Perianal Skin Care

Looseness and frequency of stool is not uncommon during the early months following pelvic pouch surgery. It generally takes at least six months for the pouch to "adapt" and basically begin to function and act like a pouch or reservoir. It is extremely important to keep the skin around the anus clean and dry.

Perianal Skin Irritation during the Initial Adjustment Period

For the most part, perianal skin irritation can be prevented: the key is to use good skin care techniques before any irritation develops. The following are some suggestions for preventing and managing perianal skin irritation:

• Avoid the use of regular toilet paper: Regular toilet paper tends to be quite abrasive and can quickly contribute to the development of skin irritation. The use of moistened large cotton balls, or pop-up wipes (those without alcohol, lanolin, fragrances or other common sensitizers) is preferred. "Dabbing", as opposed to wiping, is also suggested, as it is less traumatizing to the skin.

• Ensure the perianal skin is clean: Cleanse the skin after each bowel movement or discharge of mucous. Warm water is usually sufficient, but if a barrier product (such as Proshield, Penaten, or CriticAid) is being used, then a spray cleanser with a surfactant (which loosens and lifts debris) may be more helpful. Examples of spray cleansers include Sproam or Proshield Spray Cleanser. Avoid the use of soaps, as these can dry skin, can cause itching and further irritation.

• Use a skin barrier cream or ointment: Start using a barrier product right at the beginning, rather than waiting for the irritation to develop. The barrier product (such as Proshield, Penaten, CriticAid) literally acts as a protective layer, preventing stool from irritating the skin. Barrier creams should never be removed completely after each bowel movement. An attempt to clean skin with every bowel movement will only aggravate the area and cause more irritation. Instead, remove the worst of any stool (a spray cleanser may be helpful) and reapply another layer of barrier cream on top. Avoid using petrolatum based products such as Vaseline.

• Water baths may be helpful: Using a "squirt" bottle with warm water to cleanse the perianal area may be more comfortable than wiping. Sitz baths, or a tub bath, may also be a gentle way of cleansing the skin and may be soothing if irritation develops.

• Wear cotton underwear: Generally, cotton underwear is preferred as it tends to absorb moisture/perspiration and allows air to circulate. Avoid underwear with polyester or nylon.

• Wear pads beneath underwear: Pads or panty-liners can help to absorb any leakage of stool, and can hold barrier creams against skin. Change when soiled to avoid irritation.

If the skin should be become reddened, broken or itchy, assessment by your family doctor, ET nurse or surgeon is recommended. A fungal infection can occur due to excess moisture.