How much skin should remain exposed between the stoma and the ring of the appliance?

The skin around your stoma should look similar to the skin on the rest of your body. Immediately after you take off the adhesive, it may be a little pink, but if this doesn’t fade or if the skin is broken or damaged, your skin may be irritated.

What should I do?

• Remove the adhesive and check the back. Is there any sign of faeces or urine that could have caused the irritation?
• Is there any irritation or damage around your stoma that corresponds to what you see on the adhesive?
• How well does your pouch fit around your stoma? Is your skin exposed to the output from the stoma due to poor fitting? Assess the diameter and shape of your stoma to see if your template has the right size and shape. Use the release liner from the pouch as a guide and if needed, adjust the hole in the adhesive so that it exactly fits the diameter and shape.
• What is the position of the stoma opening in relation to the surface of your skin? Is it above the skin surface, level with the skin surface or below the skin surface? If the stoma is level with or below the skin surface, or if it is situated in a deep fold, you may need a different type of pouch or accessories for your body profile. Try the Coloplast BodyCheck tool to check fit.
• Has the adhesive eroded? If so, the pouch may have needed to be changed earlier. Try more frequent changes or consider an erosion-resistant adhesive if you’re not already using one.

If your skin irritation is caused by other reasons, consult your stoma care nurse or doctor. Use our Ostomy Self Assessment Tools to find advice and solutions to common issues such as stoma bag leakage and skin irritation.

If your skin is red and 'pimply'

If a rash seems to develop with small, painful pimples or pustules rather than a more diffuse irritation, it could be caused by an infection in the hair follicles in the skin around your stoma.

Infection in the hair follicles can develop if you shave the hair in the area around your ostomy too often or incorrectly (e.g. not using a clean, sharp razor, shaving against the direction of the hair growth etc.), or if you tear off the adhesive plate with force, tearing out hair as well. In most cases, scissors or an electric shaver will work better for the skin than a razor.

If your skin is wet and bumpy

Rashes (area of reddening, usually itchy) or with red or purple patches or with white substance over affected areas could be signs a fungal infection. If you have diabetes or lowered immune system, you could be especially at risk for this.

Dark and moist areas are particularly prone to fungal infections, so the most effective prevention is to keep the peristomal skin clean and dry when changing the pouch.

If your skin is bleeding

Start by carefully examining where the bleeding is coming from. Bleeding from the skin around your stoma could be a sign of a contact reaction, and may require treatment or preventive measures, and you must seek advice from your stoma care nurse.

However, a little bleeding from the ostomy itself is not necessarily alarming. The ostomy tissue bleeds easily, similar to gums when flossing or brushing.

Are you having an allergic reaction?

First of all: An allergic reaction is a very rare reaction. However, if you do have one, the skin would likely be quite irritated or possibly itchy in the entire area exposed to the irritant.

Start by looking at the cleaning products you use. Do you ever use perfume, soaps with moisturisers, fragrances or oils? Perhaps alcohol-based cleansing products? Try avoiding these products completely, and wash the peristomal skin gently using water only for some time.

You could also be allergic to some of the supporting products you use, such as sprays, wipes or pastes, possibly even to components of your pouching system – so if the problem persists, talk to your stoma care nurse about alternatives.

How much skin should remain exposed between the stoma & ring of the appliance?

How far from the skin should a stoma protrude?

How much larger than the stoma should the pouch opening be?

What findings would you expect to see when assessing a healthy ostomy stoma?