Peristomal Skin and Ostomy Care Basics

Healthy peristomal skin is the foundation of successful ostomy care. Most ostomy complications begin with skin breakdown caused by leakage, poor appliance fit, or repeated adhesive trauma. When the skin remains intact, residents are generally more comfortable, experience fewer leaks, and are more willing to participate in daily activities.

This guide reviews the basics every clinician should know—and when it's time to involve a certified ostomy nurse.

Assess the Stoma First

A healthy stoma should be:

• Moist
• Beefy red to pink
• Slightly raised above the surrounding skin
• Painless to gentle touch

Because the stoma is highly vascular, a small amount of bleeding during cleaning is normal.

Output varies by ostomy type:

Ostomy	Typical Output	Skin Risk
Colostomy	Formed stool	Lower
Ileostomy	Liquid, enzyme-rich stool	Higher
Urostomy	Urine with mucus	Moderate

The more liquid and enzyme-rich the output, the more important an effective seal becomes.

Escalate promptly if you observe:

• Dusky, purple, or black discoloration
• Significant retraction below skin level
• Marked prolapse
• Sudden changes in stoma appearance or perfusion

Protect the Peristomal Skin

Healthy peristomal skin should look much like the surrounding abdomen.

The most common causes of breakdown include:

Leakage — Effluent beneath the skin barrier causes irritant dermatitis (peristomal moisture-associated skin damage). Management begins by correcting the seal while protecting the skin with appropriate barrier products.

Adhesive Trauma — Repeated or aggressive removal of adhesives can damage the epidermis. Gentle removal techniques and adhesive removers help reduce medical adhesive-related skin injury (MARSI).

Poor Appliance Fit — An opening cut too large exposes skin to effluent. One cut too small may place pressure on the stoma itself.

The goal is simple:

• Keep effluent off the skin.
• Maintain a reliable seal.
• Minimize skin trauma during appliance changes.

Achieving a Good Appliance Fit

Proper appliance fit is one of the most important factors in preventing complications.

The skin barrier should fit closely around the stoma without constricting it.

Because stoma size changes during the weeks following surgery—and may also change with weight fluctuations—measure the stoma regularly rather than relying on previous measurements.

When applying a new appliance:

• Clean and dry the skin thoroughly.
• Evaluate abdominal creases or folds.
• Confirm the barrier is fully sealed before dressing the resident.

Residents with retracted stomas, abdominal folds, or uneven contours may benefit from convex barriers, barrier rings, or other accessory products.

When to Involve a Certified Ostomy Nurse

Many residents do well with routine nursing care. However, specialty consultation should be considered when you encounter:

• Persistent appliance leakage
• Peristomal skin breakdown that is worsening or not healing
• Stoma retraction or prolapse
• Suspected parastomal hernia
• Changes in stoma color or perfusion
• New ostomates requiring education and appliance selection
• Residents struggling to manage or adapt to their ostomy

Early consultation often prevents minor skin problems from becoming more complex wound care issues.

Meeting the Growing Need for Ostomy Care

Access to certified ostomy care has become increasingly limited in many communities, including the Denver metropolitan area. As availability decreases, facilities may struggle to support residents with complex ostomy needs.

ProHealth One is expanding access by providing certified ostomy nurses who deliver bedside care alongside weekly wound rounds and offer outpatient ostomy services through our clinic.