This topic is about dealing with persistent pain and irritated skin around an ileostomy stoma. The person sharing their experience has been living with an ileostomy for a year and has faced ongoing pain at the stoma site. They were not given much guidance on how a stoma should feel or look after their surgery, and they have struggled to find the right support and advice. Here are some helpful insights and advice for anyone facing similar challenges:

1. A stoma itself should not cause pain. If you are experiencing pain, it might indicate:
- Damage to the skin around the stoma, which can feel like burning or stinging.
- A possible hernia or an internal bowel issue, which might feel like pressure pain. It's important to seek evaluation from a large teaching hospital or a specialist gastro/ostomy center.

2. Finding a certified ostomy nurse can be very beneficial. You can use resources like the UOAA “Find an Ostomy Nurse” directory and explore tele-medicine options to get the support you need.

3. If the skin around your stoma is red and irritated, it might be due to irritant dermatitis. Ideally, only the stoma itself should be red, while the surrounding skin should remain pink and intact.

4. The main cause of skin irritation is often the stoma output coming into contact with the skin. This can happen if the opening in the barrier or baseplate is cut too large or if the wafer is not sealing properly. To address this:
- Test the fit by holding the backing film over the stoma; no skin should be visible.
- Aim for a snug 1–2 mm gap or use a moldable barrier that fits closely around the stoma.

5. Consider these corrective measures:
- Switch from pre-cut moldable systems to a cut-to-fit system, as some have found healing after changing to a cut-to-fit option.
- Apply a washer or barrier ring around the stoma before placing the wafer.
- Use stoma powder on raw skin, dust off the excess, and then seal with a barrier wipe or spray using the "crusting" technique.
- Barrier paste can fill gaps, but some people prefer using rings, so it might be worth experimenting.
- Allow the skin some air exposure between changes to promote healing.

6. Some product names and brands that might be helpful include:
- Convatec moldable wafer (pre-cut)
- Hollister cut-to-fit system
- Stoma powder, barrier paste, barrier rings, washers, and barrier wipe/spray

7. A useful resource is the book “Abdominal Stomas and their Skin Disorders” by Dunitz, edited by Lyon & Smith, which contains color photos and management tips.

8. A positive outcome was reported after using stoma powder and paste, with pain subsiding dramatically within an hour. Continuing this regimen is expected to help the skin heal.