Stoma care

There are so many different opinions on stoma care and ultimately you will have to find out what works best for yourself, but there are some general guidelines that will help you on your way to a happy and irritation-free stoma!

Yes - there is a hole in your belly and yes, it will take some time for your body to adjust to that foreign object because that's what your tube or your button is to your body, but there is no reason to believe that your stoma always has to be irritated and angry looking.




that's a healthy stoma - and yes, you can get there too!
(now that I am not feeding into my stomach anymore and have gotten rid
of the balloon type tube that unfortunately doesn't seal the stoma as well from the inside,
my stoma site looks even better)

My stoma did not always look like that. After 6 weeks I had my first stoma infection and luckily my dietician got me in to see the head of the Infectious Disease department at our university hospital. A culture was taken, and I was put on Medihoney Antibacterial honey until the sensitivity report came back. Medihoney has natural antibiotic properties and it is used regularly at the university hospital here in Vienna for treating severe infections. When the sensitivity report came back and showed some really nasty bugs, the Medihoney had already worked so well that I didn't even need antibiotics. Once I got over my stoma infection, I then developed my first round of granulation tissue, followed suit by a nasty case of contact eczema right around my stoma site. My dermatologist kept prescribing steroid creams for the eczema and every time I tried to get off them, it would come back with a vengeance. I then finally went to see an enterostomy care nurse and her suggestions, ideas, and knowledge made all the difference.

I have now become an expert in my own stoma care and this is what you can become too - find out what your stoma needs and be your own expert!


A stoma-care-photo-story:

That's what you need:

  • running water
  • hand washing soap
  • two cotton gauze swabs
  • barrier cream
  • scissors
  • one synthetic gauze swab (non-woven dressing) i.e. Sorbalux Drain sponge (about 2.5x2.5 inches)
First wash your hands with soap.



After drying your hands then take a cotton gauze swab and wet it with warm water.


Gently wipe away the gunk from your stoma - it is very important to try to wipe from the inside to the outside of the stoma, also clean the bottom of the external bolster of your button /g-tube.

 


With another piece of gauze dry off your stoma site.


 
 
I strongly recommend applying barrier cream around your stoma to protect your skin and stoma from leakage that might occur. (I use ZCR zinc cream by D-line, but I have heard that Calmoseptine cream is supposed to be really good as well.) With my PEG/J my stoma is well sealed from the inside and I have recently been able to stop using the barrier cream, I now only use St. John's wart oil after cleaning it.




Because I don't like the available dressings, my enterostomy nurse taught me how to cut up a regular Y-slit dressing to fit my needs. Generally speaking, cotton (woven) gauze dressings are not as good as synthetic (non-woven) gauze dressings (i.e. from Topper, Hartmann). Cotton gauze dressings have loose threads along the y-slit and these threads like the get stuck inside the stoma, something I don't care for at all. Also the synthetic gauze dressings soak up the moisture a lot better.

Here is what I do: (I use Sorbalux Drain and IV non-woven sponges.)
(click on the pics, to enlarge them.)

I love using the Y-slit dressings because I can cut them up easily, but this can be done with any type of swab.

I hold the dressing with the slit facing towards my scissors.


I then cut off the right and the left "flap" of the Y-slit - all you can see afterwards is a rectangle with a triangular top.



Afterwards, I cut off about a cm from the left and the right of the rectangle to make it smaller.




I then fold the dressing so the two small sides of the rectangular shape are on top of each other.



And fold it again.




Cut off the top corner ....



This is the result:  
 
 

Then unfold the swab again:

 


Then make a slit towards the hole in the middle...


On now the final touches....

slide the dressing underneath the button

 


Cut or rip off a piece of medical tape


Fixate the slit with the tape, so it won't slide off... - first I put it on the back of the dressing


fold it over the top and put it on the front of the dressing...
DONE!


Here is my wisdom on stoma care:

Less is more - when it comes to stoma care!
Excessive cleaning, using antibacterial cleansing solutions, wipes etc. will only make your stoma more fragile and susceptible to infections. We all have some bacteria on our skin that helps maintain a healthy skin. Using antibacterial soaps etc. will kill off these friendly bacteria as well! Your stoma does not need to be cleaned more than once or twice a day.

Don't use antibiotic creams, steroid creams, or antifungal creams on a regular basis!
These creams all have their purpose, and sometimes it can be necessary to use those creams, but there is no need to use them on a regular basis. On the opposite, repeated use of antibiotic creams will make your stoma more susceptible to stoma infections, steroid creams makes your skin really thin and therefore stoma infections are more likely to occur - the same goes for antifungal creams as well.

Dressing or no dressing - that's the question!
When it comes to using a dressing, I have heard so many different opinions. There are g-tubers, doctors, and nurses who promote not using a dressing for a healthy stoma and the other way round.
I have tried it both ways, and I have come to the decision that my stoma likes to have a dressing, it soaks up all the leakage and leaves my stoma drier and therefore healthier. I have also found that leakage encourages granulation tissue growth, therefore keeping your stoma dry is even more important.

Barrier creams are the stoma's best friend!
I always had a very irritated and inflamed looking stoma site - not infected, but irritated and some very resistant granulation tissue. I do have a bit of leakage and even with using a dressing some stomach contents leak onto my skin around my stoma and due to the acidity of the stomach contents and also the added moisture, my skin became very irritated.My enterostomy care nurse suggested using a barrier cream to me (ZCR cream by D-line).
After only two weeks all my irritation was gone and my granulation tissue started to subside as well. I have not had an irritated or red looking stoma ever since I started using a barrier cream. I therefore strongly recommend using barrier cream on your stoma. Barrier cream will help your skin stay intact and healthy - and bacteria have less chance to grow on healthy, intact skin.

The issue with the granulation tissue!
Granulation tissue actually is a good sign. It means your body is actively trying to heal itself and get rid of that foreign body a.k.a the feeding tube.
When it comes to granulation tissue, it is very important to have your tube secured as well as possible. The more movement you have, the more friction you have inside your stoma tract and the more friction you have, the more granulation tissue growth you will have.
If you have a button tube, it is important to have a good, tight sitting button to ensure less movement and also less leakage. As I have written before, leakage will make granulation tissue grow more too.
Still, granulation tissue is not something you have to live with. While some doctors and nurses promote laser treatment or the use of silvernitrate sticks to burn off granulation tissue, I have heard that these treatments will actually promote the growth of granulation tissue and will not get rid of it completely. Even my enterostomy care nurse suggested to burn the granulation tissue of, but I decided to try it the natural way. Here are my suggestions - that's what worked for me:
  • St. John's wort oil (a few drops on a q-tip and applied onto the granulation tissue twice a day)
  • swimming in the ocean :-) - or using saline solution instead of water when cleaning
  • Medihoney Antibacterial honey (applied twice daily)
  • using a good barrier cream

Stoma infections can be prevented!
Keep your stoma dry and your skin healthy. If you think your stoma is starting to get irritated or inflamed - don't wait until you have a full blown infection. Use Medihoney Antibacterial honey twice daily for a few days, this might help your stoma turn that infection corner. I can always tell when my stoma is starting to get "out of balance", I always use Medihoney for a couple days or more, until I feel my stoma is healthy again. Of course, if you suspect you have a full blown infection, please see a doctor for a wound culture and possibly antibiotics. I also use Medihoney as a preventive measure after a button change, as button changes usually mean that I rip myself open somewhere along the stoma tract.