Preventing leaks and treating severe peristomal skin damage

Transforming Stoma Care: Mrs Green’s^* Journey to Confidence and Comfort

*name changed to ensure anonymity

Background: Living with Dual Stomas and Ongoing Challenges

Mrs Green had transverse myelitis in 2015, which resulted in the formation of a colostomy and urostomy. She developed bilateral parastomal hernias shortly after surgery, and has a past medical history of non-Hodgkins lymphoma, breast cancer, asthma, osteoporosis, and arthritis (mainly affecting her hands).

Initial Stoma Complications and Quality of Life Impact

Mrs Green received a postal invitation to take part in an evaluation of Aura Plus Soft Convex and accepted, evaluating a closed pouch for her colostomy. She evaluated the pouch favourably and mentioned in her response she was experiencing complications with her urostomy.

She was referred to a Community Stoma Care Nurse and agreed to a stoma care review at her home. This was a significant step, as she had avoided seeking help due to a fear of hospitals.

Nursing support was offered by SecuriCare Medical, and during the initial review, the main challenges identified were frequent leaks and severe skin break down. These issues had persisted for years, resulting in skin infections requiring treatment with oral antibiotics and steroid preparations.

Seeking Support: Stoma Care Review and Assessment

During the initial examination, Mrs Green’s skin was found to be red, broken, weeping and itchy. Using the Ostomy Skin Tool (Coloplast, 2016), a DET score (discolouration, erosion and tissue overgrowth) of 9 was reported which indicated severe skin damage.

It was evident that the adhesive of her current appliance was causing trauma, pulling the skin, leading to tears, infections and increased leaks. The skin would then ooze and become infected, causing the pouches to leak and subsequently fall away from the skin. These leaks resulted in soiled clothing and bedding, contributing to anxiety and a reduced quality of life. Mrs Green was changing her pouch two to three times a day and required additional accessories to manage her urostomy.

Her urostomy sat in a dip and retracted at times, causing frequent leakage – a challenging situation that can potentially be resolved with a convex pouch (McNichol et al, 2021).

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The Emotional Impact: Anxiety About Her Son’s Wedding

Mrs Green explained that her son was getting married and that she was particularly anxious about attending the wedding and staying overnight at a hotel. The fear of pouch leaks and embarrassment had led to her to consider missing the event.

She had previously enjoyed holidays and socialising, but had also stopped over the last few years due to leaks from her stoma appliance.

Introducing Aura Plus Soft Convex

Having already evaluated Aura Plus Soft Convex for her colostomy with favourable outcomes, it was recommended as a suitable option for her urostomy as well and she was keen to try it.

The softness and shape of the flange were expected to offer greater flexibility and reduce skin friction. A demonstration was provided, explaining:

• How to use the pouch effectively
• Why the gentle convexity could help her stoma protrude into the pouch
• The benefits of medical-grade manuka honey, which may help improve peristomal skin conditions (White & Evans, 2019)

Due to the wet, broken skin and poor adhesion with her usual pouches, stoma powder and a barrier film spray were recommended to aid healing (O’Flynn, 2019). Mrs Green usually used barrier wipes, but a barrier spray was recommended for a more consistent and even coverage. She was also advised to continue using an adhesive remover to minimise the risk of further trauma (Rudoni, 2008).

Reduced Leaks and Healing Skin

A follow-up via email after one week – Mrs Green’s preferred method of communication – revealed significant improvements:

• No more leaks and achieving 24+ hours wear time instead of changing multiple times a day
• Noticeable improvement in peristomal skin condition
• A boost in confidence, allowing her to look forward to her son’s wedding without fear of leaks

A face-to-face visit after two weeks confirmed continued healing. The skin underneath the flange area had healed significantly, and the surrounding area was beginning to show improvements. Mrs Green was particularly pleased that she could sleep flat again, something she had not been able to do for some years. She remained leak-free both day and night, her skin was less itchy, and she was happy with her progress.

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Long-Term Success: Six-Week and Ten-Week Follow-Ups

A third home visit conducted after six weeks showed exceptional progress:

• No leaks with Aura Plus Soft Convex
• Improved sleep and peristomal skin condition
• A sample of barrier cream was provided to help protect and heal the remaining irritated skin areas

At a ten week visit, Mrs Green appeared brighter, healthier and more active. She had not required antibiotics or steroids since switching to Aura Plus Soft Convex.

She was once again able to get out and about more, telling the nurse “you can’t keep me in!”. She now enjoys walking her dog, socialising with friends, and sleeping well, all while remaining leak-free both day and night.

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Conclusion: A New Lease on Life with Aura Plus Soft Convex

The introduction of Aura Plus Soft Convex has transformed Mrs Green’s stoma care, leading to significant improvements. After struggling with frequent leaks and severe sore skin around the stoma, she is now experiencing:

• Leak-free days and nights
• Significantly improved peristomal skin health
• Greater confidence in everyday life

The plus-shaped flange provided effective adhesion to the abdominal contours around her parastomal hernia, while the soft convexity supported her stoma and completely prevented leakage.

Mrs Green has regained her quality of life and independence. Previously afraid to leave the house due to the fear of leaks, she is now enjoying socialising and going for walks. Most importantly, she was able to enjoy her son’s wedding with confidence – something she never thought would be possible!

Added Benefit: Cost Savings in Stoma Care

Beyond the quality of life improvements, there has also been a profound impact on prescribing costs. Since Mrs Green no longer needed to change her pouch multiple times a day, the reduction in appliance use has led to significant cost savings.

Mrs Green continues to use Aura Plus Soft Convex for both her urostomy and colostomy, enjoying ongoing comfort and reliability in her stoma care routine.

References

• Coloplast (2016) Ostomy Skin Tool. www.coloplastprofessional.co.uk/globalassets/hcp/pdf-file/v2/uk/oc/det_skintool_editable.pdflast. Accessed: 24/08/2023

• McNichol, L, Cobb, T, Depaifve, Y, Quigley, M, Smitka, K, Gray, M (2021) Characteristics of convex skin barriers and clinical application. Journal of Wound Ostomy and Continence Nursing 48 (6) 524-532

• O’Flynn, SK (2019) Peristomal skin damage: assessment, prevention, and treatment. British Journal of Nursing 28 (5) 275-S3

• Rudoni, C (2008) A service evaluation of the use of silicone-based adhesive remover. British Journal of Nursing 17 (2) S4-S9

• White, P, Evans, M (2019) Clinical governance for ostomates at risk of peristomal skin damage. British Journal of Nursing 28 (16) 2-10