Peristomal wounds are skin injuries that develop around a colostomy, ileostomy, or urostomy due to exposure to intestinal contents, urine, pouch adhesive, or mechanical stress. With proper pouch fit and regular skin care, most cases can be prevented and treated.
The Relationship Between a Stoma and the Surrounding Skin
A stoma is an opening created by bringing the intestine or urinary tract through the abdominal wall. The stoma itself is made of mucosal tissue and normally appears moist and pink. The surrounding skin, however, is normal skin and is not resistant to digestive fluids.
Because output from the small intestine contains concentrated digestive enzymes, it can irritate the skin rapidly. For this reason, leakage in patients with an ileostomy can lead to skin breakdown within a short period. In patients with a urostomy, the alkaline nature of urine may cause a different type of skin problem.
Types of Wounds Seen Around a Stoma
- Irritant dermatitis: Redness, weeping, and open areas caused by leakage; this is the most common problem
- Mechanical damage: Skin stripping caused by frequent or forceful removal of the pouching system
- Fungal infection: Well-defined red rashes that develop in a moist environment
- Folliculitis: Inflammation of hair follicles, especially after shaving
- Allergic reaction: Redness and itching caused by sensitivity to an adhesive or another product ingredient
- Pyoderma gangrenosum: A special type of very painful, rapidly enlarging wound with purple edges
- Parastomal hernia and prolapse: Structural conditions that can impair pouch fit and indirectly contribute to wound formation
Why Do Peristomal Wounds Develop?
- Cutting the pouch opening larger than the stoma and exposing the skin to output
- Changing the pouch too late or failing to notice leakage
- Poor pouch fit due to folds, depressions, or irregularities in the abdominal wall
- A stoma that sits below skin level
- Failing to reassess pouch size after weight changes
- Removing the adhesive by pulling it off forcefully
- Using inappropriate skin-care products
Symptoms
- Redness, burning, and itching around the stoma
- Weeping, moisture, and open areas
- Early detachment of the pouch and frequent leakage
- Pain during pouch changes
- Bleeding or crusted areas
- Unpleasant odor and recurrent leakage
A pouch that detaches earlier than expected is often one of the first signs of deterioration in the surrounding skin and should be taken seriously.
Diagnosis and Assessment
Assessment is performed after removing the pouch and carefully examining the stoma and surrounding skin. The diameter of the stoma, its height relative to the skin, the shape of the abdominal wall, and the fit of the current pouching system are evaluated. A culture may be obtained if infection is suspected, and biopsy may be needed for atypical or severely painful wounds.
Observing how the patient applies the pouch is often one of the most valuable steps in identifying the source of the problem.
Treatment of Peristomal Wounds
Stopping Leakage
This is the fundamental step in treatment. The pouch opening is cut to fit the diameter of the stoma without leaving surrounding skin exposed. Paste, barrier rings, or convex pouching systems may be used to compensate for irregularities in the abdominal wall. As long as leakage continues, no cream or dressing can provide lasting benefit.
Skin Care
The area is cleaned with lukewarm water, and soap and alcohol-based products are avoided. The pouch is applied only after the skin has dried completely. Protective powder and barrier products may be used on weeping areas. Oily creams are generally avoided because they interfere with adhesion of the pouch.
Treating Infection
Antifungal powder may be used for fungal infections, while treatment for bacterial infection is selected according to culture results.
Management of Special Wounds
Inflammatory wounds such as pyoderma gangrenosum cannot be managed with local care alone; systemic treatment may be required and assessment may be carried out together with relevant specialties. Aggressive debridement is avoided in these wounds.
Surgical Assessment
Structural problems such as a retracted stoma, parastomal hernia, or prolapse may be the underlying cause of recurrent wounds. In such cases, revision of the stoma may be considered.
Daily Care Recommendations
- Measure the diameter of your stoma at regular intervals; the stoma may become smaller over time
- Have your pouching system reassessed after significant changes in weight
- Change the pouch at planned intervals before leakage develops
- Remove the adhesive gently while supporting the skin rather than pulling it off
- Trim hair rather than shaving the area closely
- Check your skin during every pouch change
- Seek assessment promptly when redness begins
Specialist Evaluation of Peristomal Wounds
In wounds around a stoma, the solution often depends not simply on changing products but on correctly identifying the cause of leakage. Prof. Dr. Emre Özker places importance on evaluating the skin and pouch fit together and manages wound care alongside a practical daily-care plan adapted to the patient’s life.
Skin Risk According to Stoma Type
The frequency and severity of skin problems around a stoma vary according to the type of stoma.
- Ileostomy: Small-bowel output is liquid and rich in digestive enzymes. With leakage, skin damage develops most rapidly in this type
- Colostomy: Large-bowel output is usually more solid, so skin irritation is often more limited
- Urostomy: Continuous contact with urine may cause a different pattern of irritation and crystal formation on the skin
The location of the stoma on the abdominal wall is also important. A stoma located near the umbilicus, a surgical scar, or a skin fold may make it more difficult for the pouch to seal properly.
Choosing a Pouching System
Resolving skin problems often depends on selecting the right system. Flat systems may be sufficient for patients with an even skin surface. If the stoma is below skin level or there is a depression around it, a convex system may be preferred; the convex base applies gentle pressure around the stoma to help project it outward and reduce leakage.
One-piece systems are thinner and more flexible. In two-piece systems, the skin barrier can remain in place while only the pouch is changed; this can reduce repeated adhesive removal in patients with damaged skin.
Accessory products may also be helpful: paste and moldable rings fill gaps, protective powder helps manage weeping areas, and barrier film protects the skin from irritation. Using excessive amounts of these products, however, can interfere with adhesion.
The Relationship Between Diet and Leakage
The consistency of intestinal output directly affects the risk of leakage. Particularly in patients with an ileostomy, very liquid output can cause the pouch to fill quickly and increase the likelihood of leakage.
- Divide meals into smaller portions and eat slowly
- Maintain adequate fluid intake
- Keep track of foods that you notice make the output more liquid
- Limit gas-producing foods in the evening if they cause problems
- Chew high-fiber foods thoroughly
Dietary advice should be individualized; keeping a record of your own observations is often more useful than relying on general food lists.
When Should You Seek Medical Evaluation?
- If skin redness does not improve within a few days
- If the pouch repeatedly detaches early
- If pain, bleeding, or purple areas develop around the stoma
- If the stoma becomes pale or dark in color
- If swelling or a hernia develops around the stoma
- If fever and widespread redness are present
- If output suddenly stops or increases excessively
Long-Term Follow-up
The skin around a stoma changes during the first weeks after surgery. As postoperative swelling decreases, the stoma diameter becomes smaller and the pouch opening needs to be adjusted accordingly. If this adjustment is not made, skin that had healed may become damaged again.
Weight changes also alter the shape of the abdominal wall. Reassessment of the pouching system is recommended after significant weight gain or loss. Regular follow-up allows problems to be recognized before they progress into a wound.
Frequently Asked Questions
Is redness around the stoma normal?
No. The skin around the stoma should look similar to the skin on the rest of the abdomen. Redness usually indicates leakage or irritation.
Can I apply cream under my pouch?
Oily creams interfere with adhesion and may increase leakage. Only barrier products compatible with the pouching system should be used in this area.
Why does my pouch come off early?
Common causes include an incorrectly sized opening, folds in the abdominal wall, sweating, and a stoma that sits below skin level. The pouching system should be reassessed in this situation.
Should I remove the pouch when taking a shower?
You can shower with or without the pouch. The important points are to avoid irritating soaps on the area and to dry the skin completely before applying a new pouch.
Will a wound around the stoma heal on its own?
The wound will not heal while leakage continues. The cause of leakage must first be corrected; once this is achieved, superficial wounds often improve within a relatively short time.
Can I shave the hair around the stoma?
Shaving with a razor may cause inflammation of the hair follicles. Trimming the hair with scissors or another appropriate method is generally preferred.
How often should I change my pouch?
The frequency depends on the type of stoma and the system used. The key is to change the pouch at planned intervals before leakage develops. Changing it too often can traumatize the skin, while changing it too late increases the risk of leakage.
What happens if a hernia develops around the stoma?
A parastomal hernia develops when the abdominal wall weakens around the stoma. Because it can make pouch fitting more difficult, it may cause recurrent leakage. A support belt or surgical assessment may be considered.
What can I do about odor from the stoma pouch?
Deodorizing products designed for ostomy pouches may be used. However, persistent odor often indicates leakage; in that case, the pouching system should be reviewed rather than simply adding a deodorizer.
Can I exercise?
Most activities can be continued. A support belt may be recommended for heavy lifting or activities that strain the abdominal wall. With an appropriate pouching system, many activities, including swimming, are possible.
Will my stoma become smaller after surgery?
Yes. During the first weeks after surgery, the stoma usually becomes smaller as swelling decreases. The pouch opening should therefore be measured and adjusted regularly; otherwise, skin that has already healed may become damaged again.
