Peristomal skin care

Peristomal skin is the skin immediately surrounding your stoma. Keeping it intact comes down to one thing above all: getting output to leave the body without ever touching the skin. A well-fitting pouching system — re-measured regularly, with creases filled and convexity used where it is needed — prevents the great majority of sore, weeping or broken areas. When problems do appear, a stoma care nurse can usually solve them at a single review.

What peristomal skin is, and what healthy skin looks like

“Peristomal” simply means “around the stoma”. It is the ring of skin, usually a few centimetres wide, that sits under the flange — the adhesive baseplate of your pouching system. Because that skin is covered by adhesive most of the time, it is the area most likely to react, and it is the area worth inspecting at every change.

Healthy peristomal skin looks like skin anywhere else on your abdomen: intact, evenly coloured, dry, flat and pain-free. It should not sting, itch, weep or bleed when you touch it.

The stoma itself is a different matter. A healthy stoma is moist and red or pink, has a rich blood supply and no nerve endings — which is why cleaning it does not hurt, and why a small spot of blood on the gauze is normal. Red, broken or weeping skin around the stoma, by contrast, is never simply part of having an ostomy. It is a signal that something in the pouching routine needs adjusting.

Why skin around a stoma is so vulnerable

Four things work against this patch of skin at once. It is occluded, sitting under an adhesive dressing for days at a time, warm and slightly moist. It is repeatedly stripped each time a flange is removed. It is exposed to digestive enzymes in ileostomy output or to urine in a urostomy, both of which irritate skin quickly. And it often sits over creases, dips or scarring where no flat adhesive can ever seal perfectly. Understanding these four pressures explains almost every skin problem described below.

How common are peristomal skin problems?

They are very common. Surveys of people living with a stoma suggest that a substantial proportion — in many studies the majority — experience at least one episode of peristomal skin damage, most often in the first year or two after surgery. The reassuring part is the pattern: the overwhelming majority of these episodes are irritant contact dermatitis caused by leakage, and they settle once the seal is improved. Only a minority turn out to be infection, allergy or a skin condition unrelated to the stoma.

The most common cause: output reaching the skin

If you remember only one line from this article, make it this: the skin around a stoma is nearly always sore because output has got underneath the flange.

What output does to skin

Ileostomy output carries active digestive enzymes that are designed to break down food — and they do not distinguish between food and skin. Colostomy output is thicker but still moist and chemically active, and urine contains ammonia and varies in acidity. Left in contact with skin for even a short time, these substances soften and erode the outer barrier, causing redness, stinging, weeping and eventually raw, broken areas.

Why sore skin makes the next leak more likely

Once irritated, skin weeps. Moisture stops adhesive bonding properly, so the next flange lifts at the edges sooner, letting more output through — which irritates the skin further. This is the classic vicious cycle of peristomal skin damage, and it is the reason that simply applying more or stronger adhesive rarely helps. The cycle is broken by finding and correcting the fit problem.

When there is no visible leak

Not every leak is obvious. Output can creep under the flange while the pouch itself stays sealed, so you never see a stain on your clothes. Warning signs to look for at each change include:

• Output or moisture on the skin side of the flange, or staining on the barrier ring
• Skin that is red, shiny or tender in a ring shape around the stoma
• Skin breakdown starting right at the stoma edge and spreading outwards
• A flange that lifts at one particular point every time, such as a crease or a scar
• Itching or a burning feeling under the flange between changes

Getting the seal right

Re-measure your stoma

A stoma is not a fixed shape. It usually shrinks over the first six to eight weeks after surgery, and it can keep changing slightly for months. Later on, weight gain or loss, pregnancy, ageing and further surgery all change the contour of the abdomen. A flange opening that is too large leaves a ring of bare skin around the stoma where output pools; one that is too small can rub and cut into the stoma. Re-measure with the measuring guide at every change for the first few months, then periodically, and cut or order the opening a millimetre or two larger than the stoma’s widest point. A stoma care nurse will check your measurements at review appointments.

Fill creases, dips and scars

Flat adhesive cannot seal over an uneven surface. If the skin around your stoma dips, creases or is scarred, output finds those channels. A mouldable barrier ring — a soft, pliable ring of skin-barrier material that you shape and press around the stoma — fills the gap and is one of the simplest, most effective fixes in ostomy care. Paste, strips and filler rings work in similar ways. Your nurse can judge which shape suits your particular contour.

Convexity: powerful, but not risk-free

If your stoma sits flush with the skin or is retracted (below the surface), a flat flange will struggle. A convex barrier curves gently inwards, pushing the surrounding skin down and easing the stoma outward so output drops straight into the pouch. For many people this is the change that finally stops leakage. It must be fitted with care, however, because too much convexity can press on the skin and cause pressure damage or even ulceration. Always make this change with a stoma care nurse, and never build up convexity at home by stacking products.

Wear time, melt-out and the “one more day” trap

Every pouching system has a working life. Barrier material gradually softens and dissolves around the stoma — often called melt-out — and once it goes, output reaches skin. Pushing a flange beyond its capacity to save a change is one of the most common causes of a sore patch. Change on a schedule that matches your system rather than waiting for a leak, and if you find yourself changing more often than usual, treat that as a fit signal rather than bad luck.

Cleaning and day-to-day skin care

Plain warm water

Simple is best. Warm water and a soft cloth or gauze are all that is needed to clean the skin around a stoma. Soap, shower gels, wipes, lotions, oils and antiseptics leave residues that interfere with adhesion and can irritate skin in their own right, so rinse them away thoroughly if you use them elsewhere on your body and keep them off the peristomal area. There is no need to scrub, and no need for special cleansers. If your skin is very dry or you have a skin condition such as eczema, ask your nurse which products are safe rather than choosing your own.

Dry the skin properly

Adhesive needs dry skin. Pat gently and completely dry — do not rub — and give the skin a minute to settle before applying a new flange. If the skin is weeping, drying alone will not work; that needs the crusting approach described below, taught by your nurse.

Removing the pouch without stripping skin

Most mechanical skin damage comes from pulling a flange off too fast. Support the skin with one hand, peel the flange back slowly from the top, and use an adhesive remover — a spray, wipe or pen — to dissolve the adhesive as you go. Removers make changes painless and protect the skin barrier from repeated stripping. Wash or rinse the remover away afterwards so the next flange bonds properly, and let the skin dry.

Treating skin that is already sore

Protect the skin so the pouch can still stick

When skin is broken or weeping, adhesive will not hold, but you still need a pouch. The standard nursing approach is crusting: a fine dusting of stoma powder is applied to the moist area, the excess brushed away, and a thin layer of skin-barrier film dabbed over it to bind the powder into a dry protective surface. This can be repeated in thin layers until the area is dry enough for a flange. Your stoma care nurse should show you the technique, because the products are easy to over-apply.

Treat the cause, not only the surface

Crusting lets a pouch stay on, but it does not fix the reason the skin broke down. If leakage caused the damage, the flange, ring or convexity still needs reviewing, otherwise the sore patch returns as soon as the protective layers wear through.

When infection is involved

Sometimes a fungal infection has taken hold on already-damaged skin, and no amount of fit adjustment will clear it. This needs an antifungal treatment, recommended or prescribed by a clinician, alongside a good seal. The same is true for a suspected allergy or for a skin condition unrelated to the ostomy. If sore skin has not clearly improved within a few days of improving the fit, ask for a nurse review rather than persisting alone.

Common peristomal skin problems

Irritant contact dermatitis

The most frequent problem by far. Output has touched the skin, producing redness, burning, weeping and sometimes broken areas in a ring around the stoma. The fix is a better seal: correct measurements, a filled crease, appropriate convexity, and a wear time that suits your output.

Fungal (candida) infection

Warm, moist, damaged skin is ideal for yeast. Look for an itchy red rash with small separate spots — often called satellite lesions — at the edges, sometimes with white patches. It is more likely after antibiotics, in hot weather, or in skin folds. It needs an antifungal preparation plus a good seal; both together, or it comes straight back.

Allergic contact dermatitis

A true allergy is uncommon but distinctive. The rash appears in the exact shape of a flange, ring or tape, with a sharp edge where the product ended, and it may itch intensely or blister. Switching to a different product formulation, guided by your nurse, usually resolves it. Patch testing is occasionally arranged for stubborn cases.

Mechanical injury and skin stripping

Repeated forceful removal, or changing far more often than necessary, strips the top layer of skin. The result is shiny, sore, fragile skin rather than a rash. An adhesive remover and a gentler, less frequent technique solve most of it.

Overgranulation

Small, moist, red, raised bumps at the point where stoma meets skin, which bleed easily when touched. They are not dangerous but they can prevent a good seal and often indicate moisture sitting at the junction. A stoma care nurse can treat them, sometimes with a chemical cautery stick, and will also review the fit.

Hyperplasia (pseudoverrucous lesions)

A ring of small, wart-like, greyish or reddish bumps spreading outwards from the stoma edge, caused by long-standing moisture and exposure to output. It usually indicates that urine or loose stool has been sitting on the skin for a long time. Correcting the seal is the main treatment; stubborn cases may need nurse-led topical treatment.

Folliculitis

Hair follicles under the flange can become inflamed, giving small tender red spots, particularly if you shave or pull hair out. Good hair trimming technique, gentle removal and sometimes a change of product formulation help.

Accessories: what each one is for

Barrier rings and mouldable seals

Soft rings that fill dips, creases and uneven contours so adhesive has a flat surface to bond to. In many people this single change solves the problem.

Skin barrier films

Sprays, wipes or pens that leave a thin protective layer between skin and adhesive, and help powder stay in place on weeping skin. They are also useful on skin that reacts to frequent changes.

Stoma powder

Absorbs moisture on weeping skin to create a dry surface. It is only useful when used thinly and sealed with barrier film.

Adhesive removers

Dissolve adhesive so the flange lifts off without pulling skin. Available as sprays, wipes and pens; wash off residue before reapplying a flange.

Convex barriers, belts and support

Convexity for flush or retracted stomas, and belts or support garments to hold a system steady where the abdomen is soft or herniated. Used well, they transform a failing seal; used without advice, they can cause pressure damage. Ask your nurse before changing convexity.

Special situations

Urostomy: urine and peristomal skin

Urine is continuously produced, so there is no quiet period, and it becomes more irritating if it sits on skin. Night drainage systems and secure tap connections matter as much as the flange. Keep drinking normally to produce dilute urine, and contact your nurse if output becomes cloudy, strong-smelling or changes colour.

Ileostomy and enzyme-rich output

Liquid ileostomy output is the most corrosive to skin, so a snug, accurately cut opening and a reliable ring or convex system matter most here. Any episode of diarrhoea increases both leakage and skin damage, so plan for extra changes during illness.

High-output stomas

Frequent, watery output overwhelms the barrier and the pouch. This needs clinical review, not just more products, because it can also affect hydration and nutrition. Ask your nurse or doctor for assessment.

Heat, sweating and exercise

Sweat lifts adhesive. In hot weather, trim or shave hair carefully, dry the skin well, and consider a support belt or a fresh flange before exercise. Swimming is generally fine with a well-sealed system, and showering without a pouch or with one on is a personal choice — plain water does no harm either way.

When to seek help

Contact your stoma care nurse if you have:

• Redness, soreness or broken skin that does not improve within a few days
• Leaks that keep returning despite adjusting the fit
• An itchy rash with small spots, suggesting a fungal infection
• A rash in the exact shape of a product, suggesting allergy
• Bleeding bumps at the stoma edge that do not settle
• Any new pain, bleeding or change in the stoma itself

Red flags that need urgent attention

Seek same-day medical help for spreading redness with fever, severe abdominal or peristomal pain, a stoma that turns dark or black, no output with vomiting and cramping, or a wound that will not heal. These are not skin-care problems and need prompt assessment.

Support and community

Stoma care nurses are the definitive resource for fit and skin problems and can usually solve them in one appointment. National ostomy associations publish skin-care guides and run helplines, and peer communities offer practical, real-world tips — useful for confidence, but always confirm anything clinical with your nurse.

The bottom line

Healthy peristomal skin is almost entirely about a well-fitting pouching system: re-measure the stoma regularly, cut the opening accurately, fill creases with a barrier ring, use convexity where a flush or retracted stoma needs it, and change the flange before it fails. Clean with plain warm water, dry thoroughly, and remove barriers gently with an adhesive remover. Inspect your skin at every change, protect sore areas early using the technique your nurse has taught you, and do not wait before asking for a review — most peristomal skin problems are solved quickly once the underlying fit issue is found. This article is general information and cannot replace personal advice from your stoma care nurse or clinician.