Try to change your pouch when your stoma is less active. It may take some time to get to know or recognise a pattern but it may help to make changing quicker and easier. Applying a pouch may be easier if the flange is warmed slightly, holding it between your hands for a short while will bring it to body temperature.
If you have wrinkles or folds in the skin around your stoma, try standing or changing position to stretch the skin, it will give you a better fit. Always check for nicks or faults before using a pouch. Your pouch must fit properly around your stoma to help prevent sore skin and reduce the possibility of leakage; use the backing from the flange to check the pouch has been cut to the right size for you. If you need your pouch cut to size, perhaps because you find it difficult or you are short of time, we are able to do this for you, free of charge.
Use the “up and over” technique to apply your pouch. Remove the backing paper, almost fold the flange forwards in half and starting at the bottom of the flange and stoma edge, stick the flange to the skin bringing it up and over the stoma. Once the pouch is in place run your fingers around the edge to check for any crease or folds. You can then place your hand over the pouch for 30 seconds and the heat from the hand helps the pouch adhere and conform to the body shape. This technique is easier to demonstrate and if in doubt you can contact your stoma nurse for guidance.
Having a stoma does not mean you need to have any special clothing; you should be able to dress just as you always have. High-waisted clothes are often more comfortable and hide your pouch. Ask for your pouch flange to be cut off-centre toward the top of the flange, this will make it hang lower and more discreetly.
Many people find that tucking their pouch into their underwear makes them feel more secure, but you can let it hang outside if you prefer. A large capacity appliance shows less than a small one when full, handy to remember when away from home. Lycra type clothing provides excellent and effective support so look out for these in the high street stores. Support wear is available, often on prescription.
If you wear an appliance belt, make sure it is at the same level as the stoma to avoid an upward drag. Make sure that your belt or trouser waist lines do not rub on your stoma, this can be very uncomfortable. A sports protector (like a cricketer’s box) can be worn to protect the stoma while playing physical contact sports. Patterned swimming costumes mean your pouch is less visible; also a tankini with a high waist can be quite discreet.
Common Stoma Problems
There are all sorts of issues that arise when you have a stoma. Here are some of the more common problems which may occur and some helpful tips for things you can do to combat or event prevent them.
Sore skin around the stoma can occur when:
Base plates are changed too often
In some cases base plates do not need changing as often as pouches and it may be worth trying a two-piece system, which allows you to change a pouch without always having to change a base plate.
There is leakage of output onto the skin
To avoid leakage make sure that your stoma is measured on a regular basis and the base plate size changed accordingly. This is particularly important if you have experienced any kind of weight change which in turn may alter the size of your stoma. A belt can also be worn with two-piece and convex appliances to help prevent them leaking.
Hair follicles become inflamed
This can be due to improper shaving of the area. If you do shave the area, make sure it is not too often and that adequate hygiene is maintained. A clean disposable razor must be used each time.
Soap is used to wash the area
Instead of soap use water and dry wipes or a mild unperfumed soap. Fittleworth supply complimentary dry wipes to help with this. Please note that many nurses recommend that you do not use wet wipes on or around the stoma as this can cause irritation.
If you do use wet wipes and suffer from sore skin, try stopping for a while and only use dry wipes and water, to see if your skin improves.
You are sensitive to the adhesive, other products or to certain foods
To help with this try some alternative appliances or use skin protectors such as protective wafers or wipes.
Sweating occurs due to the plastic pouch sitting close to the skin
To stop sweating, particularly in hot weather, you can use a cotton pouch cover which is placed over the top of the plastic pouch. These are available on prescription through Fittleworth.
A skin protection film can be used on sore skin to help the appliance adhere. For very sore skin a `skin blanket’ can be applied onto the skin before putting on a new appliance which also acts as a skin barrier between the skin and the adhesive. Large areas of skin that are red, sore and weeping (always wet) may prevent you from getting a good seal around your stoma. It is important to treat minor irritations before they worsen. If you have any irritation or sore skin that does not clear up after a few days contact your stoma nurse.
You may notice slight bleeding from the surface of your stoma. This is normal and can be caused by cleaning the stoma too harshly. It is also normal for some stomas to bleed when you change your pouch. Take care when changing your pouch and cleaning the area. If the bleeding persists or you have any other concerns then you should contact your stoma nurse for advice. Bleeding can also be caused by friction from an ill-fitting appliance. To help reduce this you can use a stoma paste and check the size of your stoma is the same as the hole being cut in your base plate. Your stoma nurse can assist you with this.
If there is blood in the contents of your pouch, seek medical advice.
The presence of excessive flatus (wind) can dislodge your pouch and cause leakage. Different types of food and drink consumed could cause excessive wind, and will affect different people in different ways. It is helpful to keep a diary of your intake as this will allow you to see if there is a particular food or drink that is causing the problem. Remember that most people find that foods which have previously caused them upset will still generally have the same effect.
To aid reduction of wind:
Eat meals slowly and chew food well, try to eat without talking, eat small/medium regular meals, try not to miss a meal, do not consume liquids during meals and avoid fizzy drinks.
Take peppermint oil, tablets or tea. Try charcoal tablets which may also have a deodorising effect
Once you have identified foods that give you wind, gradually re-introduce them, but eat them in moderation and in convenience with your lifestyle. Excessive wind can also cause `ballooning’; where the pouch inflates. To avoid this you can either change to a pouch with a double filter, or obtain extra filters from us free of charge.
If you notice any unpleasant odours from your pouch it may be that you have developed a leak – you should check that the pouch is fitted correctly to avoid this. Remember that some foods will also increase odour, particularly if eaten in large quantities – these include: Baked beans, onion, egg, certain cheeses, peas, cabbage, fish and alcohol.
There are many different odourisers available in the form of sprays or drops which are inserted into your pouch, all of which are available on prescription through Fittleworth.
`Pancaking’ is caused by firmer stools sticking to the stoma and not moving down into the pouch correctly. It can cause problems often leading to leakage and sore skin.
Below are several ways that may help to reduce pancaking:
- Rub a small amount of baby oil into the top of the pouch, avoiding the filter, which will help the stools to slide into the bag.
- Add a filter cover to the filter to prevent too much air escaping and keep the sides of the pouch apart.
- Place a small piece of screwed up tissue or cotton wool inside the pouch, again to keep the sides apart.
- Increase your fluid intake to help soften stools.
- Try blowing some air into the pouch before applying it.
There are specific accessories and products available on prescription which can assist with pancaking. For more information please contact your stoma care nurse or speak to one of Fittleworth’s Customer Service team
If you need any help or advice, please contact our Customer Care Team:
National: 0800 378 846
Scotland: 0800 783 7148