Ostomy Concerns and Resources

In patients who received ostomy, a lifestyle adjustment will be required.

Peristomal Skin Complications

Complication Cause / Description Treatment
Radiotherapy-related skin problems Acute dermatitis with subsequent desquamation (like sunburn). With higher levels of exposure, skin may blister leaving eroded areas. Increase in stoma output (diarrhea) as a result of radiotherapy can indirectly result in peristomal skin breakdown Apply beclomethasone spray to peristomal skin with each appliance change
Malignancy Patients who have had ostomy surgery for a bowel malignancy may develop secondary deposits within or around the stoma (probably more common with adenocarcinoma of the bowel). This may represent seeding of tumor to the skin Surgical: refer to the patient’s treatment surgeon 

An Enterostomal Therapy Nurse Specialist should be consulted for recommendations

* Irritant Dermatitis Peristomal skin becomes reddened / discoloured with loss of epidermal layer. The skin is moist / macerated and may bleed Refer to an Enterostomal Therapy Nurse Specialist 
* Contact (Allergic) Dermatitis Red, irritated skin corresponding to the shape of the adhesive contact surface Follow-up with an Enterostomal Therapy Nurse Specialist to ensure appropriate pouch equipment, proper technique of application and adequate care of stoma and peristomal skin is taking place 

Consider dermatology consult for patch testing to determine allergen. Consider topical antihistamine applied to peristomal skin with each appliance change (Flonase spray can be used in this manner and does not inhibit appliance adhesion)

Candidiasis Caused by a leaking / poorly fitting ostomy appliance, heat / body perspiration, denuded skin Medline Arglaes Powder contains silver which has a topical antifungal affect. Lightly sprinkle on the area brushing away loose powder. Apply with each appliance change until resolved. Powder can be purchased over-the-counter at ostomy supply retailers

* Peristomal skin is highly susceptible to developing either irritant or contact dermatitis, as a result of the skin stripping

with repeated appliance changes, intermittent contact with irritating stoma effluent, and the occluded / humid environment that the appliance creates which increases the risk of sensitization.

Please note:

These are some of the more common peristomal skin complications which may present in this patient population.

AVOID creams and ointments as the ostomy appliance barrier will not adhere. If these types of topical therapies need to be used, the appropriate dressing must be applied to provide a drier surface for appliance adhesion.

Ostomy wear time should be three days or more once a routine is attained post-op. Short wear times should mandate a review with the surgeon or hospital Enterostomal Therapist. Irritation of the skin or ulceration that causes severe pain or difficulty with appliance changes should also mandate a review.

General Ostomy Related Resources for Patients and Primary Care

Canadian Association for Enterostomal Therapy: Find an ET Nurse     

https://members.caet.ca/etfinder

Familial Gastrointestinal Cancer Registry

Phone: 1-416-586-4800 Ext. 8334

UOAC Chapters

www.ostomycanada.ca/chapters.htm

IDEAS (Intestinal Disease Education and Awareness Society)

Phone: 604-255-9606

Email: info@IDEAS-NA.com

Crohn’s and Colitis Foundation of Canada

Toll Free: 1-800-387-1479

www.ccfc.ca

Coloplast Canada

http://www.coloplast.ca

Canadian Society of Intestinal Research

Toll free: 1-866-600-4875

www.badgut.com

Email: info@badgut.com

Hollister Canada

http://hollister.com/canada

ConvaTec Canada

http://www.convatec.ca

Argyle Medical Distributors Inc.

http://www.argylemedical.com

Financial Resources

Assistive Devices Program (ADP)

Any resident of Ontario who has a valid health card issued in their name and has a permanent ostomy can apply for funding. ADP provides $600 annually in two installments and $800 annually if receiving Ontario Works (OW), Ontario Disability Support Program (ODSP), or Assistance to Children with Severe Disabilities (ACSD). ADP will fund a maximum of two ostomies. The ADP application form can be found at:

http://www.health.gov.on.ca/en/public/programs/adp/adp_fm.aspx

Disability Tax Credit Certificate

Individuals with an ostomy may be eligible for this tax credit. The form number is T2201 and can be found online at:

http://www.cra.gc.ca/disability

The form will need to be completed by a physician. The form can be completed anytime throughout the year.