Sore stoma and hard swelling

HI and can I welcome you to forum and I am sorry to hear that your are having problems.

Is it the actual stoma that is sore or is it the skin where it meets the stoma if this is the case it could be that you're cutting the hole in the flange too small and it's cutting in or strangling the stoma. Are you still checking the hole size and cutting the hole slightly larger, using a seal between the skin and the pouch can help to stop the flange from cutting into it. NOTE cutting too large will also give your problems with leaks.

Is your surrounding skin flat or do you have a parastomal hernia forming.

The hard and swollen skin above your stoma could be caused by something you are using at a pouch change or just simply over zealous cleaning. The area should be gently cleaned using a non sterile wipe and warm water and thoroughly dried. I'm assuming you've not changed your type of pouch recently however if you've not it could be that the adhesive is irritating the skin. Do you use a barrier film between your skin and the pouch flange as this will protect your skin. Is your skin damaged or broken. 

You could also try a pea size spot of a zinc cream if you have some and rub it into the skin gently, not your stoma, but before you attach the new pouch wipe any excess off and making sure the skin is dry before attaching the pouch otherwise it will not adhere.

If it is possible and your stoma is not active you could try leaving the pouch off for a little while and let the air get to the skin, this may not be possible if you have an ileostomy but if you can give it a try.

How often do your change your pouch as leaving it on too long can damage the skin. It's a cruel world as too many changes can also damage the skin.

Are you experiencing any leaks.

If there is any further information you can give me please let me know.

I'm pleased you've got an appointment at the stoma clinic on Tuesday as 4 months when you've only had your stoma for 5 months is too long.

Are you in France or the UK.

PLEASE REMEMBER to take with you everything you use when you do a change and I would suggest at least three uncut pouches to be on the safe side.

If I can be of any further help would you please let me know.

Can I ask you to let me know after your appointment what the stoma care nurse thought was causing the problem and what suggestions she made to you to rectify them.

Ian

Apologies for the delay in answering this was due to site problems which hopefully will soon be resolved.

Hi Ian and thank you very much for your detailed and prompt response.  

The stoma itself looks fine, pink and functioning ok. It is a stinging sensation rather than it being sore now I think about it and is at the edge where the stoma meets the skin - a tiny nick where it has been stitched. The area around it is clean and doesn’t look infected at all. 

There is a chance that the hole in my pouch needs adjusting - they are automatically cut upon receipt of my order (Charter) - but it looks and feels ok to be honest.

The stoma nurse should help with these issues but I am very concerned and scared about the possibility of a hernia forming and how it can be treated. I have a hard swelling that has formed immediately above and slightly to the right of the stoma, not all the way round.

In general, I change my pouch on average twice a day, maximum 3 times occasionally. I use a convex pouch and don’t experience any leaks. I am in the UK now.

Another question I have if you don't mind - I sometimes find myself wanting to poo in the 'normal' way which scared me at first and I tried to resist as it didn't feel right. However, I couldn't hold off any longer and 2 or 3 times now I have passed a small stool through my rectum. I guess it's better out than in!

I will definitely let you know how I get on on Tuesday. Thanks again.

Julie

Julie

Hi Julie I have just posted a question about passing stools with an ileostomy! So this is a thing?! I'm also terribly scared it feels normal but also weird. What were your circumstances? I was never told this could be an issue when I was discharged it's very bewildering!

Hi Julie

Apoligies in advance, this is lengthy!

Thanks for coming back to me, as everyone on this forum will tell you I'm not a fan of precut pouches maybe it just me and I prefer to cut my own but for many ostomates it's a god send, your stoma nurse will advise if they need to be adjusted for the future.

I have heard of instances where the pouches have been cut wrong by the supplier - TRY using pouches from a new box or batch if you have some.

Your stoma sounds as if it is okay colour perfect and is getting a blood flow.

Rectal discharge

If you've had a colostomy but your rectum and anus are intact, you may have some mucus discharge from your bottom. Mucus is produced by the lining of the bowel to help the passage of stools.

The lining of the bowel continues producing mucus, even though it no longer serves any purpose. The longer the remaining section of your bowel, the more likely you are to have rectal discharge.

The mucus can vary, from a clear "egg white" to a sticky, glue-like consistency. It can either leak out of your bottom or build up into a ball, which can become uncomfortable.

Some people have rectal discharge every few weeks, while others have several episodes a day.

Contact your GP if there's blood or pus in the discharge – it may be a sign of infection or tissue damage.

Managing the discharge
You may find it helps if you sit on the toilet every day and push down as if passing a stool. This should remove any mucus and stop it building into a ball.

But some people find this difficult because surgery can reduce the sensation in the rectum. Contact your GP if this is the case, as you may need further treatment.

Glycerine suppositories that you insert into your bottom can often help. When the capsules dissolve, they make the mucus more watery, so it's easier to get rid of.

The mucus can sometimes irritate the skin around your bottom. Using a barrier skin cream should help. You may need to try a few before you find one that works for you. Ask your pharmacist for advice.

Some people find that eating certain foods increases mucus production. While there's no scientific evidence to support this, you may want to try keeping a food diary for a few weeks to see whether certain foods could be linked to an increase in mucus production.

I have an Ileostomy and about 3 years after it was formed one Saturday I had the feeling that I needed to go to the toilet and I experienced really bad diarrhea from my back passage and this lasted until the following evening then stopped, fortunately I was able to contact my stoma care nurse on the Saturday who told me it was quite normal and not to worry! Nothing since.

Parastomal hernia

A parastomal hernia is where the intestines push through the muscles around the stoma, resulting in a noticeable bulge under the skin.

To reduce your risk of getting a parastomal hernia:

wear a support garment (belt or underwear)
avoid heavy lifting and straining
maintain a healthy weight – being overweight can place additional strain on your abdominal muscles
A parastomal hernia isn't usually painful, but it may be more difficult to hold the colostomy appliance in place and change it.

Most hernias can be managed with the help and support of your stoma nurse. In some cases, surgery may be needed to repair the hernia. But the hernia can come back, even after surgery.

Once you've been checked over by the stoma nurse let me know what she says and if necessary we can start to talk about support garments and I'm pleased to say that the range that is available for ladies is quite large and most are available on NHS prescription.

Pouches 

Have you thought about a 2 piece pouch as you've got a colostomy it could save removing the flange/wafer from your body at every change you just replace the pouch and possibly change the flange approx every 3 days and improve your skin problem.

I hope this lengthy response makes sense and helps but please do come back to me at any time, I'm always pleased to help.

Ian

Hi Magsarama

I wasn’t warned this could happen either but I had my emergency surgery in France on holiday so didn’t get a lot of information on discharge. It was enough just to wake up with the bag and learn how to manage that!

however once I finally opened up my bowels and didn’t resist any longer it was ok. Small grey looking stool and mucus just as Boden described. Then nothing for a few weeks then same again. It’s not uncomfortable so far, just bewildering as you say.

ill speak to my stoma nurse tomorrow at my appointment and share any further information that may be useful on here.

best wishes to you and let’s keep in touch

julie

Hi Ian,

Here’s an update from my visit to the stoma clinic this week as promised:

The nurse believes the stinging is possibly due to my pouches being cut to the wrong size and causing irritation. The hole should currently be cut to 25mm whereas mine are 30mm - big difference. And I have just received a prescription of 90 pouches at 30mm!

Anyway that said the skin and stoma are in good nick, no sign of infection just need to resize pouch as above.

She couldn’t confirm whether the hard swelling is a hernia but has made arrangements for a home visit by a representative from CUI WEAR to have a look and if necessary discuss support garments.

Just as an aside, I wasn’t aware until you pointed it out that we are entitled to a certain number of garments on the NHS so will be taking advantage of that now that I know about it.

The nurse will call me to follow up in 2 weeks time so I feel better now that I will receive regular checks going forward.

I did forget to mention the urge to pooh every now and again!

Hope this is useful and thanks again for your help.

Julie

Hi Julie

I'm so pleased you had a good appointment with the stoma care nurse and even more relieved to find that my thoughts about wrong size hole was correct, always a worry for me that I give out the wrong information.

Unfortunately you can't send the cut pouches back but I would suggest you hang onto them just in case. I don't know if Jacobs Well charity would be interested in them perhaps in a few months we can discuss this as a possibility. 

SUPPORT GARMENTS

Please have a look at this, it's a list of companies who supply support garments

Support Garments

You will be pleased to know that you can also get support underwear and there is quite a good range for ladies, when you look at the link above open up the web page for Comfizz and I think you'll be surprised exactly what's available and on prescription.

You will be told that you can get so many items per year on prescription this is a guideline figure and your GP can prescribe you more..

Nearer the better weather we can discuss where you can obtain beach/swim wear all suitable for ostomates even a 2 piece can be worn with some nice wraps and you can purchase or make pouch covers to disguise your bag. All of which I can supply you information.

It's good that you're now going to get regular check ups and I would keeping a hold of the contact number for future reference but I am always available to help at any time and especially at week ends.

If you need more details of rectal discharge please let me know and I will let you have details on why and what to do when it happens.

Please keep in touch.

Ian

This thread is being marked for retention by the moderator, as some members are still finding this useful.