Caring for your skin

Caring for your skin is an essential part of looking after your stoma. Immediately after your surgery, your stoma and surrounding skin may look swollen and even a little irritated.

This is all to be expected post operatively and with good care it should improve in appearance over time.

You may find that your product requirements may alter due to the changes in your stoma size and shape. Your stoma template will alter and should be checked at least weekly for the first 8 weeks, or particularly if lots of healthy skin can be seen through the hole.

The area of skin around your stoma needs ongoing care and attention to prevent and reduce the risk of soreness.

If you start to develop sore, irritated or broken skin, do not delay in contacting your Stoma Care Nurse for appropriate advice on treatment and the need for alternative products.

Signs of peristomal skin problems

While some redness or mild irritation in the first days after surgery is normal, certain signs may indicate a skin problem that needs attention. If this is the case, don't hesitate to contact your Stoma Care Nurse.

Symptoms to look out for include:

Persistent itching

Itching under or around your bag is very common and does not always mean something is wrong. The skin under a wafer is covered for days at a time, so it tends to be warmer than the skin around it, and that alone can make it itch. The most common causes are:

• Healing skin in the weeks after surgery or after a patch of soreness has cleared.
• Sweat or moisture trapped under the wafer after warm weather, exercise or a hot bath.
• Hair regrowth catching under the adhesive.
• Output from a leak starting to reach the skin
• A reaction to the stoma bag itself, or to another adhesive or product such as a wipe, spray or paste.
• Dry skin

Itchy skin that lasts more than a day or two, spreads, or comes with redness, a rash or leaks is a sign to look more closely at the skin.

Redness or irritation

Redness and irritation that persists, spreads or follows a clear shape is the skin telling you something is in contact with it that should not be.

For example, if the redness that follows the outline of the wafer may be the result of a reaction to the stoma bag, a wipe, spray or paste you’ve used. Or, if the redness is where the edge of the wafer, a belt or a convex bag presses on your skin, this is likely to be pressure or friction damage.

One of the most common causes of irritation is a leaking stoma bag. When output from your stoma comes into contact with the surrounding skin, even briefly, it can cause significant irritation. Stoma output contain enzymes and acids that quickly break down the skin’s natural barrier, leading to soreness, redness and, if left unaddressed, skin breakdown.

Inflammation

Inflamed skin is red, warm, swollen and often painful, and it can have a rash or spots. Around a stoma the usual causes are:

• Folliculitis - small red or pus-filled spots where hairs have been pulled or shaved, caused by inflamed hair follicles.
• Fungal infection - a moist, red, itchy rash with small satellite spots at its edges, most often where sweat or leaks have been trapped under the wafer.
• Allergic reaction - itching, redness and sometimes small blisters across the whole area a product touches.

Inflammation will not clear up on its own if the cause is an infection, so do not wait for it to settle. Your Stoma Care Nurse can identify what is happening and arrange the right treatment.

Soreness or broken skin

Sore skin means the skin’s surface has broken down. This often follows redness that has not been addressed, most commonly because output continues to come into contact with the skin. It can also be caused by:

• Leakage under the baseplate
• An ill-fitting appliance
• An allergic reaction to an adhesive product
• A skin condition such as folliculitis (inflammation of the hair follicles).

Your Stoma Care Nurse can help determine the cause and recommend the right course of action.

Once the skin becomes sore, the bag may struggle to stick securely, leading to further leaks and more skin damage. Breaking this cycle early is important. 

Preventing itchy, red and sore skin around your stoma

There are multiple ways to prevent itching, redness and soreness around a stoma including:

• Check your template regularly

A hole that is even slightly too large lets output sit on the skin, which is the single biggest cause of redness and soreness. Recheck it weekly for the first 8 weeks and whenever your weight or stoma changes.

• Keep the skin dry under the wafer

Pat the area dry thoroughly before applying your new appliance, as moisture under the baseplate is a common cause of skin breakdown. Consider a barrier film if you sweat a lot, exercise regularly or find the skin itches in warm weather.

• Be careful when changing stoma bag

Use an adhesive remover spray or wipe to help release the seal, and always support the skin with your other hand as you peel. Pulling the bag away too quickly or without support can damage the surface of the skin. When cleaning the skin, use plain warm water and a soft cloth or wipe. Avoid soaps, baby wipes or products containing moisturisers, oils or alcohol.

• Make sure the bag is fitted correctly

If the stoma bag is not fitting correctly, leaks can occur. This can be because the aperture is too large, if the baseplate has lifted at the edges, or if the bag has been left in place for too long. Your Stoma Care Nurse can review your fit and offer advice on how to wear your stoma bag.

• Good nourishment and hydration

Skin repairs itself from the inside, so a balanced diet with enough protein, and plenty of fluids, gives it the building blocks it needs to stay supple and heal quickly.

• Consider stopping smoking

Smoking affects how nutrients and oxygen might get to your skin and so results in a drier, dull skin that is at more risk of breakdown.

• Exercise

Regular exercise increases your body’s metabolism and encourages oxygen to reach your skin cells quicker and in greater supply.

• Remove any hair from the skin around your stoma

Adhesive can pull at the hair shafts causing inflammation and trauma to the skin, so removing hair from around your stoma is important. Do not use hair removal cream.

Treating itchy, red and sore skin around your stoma

Itching, redness and soreness are usually stages of the same problem, so treating them early stops mild irritation becoming broken skin.

While the skin is healing, some general principles can help:

• Change your bag more frequently to limit the time output is in contact with the skin.
• Clean the skin gently with plain warm water and allow it to dry completely before applying a new bag.
• Review your stoma template to ensure the aperture is not too large, which can expose healthy skin to output.
• Use a barrier product as advised by your Stoma Care Nurse to protect healing skin.
• If your skin is not improving within a few days, or if it is worsening, contact your Stoma Care Nurse promptly.

Products that protect and soothe the skin around your stoma

It is important to note that standard skin creams and moisturisers are generally not suitable for use on peristomal skin, as they can leave a residue that prevents your stoma bag from adhering properly. Always seek guidance from your Stoma Care Nurse before applying any product to the skin around your stoma.

Products that are commonly recommended for irritated peristomal skin include:

• Barrier film wipes - these create a thin protective layer on the skin surface that helps prevent output from causing further damage, while still allowing the adhesive to bond effectively.
• Aloe rings - soft, mouldable rings that sit around the stoma base to fill in any uneven contours and prevent leakage from reaching the skin.
• Remover spray - releases the adhesive so the wafer lifts away without pulling at sore or fragile skin.
• Medicated treatments - in some cases, your Stoma Care Nurse may recommend a prescribed antifungal or steroid preparation if there is evidence of infection or inflammation. These should only be used under clinical guidance.

For a full range of skin care products suitable for use with a stoma, visit our additional products page, or speak to your Stoma Care Nurse for personalised advice.