There are a variety of different types of stomas to help with various bodily functions in the face of illness, cancer, accident, or surgery. Stomas that are created to allow feeding tubes to be inserted into the intestines or stomach, and stomas that are designed to help with the removal of output as waste from the body.
Feeding Tube Stomas
Feeding tube stomas are small surgically created openings in the abdominal wall that allow a small thin tube to be inserted inside of the stomach or intestines. This could happen to anyone, but those facing stroke, cancer, gastrointestinal diseases and disorders, or even burns have a greater chance of needing this medical support. Proper care is required including keeping the area clean and dry. Some of the more common complications with feeding tube stomas include infection, leakage, skin irritation, and granulation tissue growth.
Some of the styles of feeding tubes that exist are the NG tube, Pigtail G tube, Gj tube, PEG tube, Balloon G tube, Low-profile Balloon G tube, Low-profile bulb G tube, and the low-profile balloon transgastric-jejunal tube.
Feeding Tube Stoma Care
Healthy tube stoma sites don’t need a lot of extra care. Daily baths with soap and water are usually all that is needed to keep the area clean. General care tips for feeding tube stoma sites include:
- Keep the tube site clean. Clean around the tube site using soap and water at least once a day and whenever there is drainage. Use a cotton swab to clean around the tube.
- Keep the skin around the site dry. Do not use lotions, creams, or ointments unless instructed.
- Turn tubes as recommended. G-tubes and button tubes should be turned one-quarter turn each day. If your child has a GJ-tube, never turn the tube as this can move the tube out of place and prevent it from working correctly. Ask if and how your child’s tube should be turned.
- New Stomas: A gauze dressing may cover the site for the first few days after the tube is placed. Keep the area clean and dry. Change the dressing if it gets wet or dirty. A small amount of fluid may leak from the site. The fluid often forms a crust as it dries. Clean the area gently to remove the crust. No dressing is usually needed after 2-3 days.
Leaking can occur around the tube. If leaks occur from the tube, it can be due to a problem with the balloon fill. Leaks can also be related to neutropenia. Moisture and acidic stomach fluids can cause the skin to be red and irritated. If this occurs, clean the skin with water several times each day. The area will have to be cleaned more often if drainage increases. Gently dry the skin after cleaning. A barrier powder or ointment may be needed. If the skin does not improve or leaks continue or occur in large amounts, talk to your care team.
Reasons for leaking around the feeding tube site include:
- Feeding too much or too fast. The tube can sometimes leak during bolus feedings. Slowing down the rate of feeding or using a different feeding schedule may help. Talk to a dietitian or other care team member before making changes to nutrition.
- Problems with the internal balloon. Check the amount of water in the balloon. If it has less water than it should, refill with the correct amount. Contact the care team for instructions.
Steps to check the water in the balloon:- Attach a syringe to the balloon port.
- Pull back on the plunger to remove all the water from the balloon and note the amount of water.
- If the balloon has less water than it needs, add the correct amount to the syringe and put the water back into the balloon.
- Disconnect the syringe.
- Incorrect fit of the tube. This can sometimes happen with gains or loses with weight.
- Pressure on stomach or tube. Sleeping on the belly can cause pressure on the tube and trauma to the stomach. Sleeping on the side or back may reduce pressure.
- Gas and constipation. Gas and constipation can also cause fullness and pressure within the digestive tract. Being physically active and getting enough fluids can help. Your care team may also give your instructions to vent or burp the tube to remove excess air.
Granulation tissue is extra skin tissue that can grow at the site of the stoma. Granulation tissue is common. It usually appears red and moist, like the skin inside the mouth. This tissue is delicate, and there may be some bleeding or discharge. Granulation tissue may be caused by friction as the tube rubs against the skin.
Ostomy Stomas
Stomas designed for output, or to help rid the body of its waste and fecal matter, are designed by surgically creating an opening, and bringing the intestines or the bladder towards the surface of the body to then catch urine or stool in a specially designed pouch or bag. These types of stomas can be temporary or permanent, depending on the cause and underlying medical conditions.
This type of stoma creation is most often needed for those with intestinal or bladder disease or damage, diseased or removed sections of the intestine or organ, body has lost continence control, cancer, connective tissue disorders, and more.
Ostomy Stoma Care
After surgery, the stoma will be swollen. It will shrink over the next several weeks. The skin around your stoma should look like it did before surgery. The best way to protect your skin is by:
- Using a bag or pouch with the correct size opening, so waste does not leak
- Taking good care of the skin around your stoma
Stoma appliances are either 2-piece or 1-piece sets. A 2-piece set consists of a baseplate (or wafer) and pouch. A baseplate is the part that sticks to the skin and protects it against irritation from feces. The second piece is the pouch into which feces empty. The pouch attaches to the baseplate, like a Tupperware cover. In a 1-piece set, the baseplate and appliance are all one piece. The baseplate usually needs to be changed only once or twice a week.
To care for your skin:
- Wash your skin with warm water and pat it dry well before you attach the pouch.
- Avoid skin care products that contain alcohol. These can make your skin too dry.
- Do not use products that contain oil on the skin around your stoma. Doing so can make it hard to attach the pouch to your skin.
- Use special skin care products to make skin problems less likely.
If you have hair on the skin around your stoma, your pouch may not stick. Removing the hair may help.
- Ask your ostomy nurse about the best way to shave the area.
- If you use a safety razor and soap or shaving cream, be sure to rinse your skin well after you shave the area.
- You can also use trimming scissors, electric shaver, or have laser treatment to remove the hair.
- Do not use a straight edge.
- Be careful to protect your stoma if you remove the hair around it.
Carefully look at your stoma and the skin around it every time you change your pouch or barrier. If the skin around your stoma is red or wet, your pouch may not be sealed well on your stoma. Sometimes the adhesive, skin barrier, paste, tape, or pouch may damage the skin. This may happen when you first start using a stoma, or it may happen after you have been using it for months, or even years. When output changes and is more liquid, leaks are very common.
If this happens:
- Ask your health care provider about medicine to treat your skin.
- Call your provider or WCON if it does not get better when you treat it.
If your stoma is leaking, your skin will get sore. Be sure to treat any skin redness or skin changes right away, when the problem is still small. Do not allow the sore area to become larger or more irritated before asking your provider or ostomy nurse about it. If your stoma becomes longer than usual (sticks out from the skin more), try a cold compress, like ice wrapped in a towel, to make it go in.
You should never stick anything into your stoma, unless your doctor tells you to.
Citations:
United Ostomy Association of America
The Vegan Ostomy
Empowering Intimacy
Hollister
Coloplast