How to clean your ostomy site - Healthy Blue Zone

Mastering Your Ostomy Care: A Definitive Guide to a Clean and Healthy Stoma Site

Living with an ostomy is a journey of adaptation, and central to a fulfilling life with one is mastering the art of stoma site care. Far more than a simple hygiene routine, proper cleaning of your ostomy site is a cornerstone of preventing complications, promoting skin health, and ensuring your comfort and confidence. This comprehensive guide will equip you with the knowledge and actionable steps to meticulously care for your stoma, transforming a potentially daunting task into a routine that empowers you. We will delve into the nuances of preparation, technique, troubleshooting, and long-term maintenance, ensuring every aspect of your stoma care is addressed with precision and clarity.

The Foundation of Flawless Care: Understanding Your Stoma and Peristomal Skin

Before we immerse ourselves in the “how-to,” it’s crucial to understand the “why.” Your stoma, the surgically created opening, is a delicate and vital part of your body. The skin surrounding it, known as the peristomal skin, is equally important and highly susceptible to irritation if not properly cared for.

Your Stoma: A Unique Marvel: Your stoma should be moist, shiny, and typically pink or red, similar to the inside of your mouth. It has no nerve endings, so it won’t be painful to touch. You may notice small amounts of bleeding when cleaning, especially initially, which is generally normal due to the rich blood supply. However, excessive or persistent bleeding warrants a call to your healthcare provider. The size and shape of your stoma may change over time, especially in the first few weeks or months after surgery, so regular assessment is key.
Peristomal Skin: Your Protective Barrier: The peristomal skin is the guardian of your stoma. Its health directly impacts the adhesion of your ostomy appliance and your overall comfort. Healthy peristomal skin should look like the skin on the rest of your abdomen – intact, smooth, and free from redness, rashes, or breaks. Any signs of irritation, such as itching, burning, or redness, are indicators that your care routine needs adjustment and immediate attention to prevent further complications.

Understanding these fundamental aspects sets the stage for a proactive and effective stoma care regimen.

Essential Preparations: Setting the Stage for Success

Proper preparation is not just a preliminary step; it’s an integral part of a successful ostomy site cleaning routine. Rushing or neglecting these initial steps can lead to inefficiencies, frustration, and even potential complications.

Gathering Your Arsenal: Before you even think about removing your old appliance, have everything you need within arm’s reach. This eliminates the need to search for supplies mid-change, minimizing exposure time for your stoma and reducing the risk of accidental leaks. Your essential supplies include:
- New Ostomy Pouch and Skin Barrier (Wafer): Always have a fresh, appropriately sized appliance ready. Double-check that it’s the correct type for your stoma and flow.
- Warm Water: A basin or pitcher of lukewarm water is ideal for cleaning. Avoid hot water, which can irritate the skin.
- Soft Washcloths or Non-Woven Wipes: Opt for soft, disposable, non-woven wipes or a very soft washcloth. Avoid abrasive materials like paper towels or rough cloths, which can scratch delicate skin.
- Mild Soap (Optional, and with Caution): For most routine changes, plain warm water is sufficient. If you choose to use soap, it must be mild, pH-neutral, and free of oils, perfumes, and deodorants. Examples include baby wash or specific ostomy cleansing wipes. Always rinse thoroughly if using soap.
- Barrier Powder (if needed): For moist or irritated skin, barrier powder can help absorb moisture and provide a protective layer.
- Skin Barrier Wipes or Sprays (if needed): These products create a protective film on the skin, enhancing adhesion and protecting against irritation from effluent.
- Adhesive Remover Spray or Wipes (if needed): For stubborn adhesive residue or sensitive skin, an adhesive remover can make the process more comfortable. Choose alcohol-free options.
- Scissors (if needed): If your barrier needs to be cut to fit your stoma, ensure you have sharp, clean scissors specifically for this purpose.
- Measuring Guide: Essential for accurate cutting of your barrier to prevent leaks and skin irritation.
- Disposal Bags: For discreet and hygienic disposal of your used appliance.
- Mirror (Optional): A small handheld mirror can be helpful for visualizing your stoma, especially during the initial stages of self-care.
Hand Hygiene: Your First Line of Defense: Before touching any supplies or your stoma site, thoroughly wash your hands with soap and warm water for at least 20 seconds. This is paramount in preventing the introduction of bacteria and potential infections. If soap and water aren’t available, an alcohol-based hand sanitizer (at least 60% alcohol) can be used, but handwashing is always preferred.
Choosing Your Cleaning Environment: Select a private, well-lit, and comfortable space. A bathroom is often convenient due to access to water and a toilet for emptying the pouch. Lay down a clean towel or disposable pad to protect surfaces from any accidental spills. Ensure you have ample time and won’t be rushed, as this can lead to errors.

The Art of Removal: Gentle and Respectful Detachment

Removing your old ostomy appliance is a crucial step that demands gentleness and precision. Improper removal can cause skin stripping, leading to pain and irritation.

Empty the Pouch: Before removal, empty the contents of your ostomy pouch into the toilet. This reduces weight and makes the removal process cleaner and more manageable. Rinse the pouch if it has a drainable opening to remove any residual output.
Slow and Steady Wins the Race: Begin at the top of the skin barrier, or wherever it feels easiest to lift. Gently peel the barrier away from your skin, pushing your skin down and away from the adhesive with your free hand. Imagine you are “peeling the skin away from the barrier,” rather than pulling the barrier off the skin. This minimizes trauma to the peristomal skin.
Support Your Skin: As you peel, continuously support the skin around the stoma. This counter-pressure prevents the skin from stretching and tearing, a common cause of skin irritation. If the adhesive is particularly strong, an adhesive remover spray or wipe can be used to gently loosen it. Apply the remover around the edges of the barrier and allow it a moment to work before continuing to peel.
Observe and Assess: Once the appliance is removed, take a moment to observe your stoma and the surrounding peristomal skin. This is your opportunity to detect any changes, such as redness, irritation, rashes, or changes in stoma color or size. Early detection allows for prompt intervention. Note the condition of the used barrier as well – excessive output under the barrier could indicate a poor fit or a need for more frequent changes.
Disposal: Place the used appliance in a disposal bag and seal it tightly before discarding it in the regular trash. Do not flush ostomy appliances down the toilet, as they can clog plumbing.

The Core of Care: Meticulous Cleaning of Your Stoma Site

This is where the true “cleaning” happens. The goal is to gently remove all traces of old adhesive, any output, and leave the skin clean and ready for the new appliance.

Warm Water First: Start by gently cleansing the stoma and the peristomal skin with lukewarm water using your soft washcloth or non-woven wipes. Work from the stoma outwards in a circular motion. This helps to move any effluent away from the stoma and prevent contamination of surrounding skin. Do not scrub or rub vigorously. Gentle patting and wiping are all that’s needed.
Addressing Effluent and Residue: If there’s any stool or urine on the stoma or skin, continue to gently wipe it away with clean, moist wipes until the area is visibly clean. If you encounter stubborn adhesive residue that wasn’t removed with the initial peel, a small amount of adhesive remover can be applied to a wipe and gently rubbed on the affected skin. Always ensure the adhesive remover is completely evaporated or wiped away before applying a new barrier, as residue can compromise adhesion.
Soap: Use with Discretion: As mentioned earlier, plain warm water is often sufficient. If you opt for soap, dispense a very small amount of a mild, pH-neutral, oil-free, and fragrance-free soap onto a damp washcloth. Gently cleanse the peristomal skin, avoiding direct application to the stoma itself. Immediately and thoroughly rinse the area with clean water to remove all soap residue. Any soap left on the skin can interfere with barrier adhesion and potentially cause irritation.
Stoma Care Itself: The stoma itself generally doesn’t require separate cleaning with soap. The warm water that flows over it during the skin cleaning is usually enough. If there’s any dried output on the stoma, gently wipe it away with a moist wipe. Remember, your stoma has no nerve endings, so gentle contact won’t cause pain.
Drying is Paramount: This step cannot be overemphasized. The peristomal skin must be completely dry before applying a new skin barrier. Moisture is the enemy of adhesion and a breeding ground for bacteria and fungal infections. Gently pat the skin dry with a clean, soft towel or allow it to air dry completely. You can also use a hairdryer on a cool setting, held at a safe distance, to aid in drying. Ensure there’s no visible moisture or dampness.

Addressing Common Peristomal Skin Concerns During Cleaning

While the core cleaning steps remain consistent, you might encounter specific skin issues that require a tailored approach. Identifying and addressing these promptly is crucial for maintaining peristomal skin integrity.

Redness and Irritation: If you notice general redness or a feeling of irritation, assess your cleaning technique. Are you scrubbing too hard? Is there soap residue? Ensure thorough rinsing and gentle patting. Using a barrier wipe or spray before applying the new appliance can provide an extra layer of protection.
Moisture-Associated Skin Damage (MASD): This often appears as red, weeping, or broken skin, usually due to exposure to stool or urine. After cleaning and drying, apply a thin layer of barrier powder directly to the affected, moist areas. Gently blot off any excess powder. The powder helps absorb moisture and allows the skin to heal. Follow with a barrier wipe or spray to seal the powder and create a smooth surface for the new appliance.
Fungal Infections (Candida): These often present as a red, itchy rash with small satellite lesions. While cleaning, be extra gentle. After drying, apply an antifungal powder (prescribed by your healthcare provider) directly to the affected area. Again, blot off excess. It’s crucial to address fungal infections promptly, as they can severely compromise appliance adhesion.
Folliculitis: Inflammation of hair follicles around the stoma, often appearing as small red bumps or pustules. This can be caused by pulling hair during appliance removal or shaving. If you shave, do so in the direction of hair growth, not against it. Clean gently and consider using a barrier wipe to minimize friction.
Hyperplasia (Pseudoverrucous Lesions): These are benign, wart-like growths that can occur around the stoma due to chronic exposure to moisture. They are often firm and may bleed easily. Cleaning should be gentle, and meticulous drying is essential. Consult your ostomy nurse or healthcare provider for specific management.

Remember, if you have persistent or worsening skin issues, do not hesitate to contact your ostomy nurse or healthcare provider. They can provide a proper diagnosis and recommend specific treatment.

The Art of Application: Securing Your New Appliance

Once your stoma site is impeccably clean and dry, the final step is applying the new ostomy appliance. This step is equally critical for preventing leaks and maintaining skin health.

Measure and Cut (if applicable): If you are using a cut-to-fit barrier, use your stoma measuring guide to determine the exact size and shape of your stoma. Trace this outline onto the back of the barrier. Using sharp, clean scissors, carefully cut the opening, ensuring the edges are smooth. The opening should be no more than 1/8th of an inch (approximately 3mm) larger than your stoma. An opening that’s too small can constrict the stoma, while one that’s too large exposes the peristomal skin to effluent.
Warming the Barrier: Many ostomy barriers are activated by body heat. Gently warm the adhesive side of the barrier between your hands or with a hairdryer on a low, cool setting for a few seconds. This can enhance its initial tack and improve adhesion.
Positioning and Application: Remove the protective backing from the adhesive. Carefully center the opening of the barrier over your stoma. Take your time to ensure proper alignment. Once positioned, gently press the barrier onto your skin, starting from the area immediately around the stoma and working outwards to the edges. Apply firm, even pressure for 30-60 seconds, paying particular attention to the area around the stoma and the edges of the barrier. Your body heat will further secure the adhesion.
Attaching the Pouch (if a two-piece system): If you are using a two-piece system, attach the pouch to the flange on the skin barrier, ensuring it clicks securely into place or forms a tight seal, depending on the coupling mechanism. Gently tug on the pouch to confirm it’s securely attached.
Final Check: Once the entire appliance is in place, gently run your fingers around the edges of the barrier to ensure full contact with your skin. Check for any wrinkles or folds that could compromise the seal. Take a moment to ensure the pouch is positioned comfortably and won’t be easily snagged.

Beyond the Basics: Advanced Tips for Optimal Care

Maintaining a healthy stoma site goes beyond the routine cleaning steps. Incorporating these advanced tips can further enhance your comfort and minimize complications.

Regular Assessment is Key: Make it a habit to regularly inspect your stoma and peristomal skin, not just during appliance changes. Look for any changes in color, size, shape, or skin integrity. Early detection of issues allows for timely intervention. Consider taking photos periodically to track changes, which can be helpful when consulting with your healthcare provider.
Scheduled Appliance Changes: While individual needs vary, establishing a consistent schedule for appliance changes is crucial. Most people change their barrier every 3-5 days. Waiting too long can lead to adhesive breakdown, leaks, and skin irritation. Changing too frequently can also strip the skin. Find a schedule that works for your body and your appliance, and stick to it.
Hydration and Nutrition: A healthy body supports healthy skin. Ensure you are adequately hydrated and maintaining a balanced diet. Proper nutrition can aid in skin healing and overall well-being.
Ostomy Support Products: Explore the wide range of ostomy support products available. These can include:
- Belts: Ostomy belts can provide additional security and support, especially for active individuals or those with certain stoma configurations.
- Paste or Rings: Ostomy paste or barrier rings can be used to fill in uneven skin contours around the stoma, creating a flatter surface for the barrier and preventing leaks.
- Deodorants: Pouch deodorants can help manage odor, offering increased confidence.
Physical Activity: Don’t let your ostomy limit your physical activity. Regular movement promotes circulation and overall health. With proper appliance management and support, most activities can be enjoyed. Consider ostomy-specific swimwear or protective covers for water activities.
Travel Considerations: When traveling, pack extra ostomy supplies, including enough for unexpected delays. Keep a small kit of essential supplies in your carry-on luggage. Research local ostomy support resources or suppliers in your destination.
Managing Output: For some individuals, output can be quite liquid. Consider using gelling agents or thickeners within the pouch to solidify output, making emptying easier and reducing the risk of leaks.
Addressing “Pancaking”: This occurs when stool collects around the stoma, rather than dropping to the bottom of the pouch. This can be caused by a vacuum in the pouch. To prevent it, try inflating the pouch slightly before applying it, or consider using a lubricating deodorant within the pouch.
Dietary Awareness: While ostomy surgery doesn’t usually require a highly restrictive diet, some foods can cause gas or change stool consistency. Pay attention to how different foods affect your output and adjust your diet accordingly. Keeping a food diary can be helpful.

When to Seek Professional Guidance: Recognizing Red Flags

While this guide provides comprehensive information, there are times when professional medical advice is essential. Do not hesitate to contact your ostomy nurse, general practitioner, or surgeon if you experience any of the following:

Persistent or Worsening Peristomal Skin Irritation: Redness, itching, burning, or pain that doesn’t improve with careful cleaning and product adjustments.
Skin Breakdown or Open Sores: Any signs of broken skin, ulcerations, or deep wounds around the stoma.
Changes in Stoma Appearance: Significant changes in stoma color (e.g., dark purple or black), shape, or if it appears to be receding or prolapsing.
Excessive Bleeding from the Stoma: While small amounts of bleeding during cleaning are normal, heavy or continuous bleeding is not.
Signs of Infection: Fever, chills, unusual discharge from the stoma, increased pain, or swelling around the stoma site.
Persistent Leaks: Despite trying different products or techniques, if you are experiencing frequent leaks, it indicates a problem with your appliance fit or care routine.
Odor that Cannot be Controlled: While some odor is normal during emptying, persistent and strong odor from the pouch that isn’t resolved with deodorants may indicate a leak or an issue with the appliance.
Hernia Around the Stoma: A bulge or swelling around the stoma area could indicate a parastomal hernia.
Any Concerns You Have: If something doesn’t feel right or you have questions about your care, it’s always best to consult with a healthcare professional.

Your ostomy nurse is an invaluable resource and should be your first point of contact for any ostomy-related concerns. They possess specialized knowledge and can provide personalized guidance and support.

Empowering Your Ostomy Journey: A Concluding Perspective

Mastering the art of cleaning your ostomy site is more than just a task; it’s an act of self-care and empowerment. By understanding your stoma and peristomal skin, meticulously preparing, employing gentle techniques, and proactively addressing any challenges, you can ensure a healthy, comfortable, and confident life with an ostomy. This guide has provided a definitive roadmap, but remember that your journey is unique. Embrace the learning process, be patient with yourself, and never hesitate to seek support from your healthcare team. With consistent, informed care, your ostomy site will remain a testament to your resilience and commitment to well-being.