Granulomas, Stomas and Bags Oh my

[SEA_Dave]

I am just about 4 weeks of getting my colostomy. I had about 1 hour of a nurse showing me how to use a moldable ring and pouch before being discharged. I thought everything was going well but now it seems that I have developed three, what I believe are granulomas where skin meets stoma. There is one on the bottom of the stoma that has gotten a bit large that I never really noticed while looking down at the stoma. I have searched the web and used ChatGPT to try and figure out the best way to apply the barrier. Some sources say to measure the stoma not including the granuloma and cut the barrier for that size and apply over it. Other sources say go around it. I am sure many of you have dealt with this issue. What worked for you. I have an appointment with an Ostomy Nurse towards the end of the month so just trying to figure out what I can do in the meantime since I don't know if what I am currently doing is causing these. Thanks!

[Shamrock4806]

Well granulomas are quite difficult and will likely require the stoma nurse applying a silver nitrate stick to it. She will teach you how to do it because you will need to apply it yourself when you do a bag change.

So this will cause them to shrink, so be sure to bring your ostomy supplies with you and don't eat or drink anything hours beforehand so the stoma will quit spewing.

For energy I recommend drinking a glass of whey isolate protein powder mixed in lactose free milk as it packs so much protein and very gentle on your system. So this way you can cut down on the solid foods quite a bit and not much will spew out of the stoma.

What I do to insulate my one graneomola is use the wafer cut out piece cut into strips and applied around the outer edge of my convex wafer bubble. This way the wafer never comes into very hard contact with it.

Then I use a pectin based alcohol free paste and that cushions the area without pressure unlike what a ring does. So if the granulomas are not irritated, they may shrink down quite a bit and really not be much of a bother. That's how I solved my issue.

I don't use a belt, that just makes things worse, instead I center apply barrier strips over the belt hooks and hard plastic then press and stretch out the barrier strips on either side before applying to the skin. This creates a downward pressure that keeps the water perfectly in place.

Keeping the water perfectly in place is important because the paste doesn't get hard, it remains flexible so it's an ideal cushion. So if they gradually shrink, the paste sticking to it will hopefully shrink with it and maintain the seal.

I don't recommend notching out the wafer if it can all be helped, replacing with height and paste (alcohol free) should be used preferably. I think you can go about a 1/4" with the paste or so max before it starts dripping down.

What I do is use oil free eye makeup remover to remove my wafer, dry wipe the stoma area of output then soak the skin around the stoma with the eye makeup remover. It moisturizers the deep skin and removes the fine films of whatever you applied.

Wash the area three times with an ivory like non moisturizing soap and rub your fingers at the stoma, the skin should squeak. Then you know it's really clean. Appy nothing and dry well, including the stoma and the little crack going around. Stoma powder, a very light coating if you need it on wounds followed by spray skin protectant if you need it, let it dry 60 seconds instead of 30 like they say.

Squeeze the paste into the dry stoma crack going around to force it in there and another ring of paste around that. If the paste does not immediately stick to the skin when you apply it from the tube under slight pressure, your not getting good adhesion. You might have to start over if it just falls off when standing. This way you know before you waste a bag.

Then apply your wafer with the higher pieces applied. Unfortunately the thicker the paste is, the longer you need to remain flat on your back while the paste sets up some which it does to a small degree. Jumping up right away can cause thick paste to drip out or down from the top over your wafer hole.

Paste is a little more trickier to use but it has it's benefits especially with uneven skin issues. Usually only a thin layer is applied but your trying to cushion your graneomolas so it takes a bit more adapting.

The eye makeup remover and ivory soap step is important because although the wafer has adhesive bonding to the paste, the skin does not. So to prevent as much dripping out of the paste as possible a dam good adhesion to the skin helps out considerably. In fact I have to use a flat edge of a butter knife to scrape off old paste it's stuck to the skin so well.

Over time you reduce the height of the paste as the granulomas shrink down. And don't touch or rub the area through the wafer, that just irritates them.

See how that works for you.

[GeorgeS]

From what I understand, they are not an issue for colostomy ostomates. They are benign and ordinary. Calluses, if you will, due to cutting the holes too close to the stoma or touching the edges of the pouch.

For ileostomates, it may cause pain being the small intestine.

Like you, when I was about a month or so post-op, my ostomy nurse was not concerned.

[SEA_Dave]

Thanks for the information I will try some of this and see how it works for me.

[JerryNYC]

These are NOT granulomas, even though they are often mistakenly called granulomas on this site. They are granulation tissue. Granulomas are reactions to an invasion of a body organ by infective microbes or parasites. These invaders are attacked by host immunity cells called macrophages. They surround the invader in an attempt to wall it off. Granulomas appear to be small seed-like structures mostly within the inside of bodily organs, largely in the lungs or liver. For example, in tuberculosis, the granulomas within the lung are called "tubercles" after infection with bacteria (Mycobacterium tuberculosis). What is especially interesting is that pathologists looking at biopsy specimens of the large intestine can distinguish between ulcerative colitis (which usually involves only the large intestine) vs.Crohn's Disease (which usually involves both the large and the small intestine). Finding granulomas within the large intestine is usually a sign of Crohn's Disease.

Granulation tissue is formed after damage to a body part and is a part of the healing process. They have a granular look to them, which gives them their name. They can be found attached to a stoma after it has been damaged. Treating them requires care because they are filled with tiny blood vessels and bleed easily. When I had a large one years ago, my surgeon tied it off from my stoma with surgical suture thread to block its blood supply and destroy it. When I returned about a week later, it had largely shriveled and he removed what remained with a silver nitrate stick. It never came back again.

[Shamrock4806]

JerryNYC,


Granulation Tissue vs. Granuloma (Simple Stoma Reference)

Granulation tissue:

Normal part of healing

Soft, moist, beefy-red tissue

Appears in any healing wound (skin, stoma, etc.)

Made of new capillaries + fibroblasts

Temporary— fades as healing completes


Granuloma:

Abnormal chronic reaction

Firm, raised, may bleed easily

Caused by ongoing irritation or foreign body

Common at stoma edge from friction or suture

Persistent — stays until irritant removed or treated


Quick tip:

> Granulation heals — temporary
Granuloma irritates — persistent

-ChatGPT 5

So one can have either actually just one goes away after the area heals and the other doesn't thus requires treatment.

So you had a granuloma because yours was treated.

[JerryNYC]

This is my final post on this site. I am disturbed that you have monopolized this discussion board with a good deal of false information and useless advice, as though your way was was the only way. I have no need to continue on this site. I don't need further information. I have had an ileostoma (resulting from ulcerative colitis) for over 62 years and can deal with it quite well on my own. My only reason for participating has been a need to help others. I got a good deal of help from others when I was learning to take care of myself and I have always felt a need to give back to the community. I will do this on another site. But in spite of another participant warning you of the common errors found on chatboxes, you continue to use and quote from them.

We have a disagreement over the terms, "granulation tissue" vs."granuloma", which you have been misusing. I defined "granulation tissue" in a 10/26 post (above) as being "formed after damage to a body part and is a part of the healing process." It is not a result of infectious agents. I made it clear in my same 10/26 post that "Granulomas are reactions to an invasion of a body organ by infective microbes or parasites." They are found in a number of infections, including, tuberculosis, leprosy, schistosomiasis, histoplasmosis, cryptococcus, rheumatic fever, leishmaniasis, pneumocystis pneumonia and others". In spite of your trying to"educate" me that I had had a "granuloma" attached to my stoma, I know a great deal more about this than you do and can assure you that it was "granulation tissue". It is more than just definitions. Granulation tissue is part of healing in every wound we get, whereas granulomas are usually the result of infections that need to be diagnosed and treated before they lead to death.

I finally note that I don't need chatboxes or even printed material to understand these things. I was on the faculty of New York University School of Medicine for 48 years, where I was a Professor and Departmental Chair. I did not see patients, but instead taught generations of medical students and ran a research lab dealing with infections and immunity, and led the successful effort towards developing a vaccine against malaria, including the writing of more than 150 published scientific papers. If anyone would like some more details they can google me by name ("Jerome Vanderberg").

[Shamrock4806]

Well JerryNYC I'm fully open to correction and sure ChatGPT can be wrong or not entirely accurate.

And no I haven't monopolized anything, I do discuss my issues and offer advice and looking for the same or correction or better ways of doing things. I found that by being verbose I get answers to things I don't even know about.

Graneomola or granulation tissue, whatever, who really cares what it's called? It hurts, it's a pain and we want it gone, that's about it really.

I did take offense that you said I said the oral rehydration solution (recommended by the World Health Organization) is a cure for ileostomy diarrhea which it is not.

So you sound less than credible when you made such a remark. Now your claiming to be some sort of doctor or something.

Have a nice day.