Ostomy Care Advice From an Ostomy Nurse: Skin, Nutrition, Hydration & More

Living with an ostomy comes with questions that rarely have one-size-fits-all answers. Skin irritation, finding the right appliance, nutrition, hydration, granulomas, and emotional adjustment after surgery can look very different from one person to another.

In this conversation, ostomy care nurse Elizabeth Faust shares practical guidance based on her experience caring for ostomy patients. We discuss common challenges, why finding the cause of a problem matters as much as treating it, and the importance of having knowledgeable professionals and resources to turn to when something isn’t working.

One theme comes up throughout our conversation: every ostomy and every person is different. Learning what works for your body—and knowing when to ask for help—is an important part of living confidently with an ostomy.

Understanding Why Skin Irritation Happens

Skin irritation is one of the most common problems people with ostomies encounter, but Lizzie makes an important distinction: common doesn’t mean normal.

Instead of immediately asking what product should be put on irritated skin, she recommends first understanding why the irritation is occurring.

“The biggest thing is discovering why, not just figuring out what you are going to put on it.”

Leakage can expose skin to output. The opening in the wafer may not fit properly. Moisture can become trapped around the stoma. Some people may also have sensitivities or allergic reactions to adhesives or other products.

Lizzie experienced this herself during her ostomy training. After wearing ostomy appliances on her own skin, she discovered a significant adhesive allergy and had to try products from three different companies before finding something her skin tolerated.

Her experience reinforces an important point: persistent irritation isn’t necessarily something you simply have to tolerate. Identifying and correcting the cause may be more important than repeatedly treating damaged skin.

Finding the Right Ostomy Products

There are many pouching systems, barrier rings, accessories, and skin products available. What works well for one person may not work for another.

The appliance you leave the hospital with isn’t necessarily the appliance you have to use forever.

Lizzie recommends taking advantage of manufacturer support programs. Many companies provide free samples and support staff who can help troubleshoot problems and explain different product options.

These programs aren’t a replacement for seeing a certified ostomy nurse, particularly when there is an ongoing medical or skin issue. But they can be useful when exploring products that may work better with your body shape, skin, or stoma.

Bodies change. Stomas change. Weight changes. The system that worked immediately after surgery may need adjusting months or years later.

Protecting Irritated Skin With the Crusting Technique

When skin around the stoma has already become irritated or damaged, one technique Lizzie commonly recommends is crusting.

Crusting typically involves applying stoma powder to damaged or moist skin followed by skin prep. Together they create a protective layer that Lizzie describes as similar to a “liquid bandage.”

The area should first be gently cleaned with water and dried thoroughly. Lizzie emphasizes avoiding products containing lotions or other ingredients that could interfere with adhesion.

She also frequently recommends a hydrocolloid barrier ring, which can fill small irregularities around the stoma and help create a better seal.

For persistent irritation, however, crusting shouldn’t become a way of indefinitely covering up a larger problem. The underlying cause still needs to be identified.

Understanding and Preventing Granulomas

Granulomas are another issue some ostomates experience around the stoma.

According to Lizzie, two common contributors are friction and moisture.

If granulomas develop, look at what may be repeatedly irritating the area. Is the appliance opening too tight? Is something rubbing against the stoma? Are the edges of a cut-to-fit wafer rough? Is moisture sitting against the area?

Medical treatments can include silver nitrate and, in some situations, other treatments directed by a healthcare professional.

Lizzie emphasizes that procedures such as debridement or treatment of granulomas should be performed or directed by an appropriate medical professional rather than attempted independently at home.

Reducing friction and improving appliance fit may also help address the conditions contributing to the problem.

Nutrition Advice for Different Types of Ostomies

Ostomy nutrition can be confusing because recommendations depend heavily on the type of ostomy a person has.

Immediately following bowel surgery, many patients receive similar basic advice: chew thoroughly, temporarily eat a lower-fiber diet while the bowel recovers, and gradually reintroduce foods.

Beyond that initial recovery period, recommendations differ.

For someone with a urostomy, certain foods may change the color or odor of urine. With a colostomy, recommendations depend partly on where the colostomy is located, with nutrition, fiber, and preventing constipation among the considerations.

With an ileostomy, additional concerns include blockages, hydration, and the consistency and amount of output. Tough skins and difficult-to-digest foods may require particular attention, especially soon after surgery.

There simply isn’t one “ostomy diet” that works for everyone. Introduce foods gradually and learn how your individual body responds.

High-Output Ileostomies and Dehydration

For people with ileostomies, high output deserves particular attention because of the risk of dehydration and malabsorption.

Lizzie generally considers output above approximately 1.5 liters per day to be high, although even more than a liter may be excessive for some people depending on their circumstances.

Most people aren’t measuring output precisely at home, so frequency and consistency can provide useful clues. Frequently emptying a very full pouch, particularly when the output is extremely watery, may indicate high output.

People with ileostomies can be especially vulnerable to dehydration because the colon normally absorbs a significant amount of water. Anatomy also varies, so two people with ileostomies may absorb fluids and nutrients differently.

As Lizzie says:

“Everybody’s different... I think it’s always good to have options and see what works best for your body.”

If output suddenly increases, remains unusually watery, or is accompanied by symptoms of dehydration, contact an ostomy nurse or another healthcare professional.

Adjusting Emotionally After Ostomy Surgery

Physical recovery is only one part of the experience.

Lizzie has cared for people who were relieved to receive an ostomy because it represented freedom from years of illness. She has also cared for people devastated by their surgery who initially didn’t even want to look at their stoma.

Someone undergoing planned surgery after years of illness may respond very differently from someone who wakes up with an ostomy following emergency surgery or cancer treatment.

That’s why Lizzie believes people need to be met where they are emotionally.

For someone struggling after surgery, she often begins with something basic: look at the stoma and begin recognizing it as part of your body.

That process can involve denial, grief, changes in body image, and eventually some degree of acceptance. At the same time, patients have to quickly learn how to empty and change their appliance, recognize problems, and know where to get help.

That’s a lot to absorb while recovering from major surgery.

Finding the Right Ostomy Care and Support

One of Lizzie’s strongest recommendations is to know where you’ll receive ostomy-specific care after leaving the hospital.

If you receive home health care, ask whether an ostomy-certified nurse is available. Otherwise, identify an ostomy clinic and establish follow-up care.

“There are so many nuances when it comes to ostomy care that having an expert is really important.”

Manufacturer support and sample programs can also help when exploring appliances and accessories. Lizzie additionally recommends the United Ostomy Associations of America (UOAA) for education, community support, and advocacy resources.

The larger point is simple: you shouldn’t have to figure everything out by yourself.

Learning to Move Forward With an Ostomy

Toward the end of our conversation, I asked Lizzie what single piece of advice she would give someone learning to live with an ostomy.

Her answer went beyond appliances, skin care, or nutrition:

“We can’t look backward. You can only look forward.”

Most people don’t choose an ostomy simply because they want one. It becomes necessary because of cancer, inflammatory bowel disease, injury, an emergency, or another serious medical condition. In some situations, an ostomy is lifesaving.

Lizzie encourages people, when they’re ready, to begin looking at what their ostomy makes possible rather than focusing exclusively on everything that led to it.

Her most practical advice may also be the simplest:

Find a good ostomy nurse.

Having someone knowledgeable to turn to when you’re struggling with your skin, appliance, output, nutrition, or another challenge can make an enormous difference.

Living with an ostomy involves learning. Your body may change. Your products may change. What works today may need adjusting later.

But you don’t have to know everything immediately, and you don’t have to navigate every challenge alone.

This article summarizes topics discussed in our interview with ostomy care nurse Elizabeth Faust and is intended for general educational purposes. Individual ostomy needs vary. Persistent skin problems, high output, dehydration, granulomas, or other medical concerns should be discussed with an appropriate healthcare professional.