Treatment for Granuloma on Stoma: Seeking Advice on Medical Responsibility

Has anyone else had this problem of a granuloma on your stoma? I have one at the edge that gets irritated and bleeds because the skin barrier/flange seems to rub against it. I've read that they can be treated with silver nitrate, but here's the issue: My primary doc knows zero about a colostomy. The surgeon who did my surgery (2.5 years ago) left the group and moved out of state, and since I'm not a candidate for reversal, I really don't have a surgeon right now. My GI is new to me. I've only really seen him for a routine colonoscopy, and when I asked him a different question before about my stoma, he deflected it by saying he "doesn't deal with stomas" and suggested I ask an ostomy nurse! (He did do my scope via the colostomy.) The only ostomy nurse I've ever seen is the one who was part of my home care team right after surgery who visited me for about 2-3 weeks till I was back on my feet. But there aren't free-standing (ambulatory) ostomy clinics to visit around here, and Medicare won't cover the services of a home care nurse once you are able to leave your home. So, my question is, if you've had one or more granulomas on your stoma, who did you see for treatment? GP (primary)?, GI?, surgeon?, ostomy nurse? I feel like nobody is medically responsible for my stoma!

Hi Perse,

You're sort of right, as stomas are still relatively rare compared to other wound issues. Ostomy nurses fall under the Wound Care header, so contacting your local hospital's Wound Care department might get you the name of a real ostomy nurse, depending on where you're located. Also remember that the big 3 in ostomy supplies (Hollister, Convatec, and Coloplast) all have ostomy nurses on staff that will talk to you on the phone. So does Nu-Hope Labs, who I can tell you from personal experience are wonderful. You don't need a prescription for silver nitrate sticks, you can get 1 or as many as you want on Amazon for pretty cheap. I had to deal with some granulomas early on after getting my ostomy and my ostomy nurse just told me to get a couple and hit the spot every time I changed my barrier. Worked like a charm too, but silver nitrate does sting, so don't be petting the dog when you do it... or you might strangle the poor pooch. Biting on a bullet or a 2x4 works well.

;O)

Learn something new every day. I never heard of this till now. I checked the internet. Did a: stoma granuloma search. Lots of information available.

Yeah, granulomas are another one of those medical mysteries in that no one knows why they form or how to prevent. Just like every other major medical disease or issue out there. Got to love the medical system, eh?

;O)

They're easy to treat. You need a 75% silver nitrate stick, gently press on the granuloma and count to 10. You might need more than one treatment to get rid of it. You can treat them every day, but that's a bit excessive. The usual advice is 2 times a week if needed. Where on your stoma is the granuloma? Just wondering if it's at the base from the hole in the wafer being cut too small or big, or higher up just from the bag itself rubbing on the stoma.

Well... if a cure or prevention was discovered for most chronic or fatal diseases... no money to be made.

Remember how high cholesterol once was always in the news. Doctors were prescribing statin drugs. As soon as patents expired and cheap generics became available... you don't even hear about it anymore. There never has been a link between high cholesterol and heart attack or stroke.

High C-reactive protein and homocysteine levels are linked to heart attack and stroke. But doctors don't normally check these levels in blood tests. I wonder why?

Persephone

I iterate the silver nitrate - it works!

BW

Jayne

Never done one myself, but when this topic came up before, I looked it up and your procedure is exactly what I read. No idea how people get granola on their stoma. 🤷‍♂️ Oh wait, maybe I'm mixing topics. 😁

@ Alex, it's lunch time. You probably were hungry.

@everyone else - WTF is a granuloma? A cut? A popped pimple dimple bleed?

If so, does it require these sticks to cauterize them? I have had bleeds. Never gave it a thought.

💩!!

Yo bro... you know what a granuloma is... did you forget? It's an aggregation of macrophages, of course. Silly man.

;O)

Whooooooooooooooooooooa Bob - as a non-medic I will refrain from asking further questions - but have looked at this:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1457488/

 

I also try to discuss with an MD prior to getting into a 'little knowledge being a dangerous thing' when entering a debate where I am lacking the base principles knowledge ......

BUT given that most of our collective chronic illness is very often autoimmune related on this forum, perhaps the cellular levels of activity could be better understood - within a semi-lay context - thereby enabling patients to 'visualize' cellular activity .....

For I believe an active visualization does help ......

 

Like we do in sport - simile analogy being visualizing our own high jump success in action prior to actually doing it as the high jump bar is raised one more peg [literal and metaphorically speaking].

 

There are not too many medical professionals who will openly acknowledge such stuff - but most know these things at 'heart' level .....

especially when they too become the patient.

 

I really respect your level of input on here Bob - so please would you like to expand in understandable terms for us the macrophage 'war' when infection is triggered and the auto response goes into overdrive / the cellular activity of cell renewal after damage by surgical excision etc

 

TY biggly!

 

BW

Jayne

Thanks so much for your input! The hospital ostomy nurses here only see inpatients... they don't see patients that are home and ambulatory, once discharged. And the visiting nurse only comes for a couple of weeks after surgery. I'm actually a retired nurse myself, but my specialty was pediatric critical care, so, while I did deal with ostomies, because there are kids with them... it's way less than in adult care areas... and treatments are always changing. I'm familiar with using silver nitrate for wounds, both as a nurse and having had it used on my own surgical wounds from other unrelated surgeries... so I do know about the stinging... but I've had no first-hand experience with using it on an actual stoma... and since this granuloma seems to have gotten a bit larger, I was hoping to get someone to actually look at it before treating! I'm a Capricorn, so we overthink everything, lol! Let me ask you this, please: Is/was your granuloma on the actual stoma itself (bowel mucosa) like mine is... or on the skin bordering it ("regular" skin)? I know it can be on either. How long/how many treatments did it take you? If I were to treat with each bag change, it would be twice a day... since I use a closed-end 2-piece and change the bag 2x/day and the flange only once every 4-5 days! Thank you so much for responding!

Hi J,

You took me too literally... I was just messing around with Warrior by tossing out the big words to watch his eyes roll and his head spin. Granulomas occur in numerous locations and are just an immune system response. They're really just clumps of white blood cells surrounding something the immune system identifies as foreign that needs to be dealt with, whether it's an infection, a foreign body, or just inflammation. They're typically in the form of a hard nodule and are painless... until you hit them with the silver nitrate, which literally burns them off. So you have to be careful and not overdo the silver nitrate stick. A little goes a long way.

;O)

It's right at the edge where the stoma meets the skin. I don't really think the barrier irritating it is the cause. I have an extremely sensitive body. I'm allergic to many adhesives, and the trial and error process of finding the right barrier and accessory products in the beginning was exhausting. This granuloma was there from the beginning. When I came out of surgery, the entire perimeter (circumference) of my stoma had a ring of granulomas around its edge, one corresponding with each of the sutures holding the stoma in place. My surgeon said people with sensitive skin tend to overreact to sutures and other things. (I even get hives and welts from the cloth tags that are sewn inside clothing!) She said they would likely shrink/fade after the stitches were removed. She was correct... almost. After the sutures were gone, all but one of the granulomas disappeared. Only this one has stubbornly remained... for 2.5 years!

Granulomas are growths on various body tissues, including skin, mucosal surfaces, and sometimes internal organs, that are actually hyperplastic tissue (overgrowth) stimulated by the immune system in response to an irritant of some sort. (Kind of like when a grain of sand provokes the oyster to make a pearl, lol!) On the stoma, they are small red bumps made of the same "stuff" as the rest of the bowel/stoma surface, the same color and texture as the mucosa, but a protruding bump, and bleeds easily.

At Bob... smack approaching in 3...2...1...👋

 

After having it for so long, you might be better off seeing a nurse or doctor if you can. There's a minor surgical procedure they can do to remove problem granulomas.

Just burn it off...

KK - Thanks, Bob.

Indeed, within my personal experience, the silver nitrate does a very quick (and if not too careful - deep) burn off.

Regarding my Q... I have a medic friend who has explained quite a bit in terms of developing pharma supplements and also the healing phases, etc., as regards autoimmune responses - hence as soon as the 'flare' was mentioned by you - I figured that I would table the response I did... whoops ;-)

(I got to learn a fair bit about responses of foreign bodies during my TIES adventure, as you might appreciate)

But fair does - I concede.

 

TY

 

:-))

BW

J

 

PS - As mentioned before, I like the seated graphic (illustration/marketing/graphics were part of my presentation business).