What’s a mountain girl to write about when my hip injury is keeping me from the slopes and summits? Skin care, of course! After all, taking care of your peristomal skin is of utmost importance. It is hard to enjoy outdoor sports if your skin is irritated and painful or if your appliance won’t stick to weepy, damaged areas.
My stoma is fairly long at 1.5″and doesn’t have the best posture. It flops downward and a bit to the right — especially under the weight of my clothing and pouch. This actually works great because my output goes toward the bottom of my pouch which helps prevent leaks. On the downside, the area of skin just under my stoma sometimes gets irritated because stool tends to collect in that spot. Also, as my stoma flops down, it compresses my Eakin barrier ring in that area and causes it to erode more quickly. Fortunately, I discovered a great solution to this problem soon after surgery thanks to the help of my home health nurse.
There was a six-week time period after my surgery during which I had a complication with my mid-line abdominal incision (due to a rare reaction to sutures). I ended up having to leave the wound open for healing with the help of a wound vac. While this was certainly a disappointment at the time, the situation also held a hidden blessing. Every other day, a home health nurse would come and change the sponge dressing for my wound vac. In order to do this, my ostomy wafer had to be removed and replaced each time. Along with being a wound vac guru, my home health nurse also had a great knowledge of ostomy skin care. Having the nurse watch and help me change my appliance so frequently over a period of many weeks provided an amazing opportunity to practice the task and troubleshoot problems. As time progressed, my nurse saw that a sliver of skin under my stoma was consistently raw. She told me that this would likely become a chronic issue unless I did something to better protect that section of skin. I was already using Eakin barrier rings, so she suggested I add a product called Duoderm Signal to my ostomy system.
Duoderm Signal comes in a 4″ x 4″ sheet and custom-sized pieces can be cut out of it to cover whatever area needs protection. To care for the sliver of skin right under my stoma, I cut a 1/2″ by 1″ comma-shaped piece that contours with the edge of my stoma. When I place it on my skin in the trouble spot, it provides a much needed extra layer of protection. When my Eakin barrier ring erodes a little sooner in that section, my output touches the Duoderm layer instead of my skin.
Duoderm can be placed right on the skin, but it does not adhere well if the area is wet. Therefore, if I get irritation that is weepy, I must put a layer of stoma powder and skin prep under the Duoderm in order for it to stick. The best way to do this is to use the “crusting” method. First I put a small bit of powder on the sliver of skin that is irritated. I then dab it with 3M Cavillon Skin Prep. Once it dries, I add one more layer of stoma powder and one more layer of Cavillon. I give the area a final dry with a hair dryer on a low setting for a few seconds. Then, I add the strip of Duoderm over the crusted area. Finally, I put my Eakin barrier ring over the Duoderm followed by my wafer.
This method works wonderfully to protect the skin under my stoma. However, I can’t stretch wafer changes longer than four days when using the Duoderm. If I do, the Duoderm will start to peel up from being so close to my wet stoma. Then output starts to seep under it and cause skin breakdown.
Some people with ostomies are lucky enough to be able to stick their wafer right to their skin with no additional products. Unfortunately, that does not work for me. I need to build up several layers of things in order to maintain healthy skin. As soon as I try going back to more simple methods, my skin suffers. Appliance changes typically take me over 45 minutes if I include the time it takes to set up my materials, remove my old appliance, shower and do all the steps to get my new wafer on well. I never worry about it. It is not a race. Having my appliance off for a little while actually helps my skin get some fresh air. Between eating about five marshmallow prior to my change to slow down my output, and then wrapping paper towel strips around my stoma to catch any stool that might come out as I work, things go fairly smoothly when having my appliance off for that long. Of course there are always those days when my stoma doesn’t cooperate! Still, even with the occasional mishap, taking the extra time needed to better protect the skin around my stoma is worth it. Having happy skin helps me feel good about my ostomy and gives me confidence that my appliance will adhere well through all my adventures.
I do have one more skin care tip that I use which involves using both an Eakin ring and stoma paste, but that will have to wait for a future post!