Problems you may experience with a Ileostomy
Good skin care is vital to prevent sore skin. Sore skin is a common problem and is often seen but easily treated. There are a number of reasons why this may be happening. This isn’t a complete list, so please contact your Stoma Care Nurse for further guidance if your symptoms persist.
Following surgery you may find that your abdominal shape changes, especially if you gain or lose weight. This means the skin close to your stoma may not sit evenly against your bag, exposing healthy skin and allowing sore skin to occur or leakage to take place. It is therefore important to regularly check your template size and suitability of your bag.
Change in output
A change in output from your stoma could contribute to sore skin. If you experience loose stools, you may find it helpful to temporarily use a drainable bag to prevent frequent bag changes, which can result in sore skin.
Trauma to stoma or skin
Your stoma and the surrounding skin is at risk of damage and so should be well cared for. An incorrectly sized template may rub and cause injury to the side of the stoma, which may include small ulcers. It may be that the shape of the stoma remains the same but the size has altered. Get into the habit of checking your stoma, template and surrounding skin regularly.
Sensitivity to the adhesive on your bag is rare, but can occur even if you’ve been using it for a long time. It may begin as a slight irritation and become progressively worse if left untreated.
This is an inflammation of the hair follicles. It appears like small pimples, occasionally pus-filled, that can be painful and is often seen after shaving the skin around the stoma. As soon as you notice any changes to the skin immediately around your stoma, please contact your Stoma Care Nurse for advice about treatment.
To form the stoma, the bowel will be stitched to the skin. Occasionally, following surgery the stitches and skin can separate. This can sometimes look unpleasant but, like any other wound, it will heal over time. It is important to contact your Stoma Care Nurse who can advise you on treatment to aid healing.
Pancaking is relatively uncommon for individuals with an ileostomy. Pancaking occurs if the internal layers of the bag stick together causing a vacuum which prevents the contents from dropping to the bottom.
Ballooning occurs when your stoma bag blows up with wind. This can cause the bag to come away from the body. If you are using a filter cover, try removing it. If your stoma bag has a filter and you are still experiencing problems, it may be that you are suffering from excess wind. Spicy foods, some vegetables (onions, cabbage, peas, and beans) and fizzy drinks have been known to increase wind, so try to avoid these.
Also avoid drinking with your meal as this can cause you to swallow excess air. Eating regular meals will reduce the build-up of wind.
A hernia is a weakness in the muscle wall. A parastomal hernia canoccur around the stoma and is more common depending on thefollowing risk factors:
- Strenuous or heavy lifting
- Multiple abdominal and/or emergency surgery
A parastomal hernia can vary in size from as small as a golf ball to as large as a football. There are numerous abdominal support garments that are helpful in concealing and supporting the hernia. It is recommended that you wear a light support garment as prevention. However, if you are partaking in strenuous activity, it is necessary to be measured for a more supportive garment. Your Stoma Care Nurse can arrange this for you.
In some people, the parastomal hernia will not cause any discomfort, but others may experience a dragging sensation, discomfort or pain. This will often depend on the size of the hernia and can be eased by wearing a measured support garment.
It is possible to have surgery to repair the hernia depending on the symptoms and effect on quality of life, but this will be assessed on an individual basis by your Surgeon. It should be noted that there may still be a risk of another hernia developing following the repair.
A blockage can be caused by:
- Parastomal hernia
This occurs when the stoma is below skin level. There are various reasons for this:
- Difficulties with stoma formation
- Shape of the abdomen
If you have a retracted stoma, you may need to try a range of bags and additional products to find the most suitable for your stoma. Leakages are more likely, but the use of appropriate products will minimise this. Finding the ideal products may take some time, but your Stoma Care Nurse will be able to offer advice on what is best for you.
The bowel has a very good blood supply, which is why the stoma is pink/red in colour. Whilst cleaning your stoma, a small amount of bleeding on the cloth is to be expected. However, if you see blood inside your bag and/or in your stool you should contact your Stoma Care Nurse or GP.
If you take anticoagulants such as Warfarin or Aspirin this may increase your risk of bleeding. If the bleeding is heavy, persistent or comes from the inside of the stoma you should seek advice from your Stoma Care Nurse or GP.
Sometimes the bowel can extend in length, similar to a telescope effect, and this is called a prolapsed stoma. Despite the prolapse, your colostomy should continue to be a healthy pink/red colour. If this changes and becomes darker it is important that you seek urgent medical advice.
It is important to check your template frequently and it may be necessary to use a larger bag to accommodate the stoma.
Lying down may reduce the size of the prolapse, and may make it easier to apply your bag. In some cases the use of a support belt, applied whilst lying down, can be effective in managing the prolapse.
Your Stoma Care Nurse can advise you on the use of a support garment or belt.
Granulomas are red lumps that can appear on and around the edge of the stoma. They can be tender and may develop at any time. Sometimes rubbing from the wafer or base plate can increase the risk of granulomas occurring. Bleeding can happen and may interfere with the bag adhesion. The template should be checked to ensure a good fit but do not cut the template larger to accommodate the granulomas as this may allow them to grow larger.
Your Stoma Care Nurse may feel it is necessary to treat with a course of silver nitrate or you may be referred for surgical excision, although this is rare.
Ulcers can develop for a variety of reasons that may include medication, type of appliance and as a result of your original diagnosis. They can appear as broken, red, sore areas which may be painful. Ulcers are treatable and your Stoma Care Nurse can advise you following assessment.
Stenosis results in the stoma becoming very small and tight. The output from the stoma will become ribbon-like or even liquid. Following assessment, your Stoma Care Nurse may use a dilator to insert into the stoma and will request you continue to do this at home.
This is extremely rare. Necrosis occurs if the blood supply to the stoma is restricted. Initially the stoma will become a darker red/purple and may even turn black, which is an indication that the blood supply is impaired. It may also feel cold and hard to touch. It is vital that you seek urgent medical attention.