Caring for the Skin Around a Stoma: A Caregiver’s Guide

Reviewed and Approved by Derek Tanner, RN
Registered Nurse | Healthcare Experience Since 2009

If you help someone you love with their ostomy, you probably focus on the practical part first: emptying the pouch, changing it on time, keeping supplies stocked. But one of the most useful things a caregiver can do takes only a minute at each change: looking carefully at the skin around the stoma.

This skin, called the peristomal skin, sits under an adhesive barrier for days at a time and is exposed to stool or urine if the seal is not right. When it stays healthy, the pouch sticks well, leaks are rare and your loved one is comfortable. When it gets irritated, a cycle can start: sore skin makes the seal weaker, a weaker seal lets output reach the skin, and the skin gets worse. Catching small changes early is how you break that cycle.

This guide walks you through a simple check you can do at every pouch change and explains when it is time to call a wound, ostomy and continence (WOC) nurse.

What Healthy Peristomal Skin Looks Like

Healthy skin around a stoma should look like the skin on the rest of the abdomen. It should be intact, without redness, rash, open areas or weeping, and it should not hurt, burn or itch. The United Ostomy Associations of America (UOAA) describes it simply: the skin under the barrier should look the same as the skin on the other side of the belly.

The stoma itself is different. A healthy stoma is moist and pink to red, a bit like the inside of the mouth. It has no nerve endings, so your loved one may not feel it if it is rubbed or cut. That is one more reason a second pair of eyes helps.

A Two-Minute Check at Every Pouch Change

Make this part of the routine, so it never feels like an inspection.

1. Look at the back of the used barrier. Before you throw it away, turn it over. Is there stool or urine under the adhesive? Has the barrier melted or worn away more on one side? Tracks of output under the barrier show where the seal is failing, even if there was no obvious leak.
2. Look at the skin in good light. Check the whole area the barrier covered, not just the edge next to the stoma. A small mirror or a phone flashlight helps, especially for stomas that sit in a skin fold.
3. Ask how it feels. Itching, burning or soreness under the barrier are early warning signs, even when the skin still looks fine.
4. Check the fit. The opening in the barrier should fit snugly around the stoma, without a gap where skin is exposed and without pressing on the stoma. Stomas often shrink in the first weeks and months after surgery, so the size that was right at discharge may not be right now. Use the measuring guide that comes with the supplies if the opening looks too big.
5. Note what you see. A quick note on your phone (date, what the skin looked like, any leaks) gives the nurse useful information later.

Common Problems and What They Usually Mean

• Redness right next to the stoma, often moist or raw, usually means output is reaching the skin. The opening may be too large, or the barrier may not be sealing well in a crease.
• Redness in the shape of the barrier, sometimes itchy or blistered, can be a reaction to the adhesive or to a product used under it.
• Small red bumps around hair follicles can happen when hair is pulled out at each removal.
• A red, itchy rash with small spots at the edges, especially in warm, moist areas, can be a fungal rash.
• Skin that looks stripped or shiny often comes from removing the barrier too quickly or changing it too often.

These are possibilities, not diagnoses. Different problems need different solutions, and some, like a fungal rash, need treatment that a nurse or doctor should choose.

Gentle Habits That Protect the Skin

• Remove the barrier slowly. Peel it back gently, holding the skin down as you go. A medical adhesive remover can make removal easier on fragile skin.
• Clean with warm water. Plain water is usually enough. Avoid soaps with oils, lotions or strong fragrances, which can leave a film that stops the barrier from sticking.
• Dry the skin completely before applying a new barrier.
• Change on a regular schedule rather than waiting for a leak, and change promptly if output gets under the barrier.
• Avoid home remedies. Creams, oils and household products that work elsewhere on the body can stop the barrier from sealing or irritate the skin. Ask the nurse before trying anything new under the barrier.

The nurse may also suggest accessories such as barrier rings, stoma powder or a skin barrier film for specific problems. These help most when they are matched to the actual cause, so get advice first rather than adding several products at once. Some products, such as convex barriers, should only be used after a nurse has assessed the stoma.

When to Call a WOC Nurse

Contact your loved one’s WOC nurse, ostomy clinic or doctor if you notice:

• redness, rash or broken skin that does not improve within a few days, or keeps coming back;
• open, bleeding or weeping skin around the stoma;
• leaks more than once in a while, or a barrier that will not stay on as long as it used to;
• pain, burning or itching under the barrier;
• a stoma that changes color (pale, dark red, purple or black), swells, or pulls in below the skin;
• a bulge around the stoma, which can be a sign of a hernia;
• signs of infection, such as warmth, spreading redness or fever.

If your loved one does not have a WOC nurse, ask the surgeon’s office for a referral. You can also look for outpatient ostomy services through UOAA.

Look After Yourself, Too

Skin checks are a small task, but they show your loved one that you are paying attention. Do them calmly and matter-of-factly, and let your loved one take over as soon as they want to. If you are unsure about anything, ask for a teaching session with the nurse. Most caregivers feel much more confident after one.

Safe n Simple has a step-by-step guide to protecting the skin around a stoma if you want to read more.

This article is for general information and is not a substitute for advice from a doctor or ostomy nurse.