Whether you’ve just had surgery or have had a stoma for a while, it is vital to ensure your peristomal skin remains healthy. We recognize that living with a stoma can be challenging, and coping with skin irritation makes things even more challenging. 

Fortunately, our peristomal skin guidelines have been designed with the help of the Sapienza University of Rome alongside Farmoderm’s Pharmodermatological Laboratories and with the help of ten experienced ostomy nurses to give you authentic, tried and tested advice to improve your peristomal skin care routine.

We guarantee you will notice a healthy, elastic and irritation-free skin in a short time. So, if you are struggling, or just wondering how to maintain a healthy skin around the stoma, consider following the advice we offer you in the following paragraph:

The best way to approach peristomal hygiene is to use products that do not contain substances that can alter your skin, such as:  lukewarm water, a self-balancing pH and antibacterial detergent, special stoma paper cloths, and a isodermic cream. 

You should consider following these 10 simple steps for your daily peristomal skin care routine: 

1. Gather everything you need for your peristomal skin care routine close at hand
2. Wash your hands deeply 
3. Get into a comfortable position before starting your stoma hygiene routine
4. Gently remove your pouching system to prevent skin complications
5. Use an adhesive remover, if  you need extra help to peel off your skin barrier
6. Use a disposable paper towel to  wipe away any residue
7. Use tepid water, pH self-balancing soap, and special paper cloths to wash your peristomal skin
8. Dry your skin carefully and  thoroughly before applying your pouching system 
9. Keep your skin healthy by applying a tiny amount of isodermic cream
10. Apply your new pouching system

Why Do You Need to Take Care of your Peristomal Skin

You must maintain healthy peristomal skin for making ostomy management easier and to steer clear from complications that could lower your quality of life.

Studies reveal that, at a certain point in their life, the majority of ostomates tend to be affected by Peristomal skin complications.

The main negative implications of unhealthy peristomal skin are:

• Leakage 

• Irritation, itching, soreness on the skin, full-thickness ulcers, and pain

• Discomfort, anxiety, frustration, depression and social isolation 

• Higher costs for the treatment of the endangered peristomal skin

• An increased amount of time for completing the skin care procedure

Despite all of these issues, many people still don’t have faith in peristomal hygiene routines, which is why they develop various peristomal skin complications down the line. 

Our survey conducted in Italy shows that most ostomates frequently experience peristomal skin complications that are mistakenly believed to be a normal condition.

IT IS NOT! 

A Proper daily peristomal skin care routine is essential!

It will guarantee you that your skin around the stoma will stay healthy and look like the rest of the skin of your abdomen.

Peristomal Skin Care Routine

In what follows we will go more in depth on what step you should take for a proper peristomal skin cleaning and reduce the risk of complications.

1. Gather Everything You Need for Your Peristomal Skin Care Routine Close at Hand

Before removing your old pouching system, remember to prepare your new one and keep all the products that you need in your near proximity. You will need the following things: 

• A new pouching system

• A pair of ostomy wafer scissors

• Disposable paper towel

• Resistant and soft cloths

• A pH self-balancing detergent 

• An isodermic cream

• A towel

• Gloves (Optional) 

Place the towel under your belly for a more comfortable approach and added safety.

2. Wash your Hands Deeply

Washing your hands before performing any peristomal skin management routine is vital to prevent further complications.Consider following these steps before starting your peristomal skin care routine (it takes less than a minute).

• Wet your hands with warm water.

• Rub well with a consistent amount of soap.

• Brush your nails well.

• Rinse your hands thoroughly with running water to remove all soap.

• Dry your hands with a dry and resistant cloth that does not leave residues.

3.  Get into a Comfortable Position before Starting your Stoma Hygiene Routine

Contrary to popular belief, there is no single position to adopt when cleaning your peristomal skin. Instead, you can try and find what suits you best overtime.

Experienced Nurses suggest that, at least in the initial phase, it would be better for you if you stood in front of your bathroom sink and mirror for a greater feeling of comfort and security. 

Some ostomates also prefer sitting on the bidet, facing the wall, to have better access to running water.

As mentioned earlier, prepare everything you need first and keep your products close at hand so you can do the entire procedure on the bidet without having to get up. 

4. Gently Remove your Pouching System to Prevent Skin Complications

During the removal of the ostomy bag, avoid pulling the pouch too vigorously, or pinching your skin trying to grab one edge of the skin barrier. It is vital that you take special care of this sensitive area and prevent skin traumas. 

The best way to remove your skin barrier is by lightly pressing on your abdomen in the proximity of one of the upper flange edges, to ensure you can grip it the right way. Use your other hand to peel off the adhesive barrier carefully and slowly starting from top to bottom.  

You might notice a different peristomal skin colour right after removing the pouching system. That being said the skin area should gain its normal color after a few minutes. 

5. Use an Adhesive Remover, if You Need Extra help to Peel off Your Skin Barrier

Some individuals find this procedure painful. If you are one of those, consider using warm water or an adhesive remover.

Adhesive removers can be extremely helpful in case you need extra help. This is because they minimize the risk of skin damage during the barrier removal by dissolving the adhesive part.

If you use oil-based solvents, make sure you wash and rinse your peristomal skin area deeply. Otherwise, your new appliance will not stick properly due to oily skin. It will lead to leakage causing possible infection or either the new skin barrier may not stick at all.

Using alcohol to remove skin barriers is outdated and mostly inefficient. Avoid using alcohol as it causes dryness, itching, and irritation. You could experience severe pain if it accidentally comes into contact with your stoma.

6. Use a Disposable Paper to Wipe any Residue

First off, wash your hands properly with running water.

If needed, use some toilet paper or a paper towel to remove eventual dirt around the stoma.

However, experienced nurses advise the use of special paper cloth that combine the absorbency of cellulose with the softness and resistance of viscose for reducing the risk of possible rubbing injuries, while ensuring a deep cleaning without leaving residues.

7. Use Tepid Water, pH Self-Balancing Soap and Specific Wipes to Wash your Peristomal Skin

Wash the area with lukewarm water (around 37ºC) and pH self-balancing detergent, without friction, cleaning from the outside in, in circular motions with another specific wipes, and rinse well.

Experts suggest to use a pH self-balancing detergent that can offers the skin all the microelements it needs in order to rebalance its physiological pH and reconstruct the dermoprotective barrier, and of course that does not contain perfume or deodorant which would instead irritate your skin. However, if you don’t have it at home, make sure to use at least a pH neutral detergent.

During this procedure, your stoma could emit small quantities of effluent in the surrounding area of your skin. If you want to clean the stoma again, consider using a physiological serum. 

You may also see small amounts of blood since the stoma itself has many small blood vessels that can bleed very easily when washed; so don’t worry, in most occasions it stops very quickly. Nevertheless if your peristomal skin bleeds, you most likely should consult a reliable health provider. 

8. Dry your Skin Carefully and Thoroughly before Applying Your New Pouching System

According to several stoma nurses, after the peristomal skin has been cleaned, it has to be carefully and thoroughly dried with a gentle patting motion. You can use specific wipes or soft towels for this task. Just make sure not to irritate the skin.

Studies confirm that many ostomates dry their skin using a hairdryer in cold air-mode; or by letting the peristomal skin dry naturally for 1 – 2 minutes. Although, to avoid that your stoma gets contaminated or the eventual emission of outputs, we suggest to follow the nurse advice.

It is vital to dry the peristomal skin properly to avoid leakages which would lead to greater skin complications.

9.  Keep your Skin Healthy by Applying a Tiny amount of Isodermic Cream

Professionals recommend using an isodermic cream. A tiny amount of this product, applied daily, will keep your peristomal skin healthy. It favors the restoration of the hydrolipidic content of the protective mantle, an indispensable factor for keeping the skin healthy, toned, and elastic. 

Once again, make sure to use a cream which leaves no greasy residues and allows the adhesive to be applied without difficulty.

10. Apply your New Pouching System

Once the skin is clean and dry, you can go ahead and apply the new pouching system.

Keep a wipe specific for taking care of your ostomy next to you during this procedure in case of effluent leakage.

If you’re not using pre-cut barriers, cut your wafer to fit your stoma’s shape. (e.g. Rounded or Oval). 

Remember to leave a margin of 1.5 – 3mm between the stoma and the appliance.

To properly measure your stoma, use the measure guide that comes with your ostomy bags. However, more often than not, these guides are made for circular stomas. If you have a loop stoma or you do not have a measuring guide yet, don’t worry, as you can use the following ones:

Download the circular stoma measuring guide.

Download the oval stoma measuring guide.

Once you have your guide, you can place it over your stoma and see what circle fits and avoid leaving too much skin exposed. It would be best if you performed this operation in front of a mirror or with the help of a small mirror to make sure you don’t miss anything. 

Next, place the measuring guide in the center of the skin barrier adhesive area and use a pencil or marker to trace the area to cut. Use wafer scissors to avoid damaging the device.

Test the wafer onto your stoma and if it fits properly, proceed with your routine. 

KEEP IN MIND: even though it is normal for your stoma to change in size and shape over time. It is important to be aware of alarming complications to avoid further issues. Contact your doctor if your stoma:

• Starts to retract, flush with your skin
• Becomes narrower 
• Is expanding outside of your abdomen

For 1-Piece Pouching System

Once you have cut the barrier to the correct size and shape, use your fingers to smooth out the edges. For a better adherence, quietly warm the adhesive by rubbing it, then remove the film and without touching the adhesive area, set the bag over the stoma and seal it with the skin.

For a 2-piece pouching system

Once you have cut the barrier to the correct size and shape, use your fingers to smooth out the edges. Remove the film, press the barrier against the peristomal skin with your fingers and practice a circular motion to make sure that the barrier is properly attached. Also. make sure that neither the skin nor the flange has any creases. 

Apply the bag onto the wafer by carefully positioning it starting from the bottom to the top to see how you apply it. 

If you are using a drainable pouch, do not forget to tie the tail.

Ostomates’ Special Concerns – Q&A

 By following these 10 easy steps we can assure you that you will notice how your peristomal skin will get healthier and more elastic day after day. 

Many ostomates have additional concerns on how to properly take care of their skin around their stoma and in the following segments you can find the useful  answers of experts that might be very helpful for you.

We suggest you to also have a look at the most asked questions about peristomal skin care routine. 

1. What color should a normal and healthy stoma look like?
2. How can I remove hair around my stoma?
3. Should I use a sponge to clean my skin around the stoma?
4. Can I use toilet paper and baby wipes to clean my peristomal skin on a daily basis?
5. What products should I use to prevent skin irritations?
6. What should I do to avoid irritated skin around my stoma?
7. When is the best time to take care of my peristomal skin?
8. How can I prevent my stoma from getting infected?
9. Which is the best pouching system for me?
10. Can I wash my stoma and peristomal skin in the shower?

What Color Should a Normal and Healthy Stoma Look Like?

• A healthy stoma is pink or red in color and moist. However, it could appear dark red and inflamed during your first week after surgery. In this case, do not worry, as your stoma will take its normal color during the following weeks.  
• Most of the time, a stoma color variation indicates that it is not receiving the blood supply it should, causing the stoma to become paler or darker. 
• If you witness a different color other than normal pink or red (e.g. dark red, purple, grey, or black) you must contact your health provider.

 How can I remove hair around my stoma?

• For a better adherence and removal of the wafer, and to reduce the possibility of skin irritation, experts suggest the removal of hair from the peristomal skin area.

• Consider using an electric razor in the direction of hair growth. Alternatively, it is also suggested to trim the peristomal skin hair with curved-tip scissors. Always pay special attention to the stoma to avoid accidental injuries. After shaving, rinse well with water and pH self-balancing detergent.

• Avoid dry shaving with a razor or depilatory creams, it could cause micro-injuries and skin infections. However, if you decide to use one of these two non-recommended methods, consider using a stoma powder or pH self-balancing moisturizing cream free of mineral oils to revitalize the skin after the shaving.

Should I use a sponge to clean my skin around the stoma?

Sponges can irritate your skin due to rough frictions and this material commonly traps unwanted germs that can, later on, cause serious complications to your peristomal skin

Can I use toilet paper and baby wipes to clean my peristomal skin on a daily basis?

Do not use toilet paper or any other paper for your hygiene routine as they could cause irritations from rubbing and leave residues on your skin and cause infections. 

Baby wipes that contain alcohol, oils, and other harsh chemicals also must be avoided. Neutral baby wipes can be used in case of emergency, but not daily.

Consider using proper wipes, specifically made for taking care of the skin near the stoma, made of a mix of cellulose and viscose that would not cause any harmful consequence.

The following tables compare the effectiveness of Toilet paper, Regular wet wipes and Specific Cloths for peristomal skin care:

* Studies show that using low-cost, ineffective remedies often results in unpleasant skin irritations that require lengthy recovery times and costly therapies. As a result, cheap solutions are less cost-effective!

What products should I use to prevent skin irritations?

Ostomates with healthy peristomal skin do not require any type of skin protector. In the case of damaged peristomal skin, it is then advisable to use products such as skin barrier cream/paste, powders, or films to alleviate irritation and itching.

These products must be used with caution. Therefore, avoid overusing them.

Avoid using barrier creams that are too greasy or they could compromise the adhesion of the pouching system.

Creams are useful for the prevention and treatment of peristomal skin irritation, but caution should be exercised.

A daily small amount of isodermic cream can prevent annoying irritations.

What should I do to avoid irritated skin around my stoma?

The best way to avoid irritated skin around your stoma is by making sure that your pouching system adheres properly on your abdomen.

Make sure that there are no creases each time that you apply a new appliance.

Remember that your stoma could change size over time, therefore check often your stoma size and shape to always have your pouching system well fitted and avoid leakages.

Take your time to check your skin each time you change your stoma appliance and consider using a tiny amount of isodermic cream to keep your skin elastic and healthy. .

When is the best Time to Take Care of my Peristomal Skin?

Each ostomate prefers a different time to change the pouching system. Contrary to popular belief, there is no best time that could fit all wearers.

To understand what time works best for you start by performing your caring routine when your stoma is less active. Therefore, most ostomates prefer to practice this procedure before or two hours after eating or drinking. 

Other people tend to take care of their peristomal skin right after a bath or shower. Some people prefer to do it in the early morning, while others prefer to do it at the end of the day.

It will really depend on your needs and preferences, just try to pick a convenient time along the day where you can execute your routine without any rush and in total comfort. 

How can I prevent my stoma from getting infected?

Skin infections can be prevented by adopting a proper peristomal skin care routine.

It is also fundamental that you change your pouching system regularly and frequently check your stoma size and colour. 

Which is the best pouching system for me?

To determine what kind of pouching system you should use, you have to take into consideration the type of ostomy you have and the consistency of your effluents.

1-piece pouching systems are usually recommended to people with colostomy that have more formed stools, requiring only one or two changes per day.

The 2-piece pouching system is more appropriate for people with ileostomy, urostomy, and ascending colostomy with more watery outputs, which will require more frequent changes along the day.

For liquid outputs, it would be best to use open-ended pouches for a more practical approach. 

However, a 2-piece pouching system is recommended for all those people who have to replace the appliance frequently, risking damaging the peristomal skin.

Therefore, if you change your device many times per day, consider using a 2-piece device.

Can I wash my stoma and peristomal skin in the shower?

Many ostomates like to take a shower without the pouching system on. As long as you use a pH self-balancing detergent for cleaning your abdomen and peristomal skin area, it is safe to have a shower without your appliance.

In case you use a pouching system with a filter, remember to cover it before bathing with one of the covers provided by the manufacturer.

Check-out this article if you want to learn more about how to shower with or without your stoma bag.

You can also consider covering your stoma with a stoma cap in case you are afraid that water could get into your stoma. However,  do not be afraid about that because there is no risk.

Let’s do it and relax. Take off your stoma appliance and enjoy your shower!