Caring for a colostomy
As you learn more, you may have questions about caring for your colostomy. This section has many tips, but remember, no two people are alike. There’s no one right answer, only suggestions and ideas for you to try.
Protecting the skin around the stoma
The skin around your stoma should always look the same as skin anywhere else on your abdomen. A colostomy that puts out firm stool usually causes few, if any skin problems. If the stool is loose, as is often the case with transverse colostomies, it can make the nearby skin tender and sore. Here are some ways to help keep your skin healthy:
- Use the right size pouch and skin barrier opening. An opening that’s too small can cut or injure the stoma and may cause it to swell. If the opening is too large, output could get to and irritate the skin. In both cases, change the pouch or skin barrier and replace it with one that fits well.
- Change the pouching system regularly to avoid leaks and skin irritation. Itching and burning are signs that the skin needs to be cleaned and the pouching system should be changed.
- Do not rip the pouching system away from the skin or remove it more than once a day unless there’s a problem. Remove the skin barrier gently by pushing your skin away from the sticky barrier rather than pulling the barrier from the skin.
- Clean the skin around the stoma with water. Pat dry before putting on the cover, skin barrier, or pouch. You can clean your stoma in the shower, but never in the tub since you may have output from time to time. (If you take a bath, keep your ostomy covered.)
- Watch for sensitivities and allergies to the adhesive, skin barrier, paste, tape, or pouch material. They can develop after weeks, months, or even years of using a product because you can become sensitized over time. If your skin is irritated only where the plastic pouch touches it, you might try a pouch cover or a different brand of pouch. Pouch covers are available from supply manufacturers, or you can make your own.
- You may have to test different products to see how your skin reacts to them. If you feel comfortable testing yourself, follow the directions that follow under “Patch testing.” If you’re not comfortable doing this on your own and the problem continues, talk to your doctor or ostomy nurse.
Patch testing can be done to see if you’re sensitive to or allergic to a product used as part of your ostomy care. Place a small piece of the material to be tested on the skin of your belly, far away from the colostomy. If the material is not self-sticking, attach it with an adhesive tape that you know you’re not allergic to (Figures 21 and 22). Leave it on for 48 hours.
Gently remove the patch at the end of 48 hours and look for redness or spots under the patch. If there’s no redness after 48 hours, it’s generally safe to use the product. But, in a few cases, reactions that took longer than 48 hours to show up have been reported (Figure 23).
Itching or burning before 48 hours pass is a sign of sensitivity. Remove the material right away and wash your skin well with soap and water.
A reaction to the tape is also possible. If this is the case, the redness or other irritation will only be in the area outlined by the tape (Figure 24).
If you seem to be allergic to a certain product, try one made by another company and patch test it, too. It may take a few tries to find one that works for you. Keep in mind that allergies are not as common as is irritation caused by using a product the wrong way. For this reason, before using a product, always read the directions that come with it. When in doubt, check with your ostomy nurse or doctor.
Spots of blood on the stoma
Spots of blood are not a cause for alarm. Cleaning around the stoma as you change the pouch or skin barrier may cause slight bleeding. The blood vessels in the tissues of the stoma are very delicate at the surface and are easily disturbed. The bleeding will usually stop quickly. If it doesn’t, call your ostomy nurse or your doctor.
Shaving hair under the pouch
Having a lot of hair around the stoma can make it hard to get the skin barrier to stick well and may cause pain when you remove it. Shaving with a razor or trimming hair with scissors is helpful. Extreme care should always be taken when doing this. It’s recommended that you dry shave the skin around your stoma using a stoma powder, since soap and shaving creams have lotions and oils that may cause the skin barrier not to stick. After shaving, rinse and dry the skin well before applying your pouch.
Right after surgery it may seem that you have a lot of gas almost all the time. Most abdominal surgery is followed by this uncomfortable, embarrassing, yet harmless symptom. As the tissue swelling goes down, you’ll have less gas. But certain foods may cause gas, such as eggs, cabbage, broccoli, onions, fish, beans, milk, cheese, carbonated drinks, and alcohol.
Eating regularly will help prevent gas. Skipping meals to avoid gas or output is not smart. Some people find it best to eat smaller amounts of food 4 to 5 times a day.
You may be worried about how others will respond to the gassy noises. But you’ll find that these noises sound louder to you than to others. They often only sound like stomach rumblings to those around you. If you’re embarrassed by these rumblings when others are nearby, you can say, “Excuse me, my stomach’s growling.” If you feel as though you are about to release gas when you’re with people, casually fold your arms across your belly so that your forearm rests over your stoma. This will muffle most sounds. Check with your ostomy nurse about products you can take to help lessen gas.
Many factors, such as foods, normal bacteria in your intestine, illness, certain medicines, and vitamins can cause odor. Some foods can produce odor: eggs, cabbage, cheese, cucumber, onion, garlic, fish, dairy foods, and coffee are among them. If you find that certain foods bother you, avoid them. Learning by experience is the only solution to this problem. Here are some hints for odor control:
- Use an odor-resistant pouch.
- Check to see that the skin barrier is stuck securely to your skin.
- Empty the pouch often.
- Place special deodorant liquids and/or tablets in the pouch.
- There are some medicines you can take that may help. Check with your doctor or ostomy nurse about these products and how to use them. Some things that many people have found to help with odor are chlorophyll tablets, bismuth subgallate, and bismuth subcarbonate.
- There are air deodorizers that control odor very well when you are emptying the pouch.
Caring for a posterior wound
In some patients the rectum and anus are removed. This will leave a surgical wound in that area called a posterior wound. Care of the posterior wound is based on good hygiene and the use of dressings or pads to collect and contain any drainage. Infections or drainage that lasts may be treated by antibiotics, irrigations, or sitz baths (sitting in a tub or pan of warm water). Your doctor or nurse should tell you how to care for this wound and what problems need to be reported right away.
Water will not hurt your colostomy. You can take a bath or shower with or without a pouching system in place. Normal exposure to air and water won’t harm the stoma. Water will not flow into the stoma. Soap will not irritate it, but soap may interfere with the skin barrier sticking to the skin. It’s best to only use water while cleaning the skin around your stoma. If you do use soap, be sure to rinse your skin well.
In its original form this document was written by the United Ostomy Association, Inc. (1962-2005) and reviewed by Jan Clark, RNET, CWOCN and Peg Grover, RNET. It has since been modified and updated by:
Last Medical Review: December 2, 2014 Last Revised: February 14, 2017
- What is a colostomy?
- How your digestive system works
- Types of colostomies
- Closing or reversing a colostomy
- Managing your colostomy
- Choosing a colostomy pouching system
- Changing the colostomy pouching system
- Colostomy irrigation (for descending and sigmoid colostomies only)
- Ordering and storing colostomy supplies
- Caring for a colostomy
- Avoiding and managing colostomy problems
- If you are hospitalized while you have a colostomy
- Living with a colostomy
- Telling others about your colostomy
- Eating and digestion with a colostomy
- What to wear when you have a colostomy
- Returning to work after getting a colostomy
- Intimacy and sexuality when you have a colostomy
- Playing sports and staying active with a colostomy
- Traveling when you have a colostomy
- For parents of children with colostomies
- Getting colostomy help, information, and support
- To learn more