Managing Stoma Care: Erratic Output and Skin Concerns

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195
pamela.hill
Feb 03, 2025 3:47 pm

Hello everyone,

I am 2 months post-colostomy.

I feel so troubled ☹️ I don't know anyone personally or in my town with a stoma, to just ask silly questions that worry me.

I am in Spain and the support isn't good, and my Spanish isn't too good.

I have an appetite and I am eating all the right food, small and often. So that is good 👍

My output is so erratic!! It can be morning, noon, or night. Is this normal in the first few months, and please tell me it settles down to a certain pattern.

The skin around my stoma has no sores, but it is still tender and a little red and swollen, normal as it is healing. So, because of this, when I pass stools, I constantly take my bag off and clean the area and move the stools off my stoma area. So that my skin heals okay.

I cut my stoma ring well, I think 🤔 so it is snug, but after a day the edge starts to melt and I start to worry about keeping my skin clean.

Is this crazy, or have people experienced feeling like this?

I can't see how life with this is going to be any different.

I am so tired of it.

Sorry to you all for sounding so low, but I literally have no one around who can advise me.

 

 

xnine
Feb 03, 2025 4:01 pm

I use a skin prep. I also use a ring (Salts with aloe). The area must be dry. Hope that helps.

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AlexT
Feb 03, 2025 5:45 pm

We have no control over when output occurs. Eating the same stuff at the same time can help with output times, but it's no guarantee, and who wants to eat the same thing constantly? 🤷‍♂️ You may want to look into irrigation to better control your output; some on here who do it may respond.

infinitycastle52777
Feb 03, 2025 7:27 pm

I'm sorry you have no one locally you can discuss things with. I think that is one of the reasons this message board was set up. To give a sense of community to people. I have a ileostomy so I will be different to you. My output comes all the time at any time. I understand a colostomy is different though. I think you are right to want to keep your skin clean but I don't think you have to change your whole appliance every time you have output. If you have a good seal on your bag and you cut your hold snugly then I think you should be ok. The ring is supposed to go mushy as it goes around your stoma, that is how it is protecting your stoma and skin. It goes to fit tightly around your stoma. I am sure others will chime in with ideas that will help you better than I can. I just didn't' want you to feel alone. 

SusanT
Feb 03, 2025 7:44 pm

I'm sorry you are feeling so low. It's tough getting adjusted to your new normal and it is natural to have down times as well as many questions. 

My output has settled into a pattern similar to what I had before surgery.  Colostomies are less predictable than ileostomies but usually settle into a pattern you recognize but it will take time to get there. It took me 4-5 months. 

I recommend using a barrier ring under your wafer.

The ring on your wafer is melting? I'm not sure I've seen that but maybe it does and I haven't noticed.I think the barrier ring will help give you confidence that your skin is clean. It will absorb small leaks and fill gaps. I have an oval stoma but lack the manual dexterity to cut holes myself so I use a round precut wafer. I fit the barrier ring very snug against my stoma and I don't have problems with leaks. 

I use disposable bags (2-piece system) so every time I have significant output,, I take the bag off, clean the stoma area and put a new bag on. I think it's natural that you want to clean the area. We would clean after having output the old way too. 

It's early days for you, things will get better. Keep asking questions... your questions are not silly. 

 

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Worzie
Feb 03, 2025 8:12 pm

Hi Pamela!  Yes, it's common for the wafer around the stoma to get soggy and can allow for stool to get underneath.  The rings others mentioned help too.  Those also will soften and mushroom upwards.  

I've bounced back and forth between several ring brands and pastes.  Paste doesn't usually swell though.  That can have other problems such as losing adhesion.  I had one with paste only last a full day after having a very active bowel the night before due to eating soup that must have gone bad.  

Best of luck.

Gracie Bella
Feb 03, 2025 11:25 pm

No, none of what you have said, Pamela, is crazy.
I have had my ileostomy for around 28 years now, and my stoma hardly ever stops working. Changing my bag can be an enormous challenge, especially if 'Mount Vesuvius' is exploding up to 50 to 80 cm up into the air!!
Lately, my ostomy nurse suggested that I eat approximately 4 marshmallows half an hour before I change my bag - I cannot stand marshmallows. I tried it for a while, but letting the marshmallows melt in my mouth isn't very appealing to me, so I just have to not eat or drink anything in the hope that once I do change my bag, it's temporarily calm. However, this doesn't always work, and there are times when I just need to relax and place a nappy over my stoma while I read a book, waiting for 'Mount Vesuvius' to stop being a fool...

corlsharonl49
Feb 03, 2025 11:37 pm

At least you found this forum. I've had my illeostomy since 2014 and I still obsessively monitor my stoma even if it's a great day. I think it's normal to have ups and downs as of late my anxiety is getting the better of me. I change my appliance every day. It takes time so give yourself grace.

IGGIE
Feb 04, 2025 3:19 am

G-Day Pamela,

You said that you eat small but often; then your stoma will probably work a little but often. Eat as you used to eat: breakfast, lunch, and dinner. But make dinner early and not too late so it has time to let you sleep better. If you are able to get the SALTS seal, give it a go. It has aloe and keeps the skin better. I hope you get back to normal soon.

Regards, IGGIE

TerryLT
Feb 04, 2025 4:22 am

As others have said, a barrier ring may be all you need to solve your problem.  I would also recommend Salts brand, particularly the aloe rings, which are infused with aloe and very kind to the skin, and thinner than other barrier rings, so lower profile and have a really strong adhesive.  Good luck.  It sucks not to have support, but I think you would find that most of us don't personally know other ostomates, apart from this site (I don't).  That's why this forum is so great.

Terry

Beachboy
Feb 04, 2025 6:10 am

Hello,

I have a sigmoid colostomy, and I'm now 2 years after surgery. Four months after surgery, I developed a small parastomal hernia. Getting a hernia is common for people with an ostomy. Because of the hernia, I wear a Nu-Hope Corporation hernia support belt all the time. I only remove it for showers and changing the wafer. It helps to keep my hernia from getting larger. So far, it's working. The belt also makes it comfortable to have the bag hanging from my abdomen.

It took about 6 months for my stoma output to become stable. My output is usually thick and pasty... sometimes formed like little turdlets.

I use a Hollister 2-piece system with a Coloplast Brava moldable ring under the wafer (also known as a flange).

I only drain the bag when it's more than 1/2 full. (I'm lazy). If the output is really thick, I change to a new bag. It's hard to drain thick output. When changing the bag, I only wipe off the flange area that the bag snaps onto. I don't bother cleaning the inside of the flange...no need.

The moldable ring under the wafer does slightly swell up around my stoma. It's supposed to, to help seal that area.

My wife is sensitive to smells. If I burp my bag (manually release gas) downstairs, she can instantly detect it upstairs. So I go outside for burping. She does not smell anything otherwise. My bag can be half full of poop, and the wafer flange area can be covered in poop... and she remains happy next to me on the couch.

I used to eat small meals many times a day. After 6 months, I went back to my regular routine. I eat regular meals like I did before I had an ostomy. If I eat more, more comes out. If I eat less, less comes out. Pretty predictable. This only really affects me at Thanksgiving and Christmas.

I always change my wafer in the early morning when I have little to no output.

You do not have to drain the bag every time you have output, unless it fills up a bunch. There is no need to clean the flange area every time you drain the bag. You don't have to do it when changing a bag (if you use a 2-piece system).

Poop from a colostomy can have digestive enzymes in it which will damage skin. The amount of digestive enzymes in the stool depends on the type of colostomy and how much of the colon is still active.

Do you know what type of colostomy you have?

Ascending colostomy?

Descending colostomy?

Sigmoid colostomy?

If you don't know, contact your surgeon or hospital to find out. Knowing will give you an idea of how much care you must do to protect the skin around your stoma.

I can leave poop on my skin, and nothing happens because I have a sigmoid colostomy. The output has little to no digestive enzymes.

You might consider wearing a stoma support belt. It's very easy to develop a parastomal hernia where your stoma is. Wearing a belt might help prevent a hernia, but it's not guaranteed.

You're at 2 months post-op. Relax. It's going to take several more months to recover from surgery and for your stoma to heal and attain its final shape and size.

Keep us posted on your progress.

aTraveler
Feb 08, 2025 1:58 am

Eating triggers the digestive system into action. The bowel is most active in the morning and following meals. The digestive system slows down while sleeping. The following are things to keep in mind:


• The laxative effect of some chocolates — the caffeine and fiber within the chocolate can increase the rate of motility (which is the contraction of the muscles in the digestive tract that encourage bowel movements).


• On average, food takes 2 - 5 hours to empty from the stomach, 2 - 6 hours to pass through the small intestine, and 10 - 59 hours to transit through the large intestine before a bowel movement eliminates it from the body.


• If you're eating and taking in too much vitamin C and your body can't absorb it, it may increase how fast the stomach empties.


• Some artificial sweeteners can have a laxative effect, including sugar alcohols such as sorbitol, xylitol, lactitol, erythritol, mannitol, and maltitol — increasing the rate of motility.


• Acidic and spicy foods irritate the lining of your stomach and intestines. When this happens, intestinal contractions will increase to get the offenders out of your system.


• Caffeine is a stimulant. It increases peristalsis, giving it a laxative effect.


• Alcohol can irritate the stomach lining and intestines, increasing gut motility.


• Juices have a very laxative effect — persons with colostomies probably will have to avoid juices only until the bowel is healed from the surgery.


• Soluble fiber decreases the movement of food through the GI tract.


• Psyllium powder (Metamucil) taken with a full glass of water before meals may help decrease output.


• Loperamide decreases gut motility.

Eventually, as your ostomy heals, you will settle into eating 2 - 3 meals per day, and your output will become more predictable. If you have a descending or sigmoid colostomy, you can irrigate if you don't have IBS.