Red sore rash around stoma when I removed the bag

Hi Jenifer

I'm very sorry that you've had to join us but you're very welcome to the online community and of course stoma support.

I'm also sorry to see that you have some concerns about your peristomal skin being red.

From the information you have given me I would say at this stage it is nothing to worry about, however we do need to try and establish what is causing it and if you don't mind I would like to ask you some questions.

If you could let me know the following it will help me find a solution quickly.

• I assume that you didn't have the problems in the hospital.
• Since you left the hospital have you been experiencing any leaks.
• Have you changed any of your stoma accessories including the pouch since you left the hospital.
• Would you mind telling me the manufacturer and product number of your pouch.
• How do to get the old pouch off you skin (Do you gently ease it off or do you use an adhesive remover)
• Do you have a rash or broken skin?
• Do you have a burning sensation or an itch or just redness? 
• Do you have an Ileostomy or a colostomy.

If you could let me know that would be great.

Honestly at this stage there is nothing to worry about but in the meantime carry on doing your usual change procedure, washing the peristomal, surrounding, skin with warm water using a soft cloth, pat the skin dry thoroughly. If you can, if your stoma is not active, try and leave it uncovered for as long as you can and let the air get to the skin. Don't worry if you see some moisture, mucus, appear this is perfectly normal.

When ready apply your pouch as you've shown making sure that you don't have any creases in the wafer.

Come back to me when you're ready and together we'll solve this small problem.

Ian

C C.

Hello, thank you for getting back to me so quickly.

 In answer to your questions, I did not have any problems in the hospital. I have experienced two leaks, one because the bag filled up too much overnight and the second was because I didn't change the first one that leaked, thought I would be clever!

I haven't changed any of the stoma accessories.

the label on the box says Coloplast sensual mia 10421 ostomy bag.

when changing my bag I use the adhesive remover spray.

when I removed the bag yesterday I just noticed how red it was as this is really unusual for me, I didn't see any broken skin but my husband said it looked like a nappy rash. There was no burning sensation or itch that I can remember.

i had an ilestomy, the operation was 30th January this year.

When I change the bag tomorrow I will be sure to follow all the procedures and put some cream on the redness.

let me know if you need any more information 

On the contrary thank you for coming back and answering my questions.

Your husband is almost on the money when he said it looked like nappy rash and we know what causes that, poo coming into contact with the skin and the enzymes attacking the skin causing redness and leading to a breakdown on the skin, and you've had two episodes of leakages and this is what we have to concentrate on at the moment.

I think you've learned a valuable lesson you can't ignore or repair a pouch that is showing signs of leakage, changing is the only option, home or away. Do you have an emergency away from the home change bag that you take everytime you leave the house?

Overfilling during the night is a cross we all have to bear, but we can put practices into force to combat this.

Don't have a meal in the evening after 5 or 6 pm this will give your output a chance to pass into your bag before you go to sleep.

After more years than I care to remember I still set my alarm clock for 2 am so I can check the capacity and any tell tale signs.

For the meantime be careful of any creams that you are thinking about  using and only use a small pea size spot and rub it in well, then ensure that you remove any excess from your skin. The wafer adhesive will not adhere to your skin if it's still greasy and could cause creases etc. Result a leak, your output will follow any weakness in the wafer in its attempt to escape.

For my sins I swear by Independence Fusion Integrated barrier film and adhesive enhancer (click on green  to open up new page).

These apply an invisible film barrier between the skin and the wafer to protect the skin around the peristomal skin even after a leakage whilst making the skin extra tacky awaiting attaching the pouch.

It might be worth tomorrow checking the size of the hole you are cutting, slight changes in any direction can become apparent at any time.

When using adhesive remover, use sparingly and ensure that it is all removed when you wash around the skin.

There may be one other reason for the redness, you are allergic to the wafer adhesive but with the pouch you are using I think we can discount that for a minute.

Remember stretching or bending can put pressure on your pouch and cause it to rise off the skin, take it easy as much as possible.

I hope the above helps, let me know if it does, if you are still having problems let me know and we can address it further in greater depth.

Always here when you need me, don't hesitate to contact me if you have any problems that are worrying you, or if your husband needs to ask me a question (No question is out of bounds in this group).

Speak soon

Ian

CC

WHAT IS AN EMERGENCY AWAY FROM HOME BAG?

This is a grab bag that you take with you EVERYTIME you leave home.

It can have as much or as little in it as you think will need.

Minimum

2 spare pouches cut to size, adhesive remover sachets, barrier film sachets, hand sanitiser (some supply companies give you some with your monthly order, or you can get hand cleansers on prescription) disposable bags, dry wipes, wet wipes but not for washing around your stoma, wafer extenders, small bottle of water,. RADAR NKS genuine key, No wait toilet card, mirror.

Optional but could be essential

Change of lower clothing as you think you might need, Tip look at wear once pants (although they can be washed and reused!) Not essential but handy toilet seat disposable protective seat cover for use in public toilets.

The bag is your comforter when out.

You can without fear of criticism use disabled toilets in supermarkets and when the current conditions improve in cafes, restaurants, bars and public venues.

I had an emergency Ileostomy stoma on 10th February this year and for my first week I had lots of redness and soreness. It turns out my stoma was abit withdrawn and the bags I was using were flat bags meaning alot of the poo was going under the bag and not really into it. I had lots of leakage that first week and lost count the number of times I changed the bag. After a visit to the stoma nurse I changed to convex bags with a plastic circle which kind of presses on my stomach forcing the stoma out I also have an attached belt which also helps greatly. Since that day I have not had a single leakage and sorted the redness out with the bags and sum powder. The bags now use are Hollister 5683051 and I have these from coloplast. I hope this helps in some way.

Stay safe

Mark

Hi Jeni

Further to the response from Mark,  I did not go along the convex route at this time as you've just left hospital and no doubt the stoma care nurses visited you everyday to examine your stoma, it's health, size, skin condition and how you were managing and decided that the best pouch for you was the flat wafer Coloplast Sensura Mio, although different nurses around the country have their own personal choices that helps them with their decision.

To decide if a flat or convex wafer is required needs a detailed examination, something I'm not qualified to do although if I received a lot of information I could make the suggestion to speak to the stoma care nurse about making the change, the nurse would examine the stoma and surrounding skin and be looking at these points

Flat (For stomas that protrude evenly from the skin)
Soft (For stomas with an opening above skin level that need gentle support)
Light (For stomas with an opening level with the skin that need moderate help to protrude)
Deep (For stomas with an opening below skin level that need a lot of help to protrude).

Once it has been decided whether you should use flat or convex it is then up to you to decide on the manufacturer and make of the pouch that you want to use and it can be fun trying out all the different types, my list of pouch manufacturers contact details is available when you think you need a change.

When you experience a leak if possible gently clean the poo off the pouch and find the point of the leakage and check your hole measurement a few mm's can make a difference either way.

Another solution is to add a seal between your skin and the wafer, with these seals you mould it round the base of your stoma to create, as the name implies, a close seal which could help eliminate leaks and offer some skin protection at the same time and for you I would suggest 

Brava^® Protective Seal 18/48mm 2.5mm product reference 12035

sample it here

Apologies for the long drawn out response but I hope that it gives you a bit more information.

Hopefully your skin is back to normal now all smooth and normal colour and your concerns are behind you now, I'm going to be honest with you little niggly unexpected incidents will keep cropping up now and again, if anything at anytime takes you by surprise don't worry about it just give me a out out either here or on friends message and we'll find the solution together to solve the problem you have based on what you tell me.

A Friend request has been sent.

Do let me know how you are getting on and keep in touch, I'm sure you (and your husband) have many more questions to ask.

Regards

Ian

CC

Completely agree with everything Ian said I had an emergency appointment with the stoma nurse to assess my stoma and redness and soreness. It was only after the examination that I was given the convex bag which suited my stoma and particular circumstances. Everyone is gonna have a different size and shape stoma and how far it protrudes from your stomach and taking into account and creases or folds in your skin and even down to the size and shape of your stomach.

Stay safe

Mark

Thank you again for the kind response.

it is great being in touch with someone who is going through the same thing.

the cream I have used is bepanthen, just a small amount as suggested. 

All the bags have been cut to the same size so I wouldn't have thought it would be a problem.

i do have an emergency bag which we keep in the car.  I luckily already have a radar key.

i will use the nappy rash cream again when I change the bag today.

could I please ask you another question? How frequently can you use loperamide? When I saw my stoma nurse I said my output in rather loose, she advised loperamide before breakfast before lunch before dinner and at bedtime until consistency gets back to normal but what if this takes more than two days as my husband keeps panicking about the instructions on the packet. I assumed I could just keep taking them on and off to regulate my output?

Hi Jeni

A couple of points to note.

Emergency change bags- not a good idea to keep in the car all the time. We all know that the internal temperature in a car fluctuate, at this of year overnight can be very low, with early morning frost then afternoon sun making the car hot, summer time becomes like a sauna all these variation in temperatures can affect the adhesion of the pouch, advisable to take it out the car when you get home.

Precut pouches may not be a problem but changes to stoma size can make a difference to leakages, that is why it is advisable to do a regular hole size check using the guide that are normally in the boxes just to be on the safe side, but we all have our special needs and reasons for putting forward the argument for or against, and unfortunately there is no right or wrong way just personal choice which is usually biased towards the way hospital stoma care nurses started you on.

Lopermide/Imodium it depends how you got your tablets

• Over the counter follow the pack leaflet
• GP prescription the doctor can prescribe a much high dosage depending on the severity of the output but remember they are used to stop diarrhoea whilst we use them to slow down high output which can be on going for many days.

The suggested dosage is 6 per day, the GP dosage is 8 per day but it has been reported many times on this forum that 2 or 3 times the recommended dosages have been taken, unfortunately I am not medically trained and can't make any suggestion about taking more than pack recommendation if you bought over the counter, you could decide yourself if you want to take the extra 2 tablets whilst you speak to your GP practice which with the current situation may be difficult.

We do have many suggestions about thickening your output that you might want to try.

Hi Jeni (and Ian)

I hope your rash has cleared up.

I get sore red skin when I sometimes change my stoma bag. It does get very sore.

I use a barrier cream to stop this and it does help a lot. You can buy it from any chemist or online shop and it is very fairly priced.

I hope this helps with your rash.

With kindness,