Inside Out (Nov 07)

November 2007
Page 8

The Good,The Bad,The Ugly

The Good

An ostomy should look like a rose bud. It should be pink, protrude an inch or so and be circular or minimally ovoid to permit application of a leak proof device. For proper placement of the skin barrier, the stoma should be away from bony points, surgical scars and the belly button, and it should not lie in a skin fold when the patient changes positions. Finally, clothes or belts should not constrict it.

The Bad

Compromise of any of the above features results in a bad stoma, since a leak proof seal is not always obtainable. In addition to improper location or construction, narrowing (stenosis), prolapse of the stoma and peristomal hernia affect drainage and the ability to apply an adequate device. The patient has little control over the previous factors, but we patients create stomal problems for ourselves, if we gain or lose 20 or more pounds in weight, permit abdominal muscles to become flabby, or strain excessively at work or play.

Two problems peculiar to urostomies are also under control of patients. The first is encrustation of the stoma and surrounding skin by white, alkaline crystals. Urinary alkalinity can be reduced by increasing fluid intake and the use of Vitamin C, both, under medical supervision. The WOC nurse may also suggest washing the area with a dilute solution of vinegar in water. Secondly, skin around a urostomy may thicken and become wart-like, if it is constantly bathed in urine because of too large an opening in the skin barrier. The management is obviously to re-measure the stoma and apply a suitable skin barrier.

The Ugly

Ugly lesions affect the appearance of the area and cause local irritation and discomfort but they usually do not affect stomal function. Irritant dermatitis or skin excoriation occurs when intestinal contents seep under the seal or skin is stripped upon removal of the skin barrier. A WOC nurse is crucial in resolving the problem. Allergic contact dermatitis is the result of delayed sensitivity to materials in the skin barrier. It is corrected by eliminating contact between the offending agent and the skin. On occasion, local corticosteroids are prescribed.

A yeast-like fungus from the patient’s own intestines, Candida Albicans, can flourish on the moist, warm, protected skin around the stoma. Cure generally requires the use of a micro granulated anti-fungal powder on the infected skin and keeping the area as dry as possible.

Irritation and infection of hair follicles occurs if hair is pulled out from its root. This condition, folliculitis, is prevented by removing the adhesive gently and clipping hair in the area with scissors or an electric shaver.

SOURCE: The New Outlook on-line, UOA Chicago, October 2007, via Inside Out On-line Nov 07.