March/April 2001
Page 10
Bottoms up! Perianal Skin Care
Often times following reconnection of bowel (ileostomy closure), patients can experience seepage of mucous and small amounts of liquid stool from the anus. This may occur more frequently at night depending on the individual. Moisture combined with friction from normal physical movement such as walking, bending or frequent wiping with toilet tissue result in sore and weepy skin. The sensation is often described by patients as itching or burning. As you know, prevention is the key to maintaining good skin integrity.
Preventing Skin Problems
Care of perianal skin is instituted immediately following surgery to restore the normal process of stool evacuation. The following skin care regimen is recommended:
- Rinse the perianal area with water to completely remove all stool and mucus. Avoid soap as this can be irritating due to its alkaline base A squirt bottle (also known as an episiotomy bottle) or basting-type syringe can be used to rinse. Some people prefer a sitz bath for the soothing effect as well as for rinsing.
- Cleanse the skin gently with cotton balls, lucks wipes, or a baby wipe. Use a patting motion rather than wiping or scrubbing Avoid washcloths, as these can be rough on the skin.
- Allow area to dry completely by patting, fanning, or using a hair dryer on a cool setting.
- Apply protective barrier cream or ointment to the entire area around the anal opening. Use a thick layer to ensure adequate protection. You can purchase many of these products over the counter. A few recommendations include Desitin, A & P Ointment, Vaseline, Calmoseption, Smith & Nephew Extra Protective Cream and Sween Baza-Pro cream.
- Position a dry, soft dressing between buttock such as a strip of cotton roll, 4" x 3" dressing sponge or soft paper towel. Avoid synthetic fibers, as these do not absorb as well.
- Cotton underwear is suggested to promote air circulation to skin. This prevents moisture build up, which can lead to a fungal rash.
- Change dressing and repeat cleansing process after each bowel movement.
Dietary considerations
Food items which produce gas, indigestion and loose movements should be avoided. Foods associated with irritation of the bowel producing mucus or aggravating drainage include tomatoes, citrus fruits and juices, caffeinated beverages, alcoholic beverages, nuts, popcorn, milk, spices, chocolate and all types of peppers. People have varying degrees of sensitivity to these foods. Everyone is different, so limit only the foods with which you have problems. Food which safely bulks the stool such as bread, potatoes, pasta, rice, bananas, cooked cereal, and applesauce will slow the bowel peristalsis, producing a thicker consistency with fewer bowel motions. This allows more time for the bowel to absorb the fluids, cell salts (or electrolytes) and digestive enzymes. Therefore, a stool that is less watery and caustic will be less irritating to the skin. Some patients may need to add fiber in the form of over the counter medication such as Metamucil, Citrucel, or Fibercon when dietary fiber alone is not enough. Check with your physician before using additional fiber.
From The Cleveland Clinic's Pouch-O-Gram, December 2000, from http://www.clevelandclinic.org/cors/, via Inside Out On-line Mar/Apr 2001
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