Sore skin, leakage and blockage: the causes checklist

The value of these lists is that they turn three vague worries into something you can actually check.

Sore skin

• leakage from the bag
• allergy to the adhesive
• too frequent changing of the bag
• excessive cleaning of the skin
• too large an opening in the adhesive flange
• pre-existing skin conditions

Leakage

• too large an opening in the adhesive flange
• a change in body shape
• a change in body size
• inappropriate use of creams and powders
• forgetting to remove the backing paper from the flange

If you have leakage, change the bag as soon as possible.

Bleeding

Possible causes are too small an opening in the flange, causing friction — check your stoma size — the stoma being knocked, or anticoagulants and aspirin. It is normal for specks of blood to be seen on the tissue when you clean your stoma. If bleeding persists, contact your stoma care nurse or doctor; if blood comes from inside the stoma, contact your doctor.

Two that surprise people

Phantom rectum: in a small number of people whose rectum has been removed, rectal discomfort or pain can occur. It usually resolves spontaneously when the wound has healed, though that may take as long as six months. If it continues, mention it at your hospital clinic visit.

Rectal discharge: if your rectum has not been removed you may have the urge to open your bowels. This commonly occurs and is a normal feeling, and you may pass mucus, which is a normal bowel secretion. With a loop ileostomy the discharge may be brown. If soreness occurs around the anus, wash the area when possible and pat dry with a soft cloth or toilet tissue.

The one that is not on a checklist

Feelings belong on the same list as sore skin and leakage, which is a deliberate choice. While you are recovering you may experience mixed emotions — sometimes relief, sometimes apprehension — and may at times feel tearful and angry. There may be feelings of not being able to cope or of being out of control. These are normal reactions for some people.

The suggestions are modest and specific: talking it through with your partner, a family member or a close friend may help, and some people benefit from quiet times spent reflecting alone.

Two useful facts about the stoma itself

Your stoma has no muscle, so you cannot control it — you will not be able to retain a bowel motion until a socially convenient time, which is why a bag is needed. And it may work at irregular intervals, particularly in the early days while your body is readjusting.

The other is about the bag rather than the stoma. Most are drainable, with an outlet that can be opened and securely resealed as often as needed, so emptying does not mean changing. The interval between actual changes varies, and experience settles it: as you return to regular eating habits you will begin to know when your stoma is least active, and can judge when to change bags or to shower without one.