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Skin breakdown

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Posted: Sun Sep 20, 2009 4:18 pm
I have been having a problem with the skin underneath the hole in the stoma breaking down.  It becomes sore, red and bleeds when i change the bag.  There is an indentation in the skin there.  I was told to use a convex appliance and a belt.  I do and additionally use powder, paste,an Eakins ring around it and have started changing the bag more frequently.  I went from twice a week to every 3 days if I can and the pain doesn't make me do it sooner.  Is there anything else that I can try?
Posted: Sun Sep 20, 2009 11:44 pm
In reading your post you mention the "hole under the stoma", I think that is how you put it.
I would think you mean the area around the stoma under the wafer.
As described it sounds like the area around the stoma is very iritated.  The question is why the irritation?  Is it from an improper seal and intestinal enzymes getting under the wafer or seal ring.  Or is it an irritation to the seal or wafer adhesive it self?
First off I have found powders to be contrary to getting a clean dry seal area.  The powders for me simply did not even comes close to doing anything productive, but that was me, not you.
What I found to help an irritated area get a chance to heal was Benzoin Tincture.  This stuff is what legions are made from.  Its been around for ever.  Get the area clean and dry, swab a heavy coating of this stuff on the area, not the stoma, the area around the stoma,  it will sting like the dickens on the irritated areas.
Let it dry, it only takes a few minutes to dry.  Then put the seal and/or wafer on.  This stuff is a skin protectant.  The beauty of it is it not will effect the sticking ability of the seal or wafer and it protects the skin and gives it a chance to heal.

Here I go off on a tangent.  It was thought for many years by the medical community. In order for a skin wound to heal it had to be clean but exposed to the air.  It was much in part because of ostomy wears this became an untruth.  It was found that skin will heal faster when covered with an air tight seal.  That in effect is what a scab trys to do.  They found when the effected area is sealed off a natural coating of thin skin cells covers the wound almost right away.  Once that happens the skin starts to repair itself.  I could go on fore ever about this stuff but I won't bore you with it.  Basically that is why the skin will live just fine with a wafer or seal ring over it basically 100 percent of the time. If kept clean no damage will occure.  The secret word is CLEAN,  Unless of course there is a reaction to the adhesive.

The way you mentioned your problem I got the impression changing out the wafer was helping.  If that is the case I would think you have leakage into the sealed area.  Much more so for ileostomy than colostomy, the small intestinal enzymes are very corrosive to skin.
This why when they bring the small intestine out to form the stoma it is turned inside out, there can't be any normal skin open to the enzymes.  Eveything the enzyme comes onto contact with it trys to digest.

Posted: Mon Sep 21, 2009 5:32 am
I use the tincture of benzoine & rick is right.  IT BURNS LIKE CRAZY when applied to irritated skin!!  I would use a hair dryer on a cool setting when I applied it to dry it faster.  It's VERY STICKY and helps with your seal.
I also used to use the stoma adhesive paste but that burned even more and my skin did not like it! I used to DREAD having to change my bag & actually cry when it was time to do so because I knew it was going to hurt.
I found that the LONGER i could keep the bag on, the BETTER it was for the healing of my skin. That was all the first time around with my ostomies.
This is my second time around and I am happy to say, with the tinxture of benzoine, skin prep wipes, and cohesive seals, I've had no skin irritation and most times my bag lasts 4-5 days.
Posted: Mon Sep 21, 2009 6:57 am
Where do you by this this tincture? I've never heard of it, but have similar skin issues so I would love to give it a try (without the pain Wink )
Posted: Mon Sep 21, 2009 8:05 am
softncuddly, any medical supply store should have it or be able to order it for you.
Posted: Mon Sep 21, 2009 9:42 am
     Thank you for your response.  By the hole in the stoma I meant the hole where the excrement comes out.  It comes out and there is a depression in my skin in the exact spot under the stoma so the flow goes to the depression like water into a ditch.  The attempt has been to fill in this hole to keep the irritating stuff off of it so my skin can heal.  I fill it with the Eakins ring, paste, etc. and try to keep it in the exact spot by the belt etc.  When I clean it and use the seal squares they burn like crazy.  My nurse tried to get me pediatric ones that she said don't have alcohol in them but was unsuccessful.  I hear what you are saying about sealing the skin and it makes sense.  I had not heard of the product you mentioned either and don't like the idea of the burning but will look for it and try.  I do find the powder soothing.  not the first brand I tried but another company's type.  The nurse kept saying you have to get on top of the skin breakdown but it is difficult.
Posted: Fri Sep 25, 2009 11:34 am
Cee and all
Cee, from your description, it sounds like you  have a stoma that drains at the skin line with uneven skin contours and the stool undermines and gets caught there?   Assuming this is an ileostomy....

I will say after trying convention methods of correcting skin contours and no success, I will use just about anything to get containment for folks.   Tincture of benzoin is pretty toxic to open skin and will retard the healing, besides hurting like crazy.  On intact skin, some folks may find their skin rips off  too when removing their appliance.  Be cautious if you are going to use it.  Some folks have no issue with it, so hard to argue with successes like Juno Pete.  Just a note of caution.

It sounds like your nurse is on the right track.  If the wafer is burning, I would suggest putting a small layer of powder (ie, Stomahesive or Karaya) over the area, dust off the excess, then dab with a No Sting brand skin prep (Smith and Nephew No Sting, Cavilon, Relia med sting Free) to seal thepowder, then try a plug of Eakins to fill the dip, then an  Eakins ring/paste or however you have been doing your pouching.  A convex wafer and your belt may help "pop" the stoma out  a bit more to make a spout that drains into the pouch.

Your nurse is right, you do have to keep on top of it.  If the skin is moist/denuded, it will take time to heal.  You may have to change your appliance every 1-2 days for a while to get  a seal until the skin heals a bit.  

  I would not put tincture of benzoin directly on damaged skin.  You need to fill the dip first: if you wanted to put the benzoin on top of the Eakins or at the edges, should not be a problem.  You also may want to try a small amt. of Stomahesive Paste caulking at the junctions of where you plug the dent between skin and stoma.

There are some medical adhesives that are a bit less irritating to the skin, but messy to use.  Nu Hope makes one, Smith and Nephew (skin Bond Cement) makes one.  I will only use them if nothing else works.  On the powdering:  I agree, it is hard to get something to stick to powder.  It does help to dust off the excess, then dab a No Sting Skin Prep agent over it and allow to dry, then apply your Eakins or Paste on top.  It gives you a temporary dry surface and a whole lot less stinging.

For ileostomy folks:  a good goal is to shoot for is 2-3 days wear time with your appliance if you are having containment and skin issues.  Sometimes you have to start out with just 1 day.  Due to the digestive enzymes (and individual skin make up), the skin barriers do get broken down, faster for some than others.  I will go back to trouble shooting if someone is only getting 1-2 days....but I think 3 is acceptable.  5-7 days may be pushing the limits of the protective skin barrier unless you have the perfectly constructed stoma in the perfect location.  I always hope for those, but not always what happens.  Everyon's stoma is different, and you have to judge by your own.  

Juno Pete: you might find this interesting.  Decades ago, ostomy nurses found that most wounds healed under occlusion of ostomy wafers/skin barriers; kind of contrary to prior wound healing theories of "airing " wounds out.  There is a mega million dollar industry today  for dressings that heal wounds by occlusion ; much due to ostomy appliances.
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
Posted: Mon Oct 05, 2009 1:03 pm
Hi Whoa,
     I forgot to keep checking this post and missed your response until today.  Thank you for your help.  You have the problem correctly identified although I have a colostomy.  The output is 75% liquid though and it goes all the time.  I was losing my mind with the pain and one day I went through 5 bags.  I called the ostomy nurse who had helped me in patient and we met.  She was enormously helpful.  I have only had the colostomy since Aug. 3rd and the contours of the stoma had changed since the Visiting Nurse left.  I was still using the pouch system she had put into place.  The nurse at the hospital told me I was round not oval any more and needed a smaller and tighter fit.  She had a few that she gave me and the difference was immediate.  It "popped" exactly like you said.  She also had the Cavilon no sting wipes which were amazing after suffering the pain of the usual ones.  She was very negative about the tincture of benzoin saying it helps initially but can lead to long term skin problems down the road.  I hadn't been able to find it anyway.  I am hopeful that the new system will help my poor skin.

     In the "Big Picture" of it all I feel there is not enough help and support for a person who has undergone a life changing surgery.  When the Visiting Nurse left I asked her how I was going to solve the problems I had and would encounter?  She said I would find a way.  Great.  How would I know about the products that were right for me?  I am lucky this E.T. nurse saw me and helped so much.  It can be a very lonely road.  Thank you for your help.
Posted: Sat Oct 17, 2009 11:58 pm
Hi Cee
sorry late in answering thi, somehow missed the reply.  

If you are getting containment and your skin looks good, no odor or leaks...then you are in the right appliance for you.  Most larger hospitals have ostomy nurses and if you are having issues, a call to the nurse or appt. for a check would be my best suggestion.

There are hundreds of other appliances, add ons, etc. that some folks absolutely must use for containment, some of the things are just nice to have.   If mentally it makes things better, then go for it.  Containment and no odor is the baseline, and some folks are content with that.  

The best way to get educated on what is out there and how others deal with their ostomies is through a support group, or forums like this; the UOAA has a good webpage and puts out a magazine called the "Phoenix" which is really neat, good stories and new products advertised.  Whatever brand of ostomy appliance you wear, you can call them (phone number will always be on the box) or go to their web page.  The big 3 (Convatec, Hollister, Coloplast) in the USA are all vying for your business and they all have a support program for ostomates.  

There are a lot of experienced ostomates here that all seem willing to help and support you too.  Lots of folks feel alone and a bit lost with it all at first.  I think the people here can help you out alot.  I missed where you live??
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
* Please, do not post contact information like email, Facebook or MySpace account, or phone number. It will be removed by the Administartor.
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