Stoma Care Tips for Healthy Skin and Peace of Mind From an Ostomy Belt Inventor

Warm mug on a wooden bath tray, a calm self care routine for healthy stoma skin | HIRO Ostomy Belts blog by O'Hamill Inc.

Good stoma care is mostly a handful of simple habits, done the same way every time.

I've cared for my own stoma since 2008, and I've worked in the ostomy industry since 2009, when I designed my first ostomy belt. Over those years I've had thousands of conversations with ostomates, nurses and clinicians about every type, style and size of stoma you can imagine. Some stomas stick out, some sit flat, some are round, some are oval, and they all behave a little differently. What I've learned is that the people who have the fewest problems aren't the ones with the "easiest" stoma. They're the ones with a simple, consistent routine.

These are the stoma care tips I wish I'd had on day one. I've backed them with guidance from trusted medical organizations in the United States, Canada and the United Kingdom, so they apply wherever you live. This isn't medical advice, so always follow the plan from your own surgeon and ostomy nurse.

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What a Healthy Stoma Looks Like

Knowing what's normal makes it much easier to spot a problem. According to MedlinePlus, from the U.S. National Library of Medicine, a healthy stoma is pink or red, moist and slightly shiny. It's usually round or oval, and most stick out a little from the skin, though some sit flat.

MedlinePlus also notes that a little mucus, or a small amount of bleeding when you clean it, is normal. The skin around your stoma, called the peristomal skin, should look like the rest of the skin on your belly.

Your stoma is swollen right after surgery and shrinks over the following weeks. The United Ostomy Associations of America (UOAA) notes that means you'll need to make your pouch opening smaller to match as it heals. If you're new to all of this, my article on what a stoma is and what to expect early on covers the basics.

1. Clean Gently, With Water

You don't need anything fancy to clean around your stoma. MedlinePlus recommends washing with warm water and patting the skin completely dry before you put on a new pouch. In the UK, Colostomy UK and the NHS stoma team at the Royal United Hospitals Bath both recommend warm water only, since baby wipes and some soaps contain perfumes that can irritate your skin.

  • Skip alcohol based products. MedlinePlus notes they can dry out your skin.
  • Skip oils and lotions around the stoma. They can keep your barrier from sticking.
  • Dry thoroughly. Dry skin helps your seal hold, and UOAA notes it also lowers the risk of a fungal infection. Colostomy UK suggests a hair dryer on its lowest setting if you need help.

Personally, I recommend just using warm water in the shower. I take one right before most changes, and clean, dry skin is the foundation everything else sticks to.

2. Get the Fit Right

The opening in your barrier should match your stoma closely. If it's cut too big, output sits on your skin, and that's where most irritation starts.

UOAA explains that your stoma can change size for up to 10 weeks after surgery, so measure it regularly with a measuring guide during that time. Colostomy UK recommends rechecking your size every few months after that too, since weight gain, weight loss, scars and skin folds can all change the shape of your stoma and belly. If your fit suddenly feels worse, check in with your ostomy nurse.

In my own experience, my stoma's size isn't always the same from week to week either. When I'm a little sick, in a Crohn's flare, or getting over the flu, I've noticed things can get swollen and inflamed, and my stoma gets a bit bigger. When I'm feeling really healthy, it's back to its regular size. So if your barrier suddenly feels tight or doesn't fit like it usually does, take a moment to remeasure rather than assuming your old size still works.

This is where all those conversations about different stoma types and sizes come in. There is no one size fits all. A flat stoma, a stoma near a skin fold, or one that sits in a dip will each need a slightly different setup. That's completely normal, and it's exactly what the next tip is for.

3. Use Barrier Rings and Brava Strips

In my opinion, this is the single most important thing you can do to keep the skin around your stoma healthy. I've seen it in my own skin since 2008, and I've heard it again and again from the people I talk with.

  • Barrier rings are moldable rings of skin protectant that sit right around your stoma, under your barrier. They fill the small dips, scars and creases that a flat barrier can't, so output can't sneak underneath your seal.
  • Brava strips, made by Coloplast, sit a bit further out around the edge of your barrier. They help secure it, give irritated skin a chance to recover, and help your seal hold up in the shower or the pool.

Together, they protect the skin around your stoma from output and moisture, which is what keeps it healthy over the long run. In the UK, Colostomy UK also points to seals, barrier extenders and flange extenders as options for skin folds, scars and hot weather. I walk through exactly how I layer my rings and strips, step by step with a video, in my guide to ostomy skin irritation and leaks.

4. Look at Your Skin Every Change

Every time you change your barrier, take a few seconds to look at your stoma and the skin around it. UOAA lists redness, swelling or a rash as signs of irritation. MedlinePlus adds that red or wet skin under the barrier usually means your seal isn't holding well.

Colostomy UK puts it simply: you don't have to put up with sore skin or leaks. The WOCN Society's Peristomal Skin Assessment Guide is a free online tool that walks you through what you're seeing and when to call a nurse. It suggests getting professional help if a skin problem hasn't improved after 7 to 14 days of treatment, or if you see signs of infection.

5. Remove Your Barrier Slowly

UOAA advises lifting your barrier off gently while pressing down on your skin with your other hand, rather than ripping it off like a bandage. Pulling it off quickly can cause redness and irritation.

Colostomy UK notes an adhesive remover can help if your barrier is really stuck. If you use a remover wipe, I highly recommend choosing one without alcohol. In my experience, alcohol based wipes burn your skin and cause irritation.

6. Find Your Change Schedule

How often you change depends on your body and your pouching system. UOAA says wear time anywhere from three to seven days is to be expected. MedlinePlus notes that if you need to change every day or two, that's a reason to contact your provider. UOAA also points out that itching or burning under the barrier is a sign it's time to change.

When I first got my ostomy, I was changing every one to two days, and I'd often get a leak before then. After finding the right fit, adding barrier rings and Brava strips, and wearing a belt to take the weight off my seal, my barriers now routinely last five days to a full week.

Here's what my routine looks like today. I wear a belt every day, 24/7, and five to seven days is my typical cycle. Changing everything on Sunday morning works perfectly for me, so it's become part of my weekly rhythm.

There are exceptions, though. If I have a special date night coming up, a swim in the ocean, or a long beach day, I'll plan to change my appliance either right before or right after. Those days put more wear and tear on a typical appliance. If I'm going surfing for the day, I'll always plan on changing that night and putting on a fresh new one.

I've seen the same pattern in the people I talk with. In my experience, most people who don't wear a belt usually get two to three days out of a barrier at most, and they tend to deal with leaks and irritation more often. People who wear a belt that fully supports the weight of their bag usually have a much better experience, and many can go three, five, even seven days or longer between changes. Published research in the Journal of Wound, Ostomy and Continence Nursing has also found that ostomy belt use is associated with less leakage and skin irritation.

7. Empty Before It Gets Too Full

A full pouch is heavy, and that weight pulls on your barrier. UOAA recommends checking your pouch regularly and emptying it before it gets too full, and before you leave home. I empty mine before bed every single night, which I talk about in my post on sleeping with an ostomy bag.

8. Change Your Appliance Right After a Shower

This one surprises a lot of new ostomates. According to UOAA, you can bathe or shower with your pouch on or off. Water doesn't go into your stoma, and normal exposure to air or water won't harm it.

I've found that one of the best ways to change your appliance is right after a shower. Here's my routine:

  1. Prepare everything first. Put your barrier ring on your flange, get your new flange and pouch ready, and set it all under the sink in the bathroom.
  2. Take everything off. Remove your old appliance, put it in a small disposal bag, and throw it away.
  3. Take a nice clean shower. This gives your skin a chance to breathe and leaves everything fresh and clean.
  4. Dry off completely. Pat the skin around your stoma totally dry.
  5. Apply your new appliance. Since everything is already prepped, it goes on quickly while your skin is clean and dry.

On days you're not changing, you can shower with your full pouch on. Ostomy Canada Society recommends emptying your pouch first, avoiding high pressure water aimed right at your barrier, and patting your pouch dry instead of rubbing it. They also discourage showering with just the barrier on and the pouch off, since water can get under the barrier and shorten your wear time.

9. Take the Weight Off Your Seal

All of these habits protect your seal. But there's one thing they don't address: as your pouch fills, its weight pulls on your barrier all day, especially when you're active. That constant tug is one of the main reasons barriers lift early and output reaches your skin.

That's the problem I set out to solve when I designed my first ostomy belt in 2009. A good belt supports the weight of your pouch without compressing it, so your barrier isn't fighting gravity and movement all day. For everyday wear and sports, I use the HIRO Performance belt. For sleeping and lighter days, I like the slim HIRO Ostomy Support Belt™ Ultralight Sleek Fit. Not sure which fits you? My guide on how to choose an ostomy belt and our sizing guide can help.

When to Call Your Doctor or Ostomy Nurse

MedlinePlus recommends contacting your provider if your stoma:

  • Swells more than half an inch larger than normal
  • Pulls in below the level of your skin
  • Bleeds more than usual
  • Turns purple, black or white
  • Leaks often, or fits worse than it used to

Call them too if the skin around your stoma is raw, bleeding, burning, or has a rash or bumps, or if you have a fever, stomach pain or signs of dehydration. And don't hesitate to reach out with any question at all.

Where to Find Help

Final Thoughts

Stoma care gets easier with every change. Clean gently, get the fit right, protect your skin with barrier rings and strips, take your time removing your barrier, and give your pouch some support. Before long, it really does become just another part of your day.

Have questions? Check our ostomy belt FAQ or reach out to me directly. I'm always happy to talk.

Mahalo for reading.
Richard O'Hamill

Stoma Care FAQ

How often should I change my ostomy bag?
UOAA says a wear time of three to seven days is to be expected, depending on your body and pouching system. If you need to change every day or two, MedlinePlus recommends contacting your provider. Personally, I wear a belt 24/7 and change every Sunday morning, with an extra change after a surf session or a long beach day. In my experience, people who wear a belt that fully supports the weight of their bag tend to get longer wear times than people who don't.

Is it normal for my stoma to bleed a little?
Yes. MedlinePlus notes that a small amount of bleeding when you clean your stoma is normal. Call your doctor or ostomy nurse if it bleeds more than usual, or if your stoma turns purple, black or white.

Can I shower with my ostomy bag?
Yes. UOAA says you can shower or bathe with your pouch on or off, and water won't go into your stoma. Ostomy Canada Society recommends against showering with only the barrier on and the pouch off, since water can get under the barrier. I like to change my appliance right after a shower.

What should I clean my stoma with?
Warm water is all you need. MedlinePlus, Colostomy UK and the NHS all recommend warm water, and suggest avoiding products with alcohol, perfume or oil. If you use an adhesive remover wipe, I recommend one without alcohol.

Why does my stoma change size?
UOAA notes your stoma shrinks as it heals and can change size for up to 10 weeks after surgery. Colostomy UK adds that weight changes can affect it too. In my experience, it can also swell a bit when I'm sick or in a flare. Remeasure whenever your fit feels different.

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Sources

Richard O'Hamill has lived with an ostomy since 2008. He's the inventor of the performance ostomy support belt and founder of O'Hamill Inc., maker of HIRO ostomy support belts.

This article shares my personal experience and general information from trusted medical sources. It is not medical advice. Please talk with your surgeon or ostomy nurse about your own care.