A. I want to take this opportunity to clarify the often repeated, albeit inaccurate, statement that stomas have no nerve endings and therefore feel no pain.
While the stoma may have diminished sensory nerve fibers, it is not true that the bowel has no nerve endings. There are different types of nerve fibers. Some of the nerve fibers scattered throughout the bowel regulate or respond to tactile stimuli and others respond to or regulate motor (motility) and hormonal functions. Normally, the stoma has diminished sensitivity to normal touch or painful stimuli across its mucosal surface, however it still possess other (motor) nerve endings that allow stool movement via peristalsis, and the obvious wiggling so readily seen.
It is this apparent lack of sensory nerve fiber response that may "allow" a stoma to suffer injury without feeling the pain associated with the initial injury - a cut stoma is the classic example. However, the bowel, of which the stoma is a part, can feel pain when it is stretched, swollen or inflamed. Think back to those times when one has experienced an intestinal blockage or an acute flare of inflammatory disease as two typical examples. During these moments of distress the bowel will be quite uncomfortable (experience visceral pain) and the person will readily acknowledge painful distress.
I know I am drawing a fine point of distinction here; however, I do not want folks to continue to repeat an inaccurate or misleading statement that the stoma feels no pain because it has no nerve endings.
Additionally, it needs to be pointed out that some folks may well experience a painful response to a stomal injury while others may not. It is not always clear to us why this is so, however we cannot arbitrarily rule out a genuine source of the pain, be it physiological, psychological or both.
To answer your question, it depends on where the irritation on your stoma occurs. If the irritation is starting at the base of the stoma, you might have the wrong size skin barrier opening. Your stoma is still relatively new, you should consider re-measuring it. If you do not change the size of your skin barrier opening to reflect the accurate size of your stoma, the effluent may sit on your skin creating irritation, or if is too small, may rub or cut the stoma, or create bumps.
Remember: if you gain or lose weight, the base of the stoma may change in size, therefore cut-to-fit skin barriers may benefit you.
Sometimes skin irritations are caused by pouching systems that are worn too long. The key is to observe the erosion of your skin barrier after you take it off. You may need to adjust the frequency of your pouch changing routine.
There are other reasons for peristomal skin irritations and stoma bumps. If a rash is away from the stoma, it could be a yeast infection, contact dermatitis or an allergic reaction. You should consider making an appointment with your ostomy nurse. This will ensure that you receive an accurate diagnosis and find the source of the problem.
