Granulomas

Granulomas are common and refer to the granulations that appear as fleshy protuberances on the surface of the stoma. They are usually on the surface of the stoma or at the mucocutaneous junction.

What causes a granuloma?

These granulomas develop due to inflammation, infection, or irritation due to the contact of the stomal output. They can also develop due to irritation from the ostomy appliance.

How to prevent granulomas?

The first thing to do is to make sure that the hole in the flange is right according to the shape and size of your stoma. The inner edges of the hole shouldn’t rub against your stoma.

Sticking to the best techniques of changing the ostomy pouching system is key to reducing the risk of granuloma formation.

• It starts with removing the used ostomy appliance. Make sure that you are doing it slowly and gently. Start from the top and support the skin as you proceed with the procedure. You may need to use adhesive remover wipes to prevent any damage to your skin.
• Wipe the stool away using toilet paper, and wash the skin and the stoma with warm water. Dry the area thoroughly using dry wipes.
• While placing the new appliance, bend the top half of the flange away from the body so that you could see your stoma as you apply the skin barrier. Make sure that the skin barrier is accurately in place.

It is worth mentioning that some people are naturally more vulnerable to developing granulomas compared to other ostomates.

Effects of granulomas on stoma management

Granulomas can be painful to touch, and they can bleed easily, especially when you clean the skin around the stoma. This bleeding may cause problems adjusting the ostomy pouch on the peristomal skin. It is critical to stick to ideal pouch changing techniques and making sure that your flange or baseplate adheres correctly. You may also need to use additional supplies to help the ostomy pouch adhere properly.

Consulting a stoma care nurse

You may want to consult with your ostomy care nurse as soon as you notice the presence of granulomas. A review by a stoma care nurse can help identify any lesions that contain granuloma formations. Based on this diagnosis, the nurse will recommend a treatment.

Preventing granulomas with the stoma care nurse’s help

Stoma care nurses can help treat granulomas in different ways.

• They will check if the flange is rubbing against the stoma. They will also help you create the right opening for your skin barrier.
• They may recommend the use of protective paste.
• They may carefully administer a solution containing 75% of silver nitrate to burn off granulomas.
• They will help you know how to use liquid nitrogen.

A discussion with the stoma care nurse will help determine the best treatment for your case. While treatments will fix this issue, it may recur after some time. It is necessary to stick to the best ostomy pouch changing methods to keep the formation of granulomas at bay for good.