Problems you may experience with a colostomy
Sore skin
Good skin care is vital to prevent sore skin. Sore skin is a common problem, often seen but easily treated. There are a number of reasons why this may be happening. This isn’t a complete list, so please contact your Stomal Therapy Nurse for further guidance if your symptoms persist.
Ill-fitting bag
Following surgery you may find that your abdominal shape changes, especially if you gain or lose weight. This means the skin close to your stoma may not sit evenly against your bag, exposing healthy skin and allowing sore skin to occur or leakage to take place. It is therefore important to regularly check your template size and suitability of your bag.
Change in output
Any change in output from your stoma could contribute to sore skin. If you experience loose stools, you may find it helpful to temporarily use a drainable bag to prevent frequent bag changes as this can result in sore skin.
Trauma to stoma or skin
Your stoma and the surrounding skin is at risk of damage and so should be well cared for. An incorrectly sized template may rub and cause injury to the side of the stoma, which may include small ulcers. It may be that the shape of the stoma remains the same but the size has altered. Get into the habit of checking your stoma, template and surrounding skin regularly.
Product sensitivity
Sensitivity to the adhesive on your bag is rare, but can occur even if you’ve been using it for a long time. It may begin as a slight irritation and become progressively worse if left untreated.
Folliculitis
This is an inflammation of the hair follicles. It appears like small pimples, occasionally pus-filled, that can be painful and is often seen after shaving the skin around the stoma. As soon as you notice any changes to the skin immediately around your stoma, please contact your Stomal Therapy Nurse for advice about treatment.
Muco-cutaneous separation
To form the stoma, the bowel will be stitched to the skin. Occasionally, following surgery the stitches and skin can separate. This can sometimes look unpleasant but, like any other wound, it will heal over time. It is important to contact your Stomal Therapy Nurse who can advise you on treatment to aid healing.
Pancaking
Pancaking occurs if the internal layers of the bag stick together causing a vacuum which prevents the contents from dropping to the bottom. The stool remains at the top of the bag which can potentially block the filter. The bag can also be forced off the body. It may help to intermittently use the filter cover. Place some air into the bag by blowing into the bag prior to application, then apply the filter cover, this will ensure some of the air remains within the bag, then once the stoma has functioned try removing the filter cover, this will hopefully encourage the stool to drop to the bottom of the bag. Some people find it helpful to roll up a small piece of toilet paper or place a cotton wool ball into the bag. Others find using a drop of oil or liquid soap placed into the hole of the adhesive (ensuring it coats the opposite internal film) can sometimes help the output to slide to the bottom of the bag.
Ballooning
Ballooning occurs when your stoma bag blows up with wind. This can cause the bag to come away from the body. If you are using a filter cover, try removing it. If your stoma bag has a filter and you are still experiencing problems, it may be that you are suffering from excess wind. Spicy foods, some vegetables (onions, cabbage, peas, and beans) and fizzy drinks have been known to increase wind, so try to avoid these.
Also avoid drinking with your meal as this can cause you to swallow excess air. Eating regular meals will reduce the build-up of wind
Constipation
Constipation can occur for many reasons, such as reduced mobility, pain relief medication, and reduced fibre and fluid intake. It results in infrequent hard stools and may cause abdominal discomfort. It is resolved by increasing your fluid and fibre intake. If this does not work, your GP or Stomal Therapy Nurse may advise the appropriate use of laxatives.
Parastomal hernia
A hernia is a weakness in the muscle wall. A parastomal hernia can occur around the stoma and is more common depending on the following risk factors:
In some people, the parastomal hernia will not cause any discomfort, but others may experience a dragging sensation, discomfort or pain. This will often depend on the size of the hernia and can be eased by wearing a measured support garment.
It is possible to have surgery to repair the hernia depending on the symptoms and effect on quality of life, but this will be assessed on an individual basis by your Surgeon. It should be noted that there may still be a risk of another hernia developing following the repair.
Retraction
This occurs when the stoma is below skin level. There are various reasons for this:
Bleeding
The bowel has a very good blood supply, which is why the stoma is pink/red in colour. Whilst cleaning your stoma, a small amount of bleeding on the cloth is to be expected. However, if you see blood inside your bag and/or in your stool you should contact your Stomal Therapy Nurse or GP.
If you take anticoagulants such as Warfarin or Aspirin this may increase your risk of bleeding. If the bleeding is heavy, persistent or comes from the inside of the stoma you should seek advice from your Stomal Therapy Nurse or GP.
Prolapse
Sometimes the bowel can extend in length, similar to a telescope effect, and this is called a prolapsed stoma. Despite the prolapse, your colostomy should continue to be a healthy pink/red colour. If this changes and becomes darker it is important that you seek urgent medical advice.
It is important to check your template frequently and it may be necessary to use a larger bag to accommodate the stoma
Lying down may reduce the size of the prolapse, and may make it easier to apply your bag. In some cases the use of a support belt, applied whilst lying down, can be effective in managing the prolapse.
Your Stomal Therapy Nurse can advise you on the use of a support garment or belt
Granulomas
Granulomas are red lumps that can appear on and around the edge of the stoma. They can be tender and may develop at any time. Sometimes rubbing from the wafer or base plate can increase the risk of granulomas occurring. Bleeding can happen and may interfere with the bag adhesion. The template should be checked to ensure a good fit but do not cut the template larger to accommodate the granulomas as this may allow them to grow larger.
Your Stomal Therapy Nurse may feel it is necessary to treat with a course of silver nitrate or you may be referred for surgical excision, although this is rare
Ulcers
Ulcers can develop for a variety of reasons that may include medication, type of appliance and as a result of your original diagnosis. They can appear as broken, red, sore areas which may be painful. Ulcers are treatable and your Stomal Therapy Nurse can advise you following assessment.
Stenosis
Stenosis results in the stoma becoming very small and tight. The output from the stoma will become ribbon-like or even liquid. Following assessment, your Stomal Therapy Nurse may use a dilator to insert into the stoma and will request you continue to do this at home.Your Stomal Therapy Nurse may also recommend you take laxatives to keep your stool soft enough to pass and to avoid constipation. You may need surgery to refashion your stoma.
Necrosis
This is extremely rare. Necrosis occurs if the blood supply to the stoma is restricted. Initially the stoma will become a darker red/purple and may even turn black, which is an indication that the blood supply is impaired. It may also feel cold and hard to touch. It is vital that you seek urgent medical attention.
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Good skin care is vital to prevent sore skin. Sore skin is a common problem, often seen but easily treated. There are a number of reasons why this may be happening. This isn’t a complete list, so please contact your Stomal Therapy Nurse for further guidance if your symptoms persist.
Ill-fitting bag
Following surgery you may find that your abdominal shape changes, especially if you gain or lose weight. This means the skin close to your stoma may not sit evenly against your bag, exposing healthy skin and allowing sore skin to occur or leakage to take place. It is therefore important to regularly check your template size and suitability of your bag.
Change in output
Any change in output from your stoma could contribute to sore skin. If you experience loose stools, you may find it helpful to temporarily use a drainable bag to prevent frequent bag changes as this can result in sore skin.
Trauma to stoma or skin
Your stoma and the surrounding skin is at risk of damage and so should be well cared for. An incorrectly sized template may rub and cause injury to the side of the stoma, which may include small ulcers. It may be that the shape of the stoma remains the same but the size has altered. Get into the habit of checking your stoma, template and surrounding skin regularly.
Product sensitivity
Sensitivity to the adhesive on your bag is rare, but can occur even if you’ve been using it for a long time. It may begin as a slight irritation and become progressively worse if left untreated.
Folliculitis
This is an inflammation of the hair follicles. It appears like small pimples, occasionally pus-filled, that can be painful and is often seen after shaving the skin around the stoma. As soon as you notice any changes to the skin immediately around your stoma, please contact your Stomal Therapy Nurse for advice about treatment.
Muco-cutaneous separation
To form the stoma, the bowel will be stitched to the skin. Occasionally, following surgery the stitches and skin can separate. This can sometimes look unpleasant but, like any other wound, it will heal over time. It is important to contact your Stomal Therapy Nurse who can advise you on treatment to aid healing.
Pancaking
Pancaking occurs if the internal layers of the bag stick together causing a vacuum which prevents the contents from dropping to the bottom. The stool remains at the top of the bag which can potentially block the filter. The bag can also be forced off the body. It may help to intermittently use the filter cover. Place some air into the bag by blowing into the bag prior to application, then apply the filter cover, this will ensure some of the air remains within the bag, then once the stoma has functioned try removing the filter cover, this will hopefully encourage the stool to drop to the bottom of the bag. Some people find it helpful to roll up a small piece of toilet paper or place a cotton wool ball into the bag. Others find using a drop of oil or liquid soap placed into the hole of the adhesive (ensuring it coats the opposite internal film) can sometimes help the output to slide to the bottom of the bag.
Ballooning
Ballooning occurs when your stoma bag blows up with wind. This can cause the bag to come away from the body. If you are using a filter cover, try removing it. If your stoma bag has a filter and you are still experiencing problems, it may be that you are suffering from excess wind. Spicy foods, some vegetables (onions, cabbage, peas, and beans) and fizzy drinks have been known to increase wind, so try to avoid these.
Also avoid drinking with your meal as this can cause you to swallow excess air. Eating regular meals will reduce the build-up of wind
Constipation
Constipation can occur for many reasons, such as reduced mobility, pain relief medication, and reduced fibre and fluid intake. It results in infrequent hard stools and may cause abdominal discomfort. It is resolved by increasing your fluid and fibre intake. If this does not work, your GP or Stomal Therapy Nurse may advise the appropriate use of laxatives.
Parastomal hernia
A hernia is a weakness in the muscle wall. A parastomal hernia can occur around the stoma and is more common depending on the following risk factors:
- Age
- Weight
- Strenuous or heavy lifting
- Smoking
- Multiple abdominal and/or emergency surgery
In some people, the parastomal hernia will not cause any discomfort, but others may experience a dragging sensation, discomfort or pain. This will often depend on the size of the hernia and can be eased by wearing a measured support garment.
It is possible to have surgery to repair the hernia depending on the symptoms and effect on quality of life, but this will be assessed on an individual basis by your Surgeon. It should be noted that there may still be a risk of another hernia developing following the repair.
Retraction
This occurs when the stoma is below skin level. There are various reasons for this:
- Difficulties with stoma formation
- Weight
- Shape of the abdomen
Bleeding
The bowel has a very good blood supply, which is why the stoma is pink/red in colour. Whilst cleaning your stoma, a small amount of bleeding on the cloth is to be expected. However, if you see blood inside your bag and/or in your stool you should contact your Stomal Therapy Nurse or GP.
If you take anticoagulants such as Warfarin or Aspirin this may increase your risk of bleeding. If the bleeding is heavy, persistent or comes from the inside of the stoma you should seek advice from your Stomal Therapy Nurse or GP.
Prolapse
Sometimes the bowel can extend in length, similar to a telescope effect, and this is called a prolapsed stoma. Despite the prolapse, your colostomy should continue to be a healthy pink/red colour. If this changes and becomes darker it is important that you seek urgent medical advice.
It is important to check your template frequently and it may be necessary to use a larger bag to accommodate the stoma
Lying down may reduce the size of the prolapse, and may make it easier to apply your bag. In some cases the use of a support belt, applied whilst lying down, can be effective in managing the prolapse.
Your Stomal Therapy Nurse can advise you on the use of a support garment or belt
Granulomas
Granulomas are red lumps that can appear on and around the edge of the stoma. They can be tender and may develop at any time. Sometimes rubbing from the wafer or base plate can increase the risk of granulomas occurring. Bleeding can happen and may interfere with the bag adhesion. The template should be checked to ensure a good fit but do not cut the template larger to accommodate the granulomas as this may allow them to grow larger.
Your Stomal Therapy Nurse may feel it is necessary to treat with a course of silver nitrate or you may be referred for surgical excision, although this is rare
Ulcers
Ulcers can develop for a variety of reasons that may include medication, type of appliance and as a result of your original diagnosis. They can appear as broken, red, sore areas which may be painful. Ulcers are treatable and your Stomal Therapy Nurse can advise you following assessment.
Stenosis
Stenosis results in the stoma becoming very small and tight. The output from the stoma will become ribbon-like or even liquid. Following assessment, your Stomal Therapy Nurse may use a dilator to insert into the stoma and will request you continue to do this at home.Your Stomal Therapy Nurse may also recommend you take laxatives to keep your stool soft enough to pass and to avoid constipation. You may need surgery to refashion your stoma.
Necrosis
This is extremely rare. Necrosis occurs if the blood supply to the stoma is restricted. Initially the stoma will become a darker red/purple and may even turn black, which is an indication that the blood supply is impaired. It may also feel cold and hard to touch. It is vital that you seek urgent medical attention.
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