Common concerns for people with a stoma

Common concerns for people with a stoma
Colorectal Nursing Department
Common concerns for
people with a stoma
Wind (flatus)
Everybody passes wind, but if you have a stoma this can
sometimes be inconvenient or embarrassing, as you have no
control over it. However, the following advice may help:
•Diet: Some people with a colostomy have found that green
vegetables, onions and fruit cause excessive wind, whilst
people with an ileostomy have found that peas, onions, beans
or green vegetables can be a problem. It is very much an
individual issue; a certain food that causes one person to have
wind may be perfectly acceptable to another. Try to make a
note of which foods cause you to produce more wind, so that
you can avoid them if you wish to.
•Fizzy drinks: These may cause wind. Some people also find it
helpful not to drink whilst eating a meal, but to wait until the
end.
•Flatus filters: Most modern appliances have an integral filter,
which controls the release of wind, helping to prevent the bag
from inflating or ‘ballooning’. These filters contain charcoal,
which helps to neutralise any odours.
•Charcoal tablets: These are available over the counter from
your local pharmacist and may help reduce excessive wind.
•Natural yoghurt (probiotic): Eating natural or ‘live’ yoghurt
can help to neutralise the bacteria in the gut; reducing
excessive wind. Actimel and Yakult are brands of yoghurt drink
available from most supermarkets, or you may find they have
their own brand available.
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Odour
All modern appliances are now made from odour-proof materials
and most are available with a flatus filter. You should not get
odour unless you are emptying or changing the bag. Deodorants
are available on prescription in the form of sprays, drops and
powders. Please ask your Advanced Nurse Practitioner or
Specialist Nurse Practitioner for advice.
If you have a problem with odour, it is likely to be diet related,
but again this is individual. Some people with a colostomy report
problems with odour after eating green vegetables and onions.
For people with an ileostomy the culprit foods may be fish, eggs,
onions and cheese.
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Pancaking
This is a particular problem for people with a colostomy, when
the faeces remain stuck around the stoma instead of dropping
down into the bag. The following may help:
•Cover the flatus filter: This will prevent a vacuum from
forming in the bag and helps to stop the faeces from sticking
at the top.
•A piece of screwed up tissue or cotton wool ball in the
bag: Placing this in the bag before wearing it allows some air
to remain in the bag. This prevents a vacuum from forming.
•A small amount of oil (vegetable or sunflower) in the
bag: Apply a small amount to the inside surface of the bag;
this will help the faeces to slide down. Take care not to get the
oil on the outside of the bag or on the sticky surface, as this
will make it oily and it may not stick.
•A stoma bridge: This is a small strip of plastic which is stuck
onto the outside of the bag, over the stoma. It can be bent
to allow the bag to sit away from the stoma, helping the
faeces to drop down into the bag. Ask your Advanced Nurse
Practitioner or Specialist Nurse Practitioner if you would like to
try one of these.
•Increase your fluid intake: Dehydration and not drinking
enough fluid can result in larger quantities of water being
reabsorbed by the intestine; this causes dry faeces, which tend
to stick.
•Lubricating deodorants: These are gels which go inside the
stoma bag, helping faeces slide to the bottom of the bag.
•Colostomy irrigation: It is possible for some people with a
colostomy to wash out their bowel regularly with water, to
avoid having to wear a bag. Please speak to your Advanced
Nurse Practitioner or Specialist Nurse Practitioner, who will be
able to tell you if this type of management might work for you.
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Sore skin
This will probably happen to everybody at some stage. The
important thing is to work out what the cause of the soreness
is, before trying to deal with it. Clean around your stoma with
warm water only – no soap. Avoid using baby wipes, as some of
these contain lanolin (moisturiser), which can stop the adhesives
from sticking. They can also sometimes cause skin soreness.
Never apply any creams which you would usually use for skin
complaints elsewhere on your body to the area around your
stoma (they won’t work and the appliance won’t stick!). There
are many products available on prescription especially for stoma
care, but as a simple, cheap remedy we have found calamine
lotion to sometimes be effective.
The following are some common causes of sore skin and simple
remedies:
• The area immediately around the stoma is sore. This
would suggest that the hole in your template needs to be cut
smaller, so that none of your skin is exposed. In the first 6-8
weeks after your operation the stoma will shrink in size. The
template will need to be adjusted as this happens.
•Changing the appliance too frequently. As a general
guide, most people with a colostomy change a one-piece bag
twice a day. People with an ileostomy would wear a onepiece bag for about three days. Contact your Advanced Nurse
Practitioner or Specialist Nurse Practitioner for advice.
•Poor technique when changing the appliance. Check you
are removing the old appliance correctly; you should support
the skin directly above where you are gently peeling the
appliance off – from top to bottom. If you are removing your
appliance incorrectly, this may cause skin soreness.
Your Advanced Nurse Practitioner or Specialist Nurse
Practitioner may recommend adhesive removers if you are
using an appliances that is particularly ‘sticky’.
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Are you cleaning the area well with water and, more
importantly, drying the area thoroughly? You may need to use
a mirror to help position the new appliance, or might need
to change position from standing to sitting, or vice-versa. Do
allow time for the appliance to stick properly – simply placing
your hand over it for a few minutes works wonders and can
prevent accidents later on.
•Leaving the appliance on too long. This can also cause your
skin to become sore, as the adhesive will start to break down,
allowing the waste onto your skin.
•Weight gain or loss: This can cause body contours to
change, sometimes resulting in skin folds or dips. Contact your
Advanced Nurse Practitioner or Specialist Nurse Practitioner,
who will be able to give you advice.
•A skin reaction: This can sometimes happen in response to a
particular product. Contact your Advanced Nurse Practitioner
or Specialist Nurse Practitioner as they may be able to suggest
an alternative product or a protective skin barrier.
•Pre-existing skin conditions: Such as eczema or psoriasis.
Contact your Advanced Nurse Practitioner or Specialist Nurse
Practitioner, who will be able to give you advice.
•Inflammation of hair follicles: This can happen if you have
hairy skin on your abdomen. It is best to keep the area around
your stoma shaved and hair-free.
If your skin remains sore, please contact your Advanced Nurse
Practitioner or Specialist Nurse Practitioner who will be able to
help you. The vast majority of skin problems are easily resolved.
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How to contact us
To contact an Advanced Nurse Practitioner or Specialist Nurse
Practitioner in Oxford:
Tel: 01865 221 839 or 01865 235 367
(9.00am to 5.00pm, Monday to Friday)
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If you have a specific requirement, need an interpreter,
a document in Easy Read, another language, large print,
Braille or audio version, please call 01865 221 473
or email PALSJR@ouh.nhs.uk
Authors: OUH Stoma/Colorectal Nursing Team
March 2016
Review: March 2019
Oxford University Hospitals NHS Foundation Trust
Oxford OX3 9DU
www.ouh.nhs.uk/information
OMI 13174P
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