Stoma bags for sensitive skin – recommendations from our nurses

Sensitive skin is a common issue for many individuals, but when you are living with a stoma it can become very confusing to know why it is happening and what to try next. Having sensitive skin around your stoma can become a frustrating and uncomfortable cycle! Often the skin becomes red, broken, sore and tender, which can cause pain and the constant irritation can be really quite distressing. Trying to apply or remove a stoma pouch when your skin is inflamed is a real challenge, but don’t feel alone, reach out and speak to your Stoma Care Nurse for support and advise as there are many ways to calm the skin down to help you feel more comfortable.

What causes sensitive peristomal skin?

Red, sore and irritated skin around your stoma can be from several sources. The most common cause can be from the stool or urine itself having direct contact with the peristomal skin. Stool from a colostomy can cause soreness to the healthy skin, yet from an ileostomy it can be quite corrosive and can cause damage to the skin in a short period of time. Urine is both liquid and acidic and can cause seepage into the flange before it then leaks, both of which can cause itching and redness very quickly. Often ostomates can feel a prickly itching sensation to the skin around the stoma before the skin starts to become damaged and irritated. If the irritation is unresolved is can cause the skin to bleed which is alarming.

Symptoms of sensitive skin:

• Eczema
• Hives
• Patches of redness
• Rashes which may itch, sting or burn
• Itching stinging or burning without a visible rash

What can I do if my skin is sensitive?

If the skin is exposed to stool/ urine it is worth checking the aperture (size) of the opening of the flange/baseplate of the appliance. If there is a lot of skin around the stoma exposed, the flange will need to be re-sized, so it fits correctly. Also check for any folds, creases, or dips in the skin around the stoma, where the stool or urine can seep through and meet your skin. You may even need a convexity product to prevent leakage and skin exposure. Your Stoma Care Nurse will be happy to help you, to assess your skin and help choose a more appropriate pouch and introduce convexity if needed.

Other options are to use stoma accessories such as slims or seals which will provide protection to the skin directly around your stoma, beneath your pouch.  There are plenty of skin barrier creams and powders which also can be lightly sprinkled onto the sore skin and are compatible with using a stoma pouch. Stoma pastes can also be used as a barrier, and some also help to soothe sore skin. Just be careful that you are not using a stoma paste containing alcohol if your skin is already sore as this can make things worse!

Make sure you have a good adhesive remover spray to help remove your stoma pouch. This can help avoid what is called “skin stripping” which is the result of the pouch being pulled off the skin, causing irritation and soreness.

Sensitivity and irritation can also signify a reaction to one or more of the products you are using. You may have a sensitivity to an ingredient or even have an allergy to the product. With an allergy you tend to find there is a defined border of inflammation, which mimics the borders of the product. You may even notice blistering if it is indeed a skin allergy. Stopping each product and monitoring the outcome can help identify which product is the offending item. In some cases, your stoma care nurse may suggest a tape impregnated with a steroid treatment is used. This is applied directly to the skin beneath the flange to try and calm the inflamed skin. If the allergy persists and causes an obvious reaction, you may be referred to the Dermatology Outpatient clinics for patch testing, which will identify the ingredients you are reacting to. Your Stoma Care Nurse can help identify which stoma products are then safe to use.

Sore and irritated skin can also be caused by a yeast infection. Yeast infections love a dark, warm, and moist place to live, so underneath a stoma flange provides the perfect conditions! The skin tends to be bright red in the initial stages of a yeast infection, which then calms down. It has an irregular borders or edges and will likely have several smaller pink dots on the skin away from the main part of the redness/infection. There are often moist, white spots and it is always very itchy! Once a fungal infection has been identified by your Stoma Nurse or GP, it can be easily treated with anti-fungal treatments beneath the flange for a couple of weeks.

Which pouch should I use for my sensitive peristomal skin?

There are a lot of different stoma pouches out there, so it is hard to know which will help you if your skin is sensitive. Most of the flanges are made of hydrocolloid ingredients which are usually skin friendly, but if you find this is causing the issue it may be worth trying another pouch made of very different ingredients, such as the alginate pouch which is extremely gentle for those with allergies.

Alginates are incredibly soothing for all types of damaged skin including wounds. Found in many species of seaweed, it is the alginate extracted from brown seaweed that are proven to help heal sore skin. Alginates have been used effectively in wound healing for many years. Oakmed’s alginate product also contains Vitamin E proven to promote skin integrity and absorb moisture

“As a stoma Care Nurse the one stoma pouch I tend to reach for time and time again is the alginate based pouch. I find the patient feels immediate relief from skin irritation and I’ve had some amazing results healing sore and irritated skin. The alginate pouch can also be used on sensitive and vulnerable skin, perfect for those starting treatments such as chemotherapy. Although the flange feels thicker, I explain to my patients that this is so it can be highly absorbent, taking the effluent away from their skin”.

There are many other pouches, those with a thinner flange such as Microskin or Bioform which are more breathable and moisture vapour permeable for a healthier skin. Due to the thin and flexible design of the flange, it moulds easily to the skins creases and folds.

“Perfect for those who find the standard stoma pouch lifts or doesn’t adhere well to areas which have dips or bulges around the peristomal area, this microskin and bioform usually gains a really good seal due to its flexibility. The bonus is the skin can breathe which really help sensitive skin. Patients love it as it is SO discreet!”

Other pouches are available which contain Aloe Vera or Manuka Honey, which are both soothing for sensitive and sore skin.

“Involving my patients in the decision making stage of product choice is so important, especially when their skin is sensitive or sore. Discussing the options available such as trialling a flange infused with aloe vera or manuka honey to soothe sore skin can really help empower my patient.

Tips to help soothe sensitive and irritated skin:

• Take shorter shower and baths of less than 10 minutes as the hot water can dry the skin and cause additional irritation and itching
• Try to avoid hot temperatures in the bath or shower
• Avoid using any fragranced soaps or shower gels
• Also avoid using baby wipes as they contain oils and fragrance, and stop your stoma pouch from adhering effectively
• Pat the skin dry gently after washing, rather than rubbing at the skin
• Always patch test a new product for 24hours before using on a larger area such as around your stoma. This can be done by applying the new product to the inner side of your arm for 24 hours to monitor any reactions.