used in various parts of the tract – chemicals so strong that we’re not allowed to buy them in shops. If fluid gets past our stoma seal it will be chiefly sodium hydroxide, ‘caustic soda’, that attacks our surrounding ordinary unprotected skin, painfully. Those pains are quite similar to the ones mentioned above. And let’s face it, some nerves around there were inevitably damaged during the surgical operations involved originally. So it can be quite difficult to differentiate reliably between the two types of pains.
- If any darkening is visible through the plastic surrounds of the stoma, immediately replace your stoma bag.
- Otherwise, discretion can be used to defer a decision for a couple of hours to see if the condition eases by itself.
Apply
- Make sure the skin is clean and dry as detailed above, before applying.
- The adhesive baseplate must fit snugly around your stoma, with the hole cut to the right shape and size of your stoma – too big or too small could irritate the skin or even cause leakage. (Experiment with supporting products such as rings or seals, or a paste, to achieve a snug fit around your stoma and protect the skin only as a last resort.)
- Stand tall during the actual application, avoiding or minimising any skin wrinkles in the stoma region. Ensure that the hole lines up as exactly as possible with your stoma. Then check that the adhesive makes full contact with the skin by pressing the adhesive section during the application. Allow any clothing waistband to continue that pressure even if you will need to re-align clothing differently at a later time.
Remove
- It is safest always to empty your drainable bag ahead of replacement.
- Having been careful with its application and followed the guidelines for maintaining adhesion, there will still be a high percentage grip between the baseplate and your skin (albeit not 100% if a leakage had developed). My advice is to eliminate all adhesion instantly using an adhesive remover spray. The remover liquid evaporates almost instantly and will have no effect on securing your next appliance:
- Ease the top tab away from the skin slightly.
- Aim a brief squirt of the aerosol spray at that top sector of the base plate.
- As the base plate is released aim further squirts at the sectors remaining until the whole appliance comes away.
- Remove into a disposal bag.
- Use soft toilet paper for an initial cleaning of the stoma and immediate surrounds.
- Proceed with your shower or whatever washing and drying procedures may be appropriate.
Check
- You will probably have inspected the base plate before disposal. Ideally the adhesive area should be clean apart from a minimal circle round the stoma hole. Material or staining over a wider area is linked to skin irritation. Actual leakage is associated with material extending beyond the adhesive area.
- Examine your skin colour and texture, using a hand mirror perhaps. Do not be unduly alarmed by redness on areas where leakage has caused soreness: with habitual use of remover and careful bag replacement the skin will usually return to normal without any specific treatment.
- It is not unknown for some irritation to occur as a result of the processes involved in renewing a bag, but it passes after a time – usually a few minutes.
Emptying
Some patients struggle to find suitable guidance on how to empty ileostomy bags; the assumption must be that every patient is fully instructed in hospital. Certainly their advice should be sought if you do find yourself in need of help.
Note: The procedure described here is best facilitated if any knickers or underpants waistband is habitually located below the fixed part of your bag.
- Kneel beside the toilet with trousers/jeans flies fully open to give access to your bag.
- Seat up; fold two sheets of toilet paper, separately, into four and rest them on the back rim.
- Release two turns of the drain flap; hold any home-made backer board behind the bag; release the final turn of the drain flap.
- Allow whatever will, to drain out; massage the remainder downwards against the backer board, without generating any internal pressure inside the bag.
- Replace the backer board on the shelf or wherever; use one of the prepared papers to bulldoze material off the flap.
- Use the other to clean the back and front of the flap.
- Fold up and secure the drain flap; smooth the empty bag back within your clothing.
We’d like to thank Mike for sharing his experiences, and for so kindly listing out some quite specific procedures for managing a stoma and maintaining good hygiene. We would like to stress that if you have any questions about the above information, please feel free to contact us. In the first instance we urge you to contact your stoma nurse or healthcare practitioner who will be able to help with personalised care.
