Caring for an ileostomy
As you learn more, you may have questions about caring for your ileostomy. 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. But ileostomy output can make this skin tender or 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 away from the skin.
- Clean the skin around the stoma with water. Dry the skin completely before putting on the skin barrier or pouch.
- 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 under “Patch testing” that follow. 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 stoma. 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.
Water will not hurt your ileostomy. You can take a bath or shower with or without a pouching system in place. Normal exposure to air or contact with soap 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.
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. Extra care should always be taken when doing this. It’s recommended that you dry shave the skin around your stoma with stoma powder, since soap and shaving creams have lotions and oils that may cause the skin barrier not to stick. After shaving, rinse well 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 – it will make your small intestine more active and might cause more gas and watery output. Some people find it best to eat smaller amounts of food 4 to 5 times a day.
You may be worried about how others may respond to 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.
Ileostomy output does not smell the same as normal stool. This is because the bacteria in the colon that break down food and cause odor aren’t in the small intestine. 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 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.
Be aware that coated tablets or time-released capsules may come out whole in the pouch. In most cases, this means you didn’t get the medicine. If you notice this, talk with your health care provider or pharmacist. There may be other medicines you can use to make sure you’re getting what you need. Liquid or liquid gel medicines tend to absorb faster and may work better for you.
- What is an ileostomy?
- How your digestive system works
- Types of ileostomies
- Managing your ileostomy
- Choosing an ileostomy pouching system
- Emptying and changing the ileostomy pouching system
- Ordering and storing ileostomy supplies
- Caring for an ileostomy
- Avoiding and managing ileostomy problems
- If you are hospitalized while you have an ileostomy
- Living with an ileostomy
- Telling others about your ileostomy
- What to wear when you have an ileostomy
- Eating and digestion with a ileostomy
- Returning to work after getting an ileostomy
- Intimacy and sexuality when you have an ileostomy
- Playing sports and staying active with an ileostomy
- Traveling when you have an ileostomy
- For parents of children with ileostomies
- Getting help, information, and support
- To learn more
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: December 2, 2014