Skin Around Your Stoma: Fit Checks, Gentle Care and When to Call a Nurse
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Quick answer: Healthy skin around a stoma should generally look and feel similar to the surrounding abdominal skin. Burning, itching, repeated leakage, open or weeping skin, or a pouch seal that will not hold are reasons to check the fit and contact an ostomy nurse. Do not keep covering a leak with extra tape.
The skin around a stoma is called peristomal skin. It helps support the pouch seal, so skin health and appliance fit are closely connected. This guide explains the routine checks recommended in the Wound, Ostomy and Continence Nurses Society’s consumer assessment guide.
1. Check how closely the barrier fits
At a routine pouch change, measure the stoma and check that the skin-barrier opening fits closely around its base without pressing on the stoma. A gap can allow stool or urine to reach the skin, while an opening that is too tight can cause pressure or trauma.
Stoma size and shape can change, especially in the weeks after surgery. Weight changes, abdominal contours and movement can also affect the seal. If a previously reliable system starts leaking, a new fit assessment may be more useful than simply changing accessories.
2. Act on burning, itching or leakage
Burning or itching under the barrier can be an early sign that moisture or output has reached the skin. WOCN guidance advises changing the pouching system when burning, itching or leakage occurs rather than reinforcing a leaking pouch with extra tape.
When the system is removed, inspect both the skin and the adhesive side of the used barrier. Swelling, colour change, open areas, moisture or a clear pattern of leakage can help an ostomy nurse understand what is happening.
A single leak does not automatically mean the skin is infected or that a particular product is needed. Repeated leakage deserves a fit review because the cause can involve the opening size, stoma height, abdominal contours, movement, wear time or another individual factor.
3. Keep cleansing simple and gentle
WOCN’s consumer guide advises cleansing peristomal skin with warm tap water. Remove adhesive gently while supporting the skin rather than pulling quickly. Pat or allow the skin to dry before applying the next system.
Avoid vigorous scrubbing and avoid experimenting with household antiseptics, oils or unverified remedies. Products left on the skin can sometimes affect adhesion. If your care team has recommended a specific cleanser or skin product, follow their instructions and the product directions.
4. Know what to observe
At each change, look for:
- burning, itching or tenderness;
- a colour change compared with the surrounding skin;
- open, moist or weeping areas;
- pus or an unpleasant odour from damaged skin;
- a barrier that shows output underneath;
- a seal that fails much sooner than expected;
- skin changes that are spreading or not improving.
Do not try to diagnose a rash from appearance alone. Irritant exposure, adhesive injury, pressure, moisture, infection and other skin conditions can look similar. Treatment depends on the cause.
5. Know when to contact an ostomy nurse
The WOCN consumer guide advises contacting a WOC or ostomy nurse when the seal cannot be maintained for 24 hours, the contributing factors are unclear, or the skin has not improved within seven days of recommended management. Open or moist skin loss and pus need earlier clinical contact.
Seek medical advice sooner if pus is accompanied by fever, chills, reduced appetite, nausea, vomiting or feeling generally unwell. These symptoms require assessment rather than further trial and error with the pouching system.
Why product advice must be individual
Barrier rings, powders, films, convex systems, belts and other accessories can be useful in selected situations, but they are not universal solutions. The right choice depends on the cause of the leak or skin change, the stoma and abdominal profile, the person’s dexterity and the pouching system being used.
For this reason, this article does not provide a step-by-step treatment recipe. An ostomy nurse can assess the skin and fit, identify likely contributing factors and show how to use any recommended accessory correctly.
A simple routine to remember
- Measure and check the fit during routine changes.
- Change the system when burning, itching or leakage occurs.
- Inspect the skin and the used barrier.
- Clean gently with warm water and dry well.
- Ask for clinical review when the seal fails repeatedly or skin damage persists.
This article is general education and does not replace assessment by an ostomy nurse, WOC nurse, enterostomal therapist or doctor.
Frequently asked questions
Should I tape over a leaking ostomy pouch?
No. WOCN guidance advises changing a leaking system rather than reinforcing it with extra tape. Check the skin and the used barrier for signs of leakage.
What should healthy peristomal skin look like?
It should generally look and feel similar to the surrounding abdominal skin. Persistent burning, itching, moisture, open skin or repeated leakage needs review.
Can I clean around my stoma with warm water?
WOCN’s consumer guide recommends warm tap water for routine cleansing. Handle the skin gently and dry it before applying the next pouching system.
When should I contact an ostomy nurse?
Contact a WOC or ostomy nurse if the seal cannot be maintained for 24 hours, the cause is unclear, or the skin has not improved within seven days of recommended management. Open or moist skin loss and pus need earlier clinical contact.
Does a red or itchy rash always mean a fungal infection?
No. Several skin and fit problems can look similar. Avoid self-diagnosing from appearance alone and ask an ostomy nurse or clinician to assess persistent symptoms.
References
- Wound, Ostomy and Continence Nurses Society. Peristomal Skin Assessment Guide for Consumers.
- D’Ambrosio F, et al. Peristomal Skin Complications in Ileostomy and Colostomy Patients. 2022. PMID: 36612395.
- WOCN Society Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy. PMID: 29300288.