Peristomal Skin Health: Keeping the Skin Around Your Stoma Healthy

However long you've had an ostomy, the skin around your stoma — your peristomal skin — deserves just as much attention as the stoma itself. A good pouching system is designed to protect that skin from stool or urine, but leaks, irritation, and everyday wear and tear can still take a toll over time. Based on the Wound, Ostomy, and Continence Nurses Society's Basic Ostomy Skin Care guide, here's what healthy skin should look like, what commonly causes problems, and how to keep your skin in good shape.

This article is for general information only and isn't a substitute for advice from your surgeon, ostomy nurse, or other member of your health care team. Your own care plan should always come from them.

What Healthy Peristomal Skin Looks Like

The skin around your ostomy should look essentially the same as the skin anywhere else on your abdomen. It shouldn't hurt, itch, or appear red or darker than the rest of your skin. The main job of your pouching system is to protect this skin from contact with stool or urine while containing output and giving you good wear time — extra products should only be added when needed to keep the skin healthy or prevent leaks.

It's normal for the skin to look a little more pink, red, or darker than usual right after you remove a pouching system — this should fade within a few minutes. What's worth paying attention to is skin that stays irritated, or that shows new redness, darkness, rashes, or open areas each time you change your system.

What Commonly Causes Skin Problems

Most peristomal skin irritation comes down to a handful of everyday culprits:

• Stool or urine reaching the skin, usually from a leak or a skin barrier that no longer fits the shape of your stoma well.
• Products not suited to your skin, such as soaps with oils, alcohol-based products, or harsh chemicals used to clean around the stoma — all of which can cause soreness or stop a pouching system from sticking.
• Baby wipes, which aren't made for use around a stoma and can irritate the skin or interfere with adhesion. Only wipes made specifically for peristomal skin should be used.
• Body hair, which can keep a pouching system from sticking properly or cause pain when it's removed.

Tell your ostomy nurse or health care worker if you know your skin is sensitive to tape or adhesives, so they can help you choose products less likely to cause a reaction.

Everyday Habits That Protect Your Skin

A few simple habits during each pouching system change go a long way toward keeping your skin healthy:

• Remove the old system gently, pushing down on the skin while pulling back on the barrier, working from the top down and going slowly in the direction hair grows.
• Use warm water, or an adhesive remover if needed, rather than pulling the barrier off dry. If you use an oil-based adhesive remover, be sure to wash any residue off with non-oily soap and water afterward.
• Clean with warm water and a soft cloth or paper towel, then pat dry — the skin around a stoma doesn't need to be cleaned as thoroughly as the stoma itself, and a little blood when wiping the stoma is normal.
• Dry the skin fully before applying a new pouching system, and clip any body hair with an electric razor or clippers (in the direction it grows) rather than shaving.
• Check your skin at each change, using a mirror if needed, and look for any areas where stool or urine may have leaked under the system.
• Hold the skin smooth as you apply the new system to avoid wrinkles, and apply gentle, even pressure afterward to help the barrier adhere. Standing (or sitting, if your belly is flatter that way) can make this easier.

Accessories That Can Help

If you're getting a consistent seal and your skin looks healthy, you may not need anything beyond your pouching system. But a few accessories can help improve wear time, protect irritated skin, or fill in uneven areas around the stoma:

• Skin barrier rings are moldable rings that can be stretched, cut, or shaped to improve the seal and fill uneven areas around the stoma.
• Skin barrier paste works similarly to fill small uneven areas or caulk the inner edge of the barrier — it's not an adhesive or glue on its own, and it's not commonly used with urostomies.
• Skin barrier powder helps heal open or irritated skin and absorbs excess moisture. It's applied directly to the irritated area (brushing off any excess), and can be sealed in with a barrier film for a dry surface.
• Skin barrier film or sealant provides a thin protective layer to reduce skin damage when the pouching system is removed. Look for an alcohol-free (no-sting) option if you're applying it to broken skin.
• An ostomy belt or support garment attaches to the pouching system to help hold it in place — it should fit snugly but never tightly enough to cause trauma to the skin.
• Adhesive remover helps gently release the pouching system from the skin at each change, which can reduce the tugging and tearing that leads to irritation over time.

Your own needs may change over time, so it's worth revisiting which products work best for you periodically with your ostomy nurse or health care worker, rather than sticking with whatever you started with after surgery.

Managing Sweat and Moisture

Heat, activity, or humid weather can make it harder for a pouching system to stay sealed. If sweat is affecting your wear time, dusting the skin with ostomy powder to absorb moisture, then dabbing with a barrier wipe before applying the pouching system, can help improve adhesion.

When to Contact Your Health Care Team

Most peristomal skin issues are manageable once caught early, but reach out to your ostomy nurse or health care worker if you notice:

• Skin that's red, sore, or itchy and doesn't settle down
• You're suddenly changing your pouching system more often than usual
• Signs of leakage under the skin barrier, or odor between scheduled changes
• Open skin, rashes, or discoloration that doesn't fade

If you don't have an ostomy nurse you can reach easily, CanMedDirect's Clinical Support page, developed in partnership with NurseCraft, can help connect you with one.

Reminder: this article provides general information and is not a substitute for professional medical advice. Please consult your surgeon, ostomy nurse, or health care worker to determine what's appropriate for your specific situation.