Question:

Just recently the skin around my Ileostomy has become bright red and moist. My Coloplast appliance will not stick even using adhesive paste and window paning with paper tape. Can you help?

Response:

It sounds like there is effluent leaking from under the flange. Window framing the appliance promotes pocketing of effluent under the flange between the seal and the outer part of the flange, causing skin breakdown. The goal is to prevent the effluent from breaking the flange barrier. Here are some steps and questions to consider:

1. Assess Changes in Abdomen Shape

Have you gained or lost weight, causing your abdomen shape to change? For example, dimples or bulges around the stoma, or a hernia causing increased curvatures at the stoma site. If so, you may need to:

  • Use stoma strips to level the skin around the stoma before applying stoma paste and/or skin strips and the flange.
  • Consider a convex flange.
  • Use an appliance belt to help secure the flange and maintain a longer seal.

2. Dealing with Macerated Skin

Steps to treat and protect your skin:

  • If possible, lie down with the flange off for several minutes (the best time is before eating in the morning).
  • Cleanse the area and pat dry.
  • Dust the area with stoma powder.
  • Once the area is dry or close to dry, apply No Sting Skin Barrier wipes or spray around the stoma and let it dry.
  • Dust with more stoma powder and blow off any excess.
  • Apply another layer of No Sting Skin Barrier and allow it to dry.
  • Fill in dips and crevices to make the skin level using stoma strips or stoma paste.
  • Apply the flange, ensuring it is the correct size around the stoma (should be 1/8 inch larger than the stoma).
  • Using warm fingertips, press down on the inner flange, rotating fingers to cover all areas for about 2 minutes to achieve a good seal.
  • Secure with an appliance belt.
  • For some, lying on their back for 10 minutes with a hand over the flange/pouch can help increase adherence due to the warmth of the hands.

If you follow these steps and still experience issues, consider consulting with your healthcare provider for further advice and assistance.

Warm Regards,

Karen Bruton, RN BScN MCISc-WH WOCC(C)
Nurse Education Consultant – Interprofessional Practice Support
Indigenous Services Canada, Government of Canada
Ostomy Canada (Volunteer)
Medical and Lifestyle Advisory Team Lead

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