Ask the Ostomy Nurse

Linda Coulter has been a Certified Wound Ostomy & Continence Nurse for 10 years. In addition to working with hundreds of people with stomas, she has trained several WOC nursing students at the R.B. Turnbull Jr. School of WOC Nursing. Linda has presented nationally and internationally on ostomy related topics. From her home base at University Hospitals’ Ahuja Medical Center, Linda is active in raising Ostomy Awareness, and works to distribute ostomy supplies to people in need throughout the world.

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Skin Cleansing

I’ve had my colostomy for two years. I’ve always used regular hand soap to clean around my stoma each time I change my pouch. I just read that I should only use water and NO soap. This doesn’t seem right, but it was in an email from Hollister. What do you recommend? K.D.
Dear K.D.,

Whether to use soap or not is a debate among stoma nurses. In my ostomy nurse education, I was taught to use soap, specifically soap that does not contain lotion or oil. In other words, a non-moisturizing soap was recommended. Lotions and oils in the soap can build up on the skin so that the baseplate doesn’t adhere well. This leads to a shortened wear time and leaks. However, soap helps clean stoma output, tape residue and adhesive remover off of the skin. If not removed from the skin, stoma output can cause skin breakdown and adhesive remover can cause a sensitivity reaction and decrease pouch adhesion. Tape residue is unsightly because it collects fuzz from clothing which looks dirty.

I was surprised to learn that nurses in other programs were taught to not use soap. In fact, stoma nurses who recommend using soap are in the minority. So why is there this discrepancy? It has to do with the natural pH of the surface of human skin which is slightly acidic. This “acid mantle” protects the skin because it is a barrier to bacteria. If the pH rises, the skin doesn’t protect as well against bacteria. Most soaps tend to raise the pH of the skin, making it less acidic, and therefore more susceptible to bacteria and possible infections.

When I learned this, I was concerned. Had I been unintentionally harming my patients? So I did a some research and found that yes, soap can raise the pH of the skin, but this affect lasts for only about two hours. If alkaline soap is used every day, there is some evidence that this may negatively affect the natural protective barrier of the skin. However, pouches are usually kept in place for tree to seven days, giving the skin lots of time to recover its protective pH level.

As far as I understand, these are the two sides of the soap debate. I still teach new ostomates and their family members to use lotion-free soaps, followed by a good rinse with water. For those with sensitive skin I teach them to either use only water or a pH balanced skin cleanser which are readily available.
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