Can You Pack an Old (Mature) Stoma?
No, you should not pack a mature stoma itself, but you can and should use absorbent dressings and protective barriers around the peristomal skin to manage high-output drainage and protect skin integrity.
Understanding the Clinical Context
The question of "packing" a stoma requires clarification of what is being protected or managed:
- The stoma itself should never be packed - the intestinal mucosa at the stoma site is delicate vascular tissue that requires unobstructed drainage 1
- Peristomal skin protection is the actual goal when dealing with leakage or high output, not packing the stoma opening itself 1
Managing High-Output Drainage from Mature Stomas
Immediate Skin Protection Strategies
Apply zinc oxide-based skin protectants directly to peristomal skin when leakage of intestinal contents occurs 1. This creates a barrier between caustic effluent and vulnerable skin.
- Use powdered absorbing agents or barrier films, pastes, or creams containing zinc oxide to minimize skin breakdown 1
- Foam dressings are superior to gauze because foam lifts drainage away from skin, whereas gauze contributes to maceration 1
- Apply antifungal powder if fungal infection develops (presents as itchy maculopapular rash with satellite borders), then seal with skin sealant 1
Addressing the Root Cause
High output or leakage from a mature stoma indicates an underlying problem that requires investigation 1, 2:
- Infection (local or systemic) 1
- Structural problems including stomal stricture, dysfunction, or intestinal obstruction 1
- Recurrent inflammatory bowel disease 1
- Gastroparesis or increased abdominal pressure (for gastrostomy tubes) 1
- Improper appliance fit or technique 1, 3
Proper Peristomal Skin Care for Mature Stomas
Routine Maintenance
After initial healing (approximately one week), mature stomas require minimal intervention 1:
- Cleanse the peristomal area 1-2 times weekly with soap and drinking-quality water 1
- Dressings can be reduced to once or twice weekly for well-healed sites 1
- Alternatively, dressings can be omitted entirely and the site left open once fully matured 1
When Complications Arise
Healthy peristomal skin is essential for pouch adherence - any breakdown creates a vicious cycle of leakage leading to further skin damage 3, 4.
For managing specific complications:
- Peristomal dermatitis from effluent contact: Use skin protective products including barrier creams, films, powders, pastes, and seals 5, 3, 6
- Mechanical trauma or creases: Consider filler paste, seals, or convex appliances to level irregular skin surfaces 5
- Retracted stomas: Convex stoma appliances protect skin against fecal leakage 6
Critical Pitfalls to Avoid
- Never obstruct the stoma opening - this can lead to obstruction, increased intra-abdominal pressure, and potential perforation 7
- Do not use gauze packing in the stoma tract - this increases maceration risk and can cause mechanical trauma 1
- Avoid excessive tension or pressure on the stoma itself, which can compromise blood supply 1
- Peristomal irritant dermatitis from effluent contact is by far the most common complication (affecting up to 80% of ostomates), not allergic reactions which occur in only 0.6% 8, 4
When to Escalate Care
Refer to wound ostomy continence (WOC) nursing or surgical consultation for 1:
- Persistent leakage despite proper appliance fitting
- Painful ulcers with purple halos (possible pyoderma gangrenosum, especially in IBD patients)
- No improvement after 2 weeks of antifungal treatment
- Signs of stoma ischemia (purple/black discoloration)
- Incarcerated parastomal hernia (surgical emergency)