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Improving peristomal skin integrity and relieving stoma related anxiety

Mrs White* had an end ileostomy formed following a panproctocolectomy for ascending colon cancer. Past medical history includes Ulcerative Colitis and a previous knee surgery.

*name has been changed to ensure anonymity

Mrs White was discharged with a flat backed stoma pouch and a convex washer but experienced leaks. Her stoma was flush to the skin, so she was sampled on a soft convex pouch. From this point, Mrs White experienced occasional leaks but adjusted well to life with a stoma, returning to her normal daily activities including travelling abroad. She experienced sore skin with this soft convex stoma pouch, managing this with stoma powder and skin barrier wipes. Following an appointment with her Stoma Care Nurse, a ring of erythema was noted around her stoma.

Due to her previous issues with leakage when using a flat pouch, it was agreed that Mrs White would continue to use this soft convex pouch to help manage these leaks and skin integrity would be closely monitored and managed using additional accessory products.

Mrs White also reported changes in her abdominal appearance following a prolonged cough. The swelling settled and there was no evidence or diagnosis of parastomal hernia, although it was noted that there was a circle of blushed skin corresponding to the convexity of her pouch.

Mrs White was identified as a suitable user for Aura Plus Soft Convex. The soft convexity was felt to be a suitable product to the other pouch she was using, offering more gentle support, with the plus-shaped adhesive having the benefit of conforming and moulding around the abdomen to help maintain a secure seal throughout the day.1

Mrs White agreed to try Aura Plus Soft Convex, whilst also evaluating the product by filling out a questionnaire to record her experience. Mrs White provided written consent for this and for clinical photography to be captured and shared. The pouches were demonstrated and Mrs White used these two weeks up until the date of a follow up appointment with her Stoma Care Nurse.

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Pre-evaluation photograph

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Post-evaluation photograph

Mrs White had a positive experience with Aura Plus Soft Convex, explaining how she really likes the pouches and how they’re making a positive difference to her wellbeing and quality of life. Mrs White has started to use Aura Plus Soft Convex as her stoma pouch of choice. She reported an improvement in her peristomal skin integrity which is clearly visible in the post-evaluation photograph, which demonstrates the improved skin condition following the use of Aura Plus Soft Convex. Using Aura Plus Soft Convex has helped reduce Mrs White’s anxiety around her stoma pouch becoming full, and she no longer worries about her pouch becoming unsecure and leaking. Concerns about leaks are known to have a significant impact on a person’s ability to adapt to life with a stoma2,3, and it’s clear how Aura Plus Soft Convex has improved Mrs White’s stoma care routine and pouch experience.

This clinical case study demonstrates how medical grade Manuka honey can be beneficial in promoting skin integrity, correlating with widely reported benefits of the use of Manuka honey in stoma care.4,5 As well as the inclusion of medical grade Manuka honey in the hydrocolloid, the benefits of the plus-shaped convex flange are demonstrated. This can benefit patients who may struggle to obtain sufficient adhesion with a circular or oval shaped adhesive, with additional flexibility and conformability to ensure an optimal fit. The gentle nature of the convexity may also reduce the risk of skin trauma whilst still providing security and reducing the risk of leaks.

References

  1. Bedford, F (2022) Evolving stoma appliances to improve patient outcomes and increase stoma acceptance. British Journal of Nursing. 31 (16 Stoma Care Supplement), S18 – S23
  2. Aibibula, M., Burry, G., Gagen, H., Osborne, W., Lewis, H., Bramwell C., Pixley, H. and Cinque, G. (2022) Gaining consensus: the challenges of living with a stoma and the impact of stoma leakage. British Journal of Nursing. 31 (6 Stoma Care Supplement), S30 – 39.
  3. Bekker Jeppesen, P., Vestergaard, M., Bo Boisen E. and Adeltoft Ajslev, T. (2022) Impact of stoma leakage in everyday life: data from the Ostomy Life Study 2019. British Journal of Nursing. 31 (6 Stoma Care Supplement), S48 – S58.
  4. Evans, M. (2018) The use of manuka honey within stoma care to maintain peristomal skin integrity: the ostomates perspective. World Council of Enterostomal Therapists Journal. 38 (2): 40
  5. Evans, M. and White, P. (2020) Selecting convexity to improve and maintain peristomal skin integrity. British Journal of Nursing. 29 (16 Stoma Care Supplement), S8 – S14)