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Ileostomy - caring for your stoma

Description

You had an injury or disease in your digestive system and needed an operation called an ileostomy. The operation changes the way your body gets rid of waste (stool, feces, or poop).

Now you have an opening called a stoma in your belly. Waste will pass through the stoma into a pouch that collects it. You will need to take care of your stoma and empty the pouch many times a day.

Alternative names

Standard ileostomy - stoma care; Brooke ileostomy - stoma care; Continent ileostomy - stoma care; Abdominal pouch - stoma care; End ileostomy - stoma care; Ostomy - stoma care

About your stoma

  • Your stoma is the lining of your intestine.
  • It will be pink or red, moist, and a little shiny.
  • Stomas are usually round or oval.
  • A stoma is very delicate.
  • Most stomas stick out a little over the skin, but some are flat.
  • Your may see a little mucous. Your stoma may bleed a little when you clean it.
  • The skin around your stoma should be dry.

The feces that come out of the stoma can be very irritating to the skin. So it is important to take special care of the stoma to avoid damage to the skin.

Stoma care

After surgery, the stoma will be swollen. It will shrink over the next several weeks.

The skin around your stoma should look like it did before surgery. The best way to protect your skin is by:

  • Using a bag or pouch with the correct size opening, so waste does not leak
  • Taking good care of the skin around your stoma

Stoma appliances are either 2-piece or 1-piece sets. A 2-piece set consists of a baseplate (or wafer) and pouch. A baseplate is the part that sticks to the skin and protects it against irritation from feces. The second piece is the pouch that feces empties into. The pouch attaches to the baseplate, similar to a Tupperware cover. In a 1-piece set, the baseplate and appliance is all one piece. The baseplate usually needs to be changed only once or twice a week.

To care for your skin:

  • Wash your skin with warm water and dry it well before you attach the pouch.
  • Avoid skin care products that contain alcohol. These can make your skin too dry.
  • Do not use products that contain oil on the skin around your stoma. Doing so can make it hard to attach the pouch to your skin.
  • Use fewer, special skin care products to make skin problems less likely.

If you have hair on the skin around your stoma, your pouch may not stick. Removing the hair may help.

  • Ask your ostomy nurse about the best way to shave the area.
  • If you use a safety razor and soap or shaving cream, be sure to rinse your skin well after you shave the area.
  • You can also use trimming scissors, electric shaver, or have laser treatment to remove the hair.
  • Do not use a straight edge.
  • Be careful to protect your stoma if you remove the hair around it.

Carefully look at your stoma and the skin around it every time you change your pouch or barrier. If the skin around your stoma is red or wet, your pouch may not be sealed well on your stoma.

Sometimes the adhesive, skin barrier, paste, tape, or pouch may damage the skin. This may happen when you first start using a stoma, or it may happen after you have been using it for months, or even years.

If this happens:

  • Ask your doctor about medicine to treat your skin.
  • Call your doctor if it is does not get better when you treat it.

If your stoma is leaking, your skin will get sore.

Be sure to treat any skin redness or skin changes right away, when the problem is still small. Do not allow the sore area to become larger or more irritated before asking your doctor about it.

If your stoma becomes longer than usual (sticks out from the skin more), try a cold compress, like ice wrapped in a towel, to make it go in.

You should never stick anything into your stoma, unless your doctor tells you to.

When to call the doctor

Call your doctor or nurse if:

  • Your stoma is swollen and is more than a half inch larger than normal.
  • Your stoma is pulling in, below the skin level.
  • Your stoma is bleeding more than normal.
  • Your stoma has turned purple, black, or white.
  • Your stoma is leaking often or draining fluid.
  • Your stoma does not seem to fit as well as it did before.
  • You have to change the appliance once every day or two.
  • You have a discharge from the stoma that smells bad.
  • You have any signs of being dehydrated (there is not enough water in your body). Some signs are dry mouth, urinating less often, and feeling lightheaded or weak.
  • You have diarrhea that is not going away.

Call your doctor if the skin around your stoma:

  • Pulls back
  • Is red or raw
  • Has a rash
  • Is dry
  • Hurts or burns
  • Swells or pushes out
  • Bleeds
  • Itches
  • Has white, gray, brown, or dark red bumps on it
  • Has bumps around a hair follicle that are filled with pus
  • Has sores with uneven edges

Also call if you:

  • Have less waste than usual in your pouch
  • Have a fever
  • Experience any pain
  • Have any questions or concerns about your stoma or skin

References

Burch J. Caring for peristomal skin: what every nurse should know. Br J Nurs. 2010;19(3):166, 168, 170.

Cima RR. Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M. Friedman LS, Brandt LJ. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Saunders Elsevier; 2010:chap 113.

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 52.


Review Date: 6/1/2014
Reviewed By: Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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