Close Contact - Protecting Stoma and Wafer

This is probably remedial for most of you folks but sometimes the basics get ignored. I believe any unprotected skin will get damaged. Unless I used some skin protectant like Cavilon barrier film any space between the wafer and the stoma would get damaged. Therefore, for me, there can be no space between the stoma and the wafer. That might not be easily accomplished by some of us, especially if the stoma circumference is irregular. Mine is a colostomy and I use Convatec moldable wafers after applying a skin barrier liquid film. I allow about an eighth of an inch (0.3 cm)all around and in a short time the moldable material closes in and actually turtlenecks the bottom of the stoma. That works very well for me but not all of us have similar situations. I just think it’s something very worth considering.
Respectfully,
Mike

Hi Mike, I have a problem right where the skin and the stoma meet. I have started to use a cream the Dr. gave me and then some stoma powder on that and a skin protector on top of the powder. It has helped but just out from the stoma the skin looks kinda dark. It may be the pressure of pushing on the wafer that causes that, not sure. My output is real thick and I have to push it down in the bag. I wonder if, like you said, I may need to cut the wafer a little bit bigger than I do. I may try that.

Hi Lovely. I think the cream you’re using is an anti-fungal and it will heal the skin if you continue doing the same thing you’re doing now. I think there’s a difference between the darkened skin from the wafer and red skin from damage. Also, pushing the stool out of you is different from pushing it down in the bag. I use a lubricating deodorant so the stool slides down. It’s something else if you need to push the stool out of you and the wafer might be too tight.
Please keep us informed as you make things better.
Sincerely,
Mike

Hello Mike. I don't have a problem with gaps between the stoma and wafer now, but when I did I found a device called a stoma-guard or stoma-sleeve( memory is going!) It was made of a really soft material which 'tubed' up the stoma and protected it from damage. It was so long ago that I cannot recall who made it but it was very effective and comfortable to wear. Perhaps someone else can fill in the details.

Best wishes

Bill

Hi Mike,

I've been plagued by that annoying area between the stoma and abdominal skin that you mention since day 1, which was 5 years ago. My stoma is a bit odd-shaped, but that very specific area of skin where the stoma meets the ab wall has always weeped on me, and that moisture makes the ring's job tough. Without the ring, the barrier material gives up pretty quickly. I've tried lots of things, but I write down what people on here claim works for them and try those things eventually. My skin is livable right now, as I've always changed my barrier every other day, but I don't want it to get worse and run away on me, as has happened in the past. So I'm always hesitant to try new things, as things can get worse pretty quickly. But I'm always interested to hear what works for folks. I also plan to try other manufacturers' products, but I've been saying that for oh.....5 years now. But I think this winter I'll actually sit down and go through some online catalogs and order some samples to try.

In regards to how you leave a small space around your stoma for the material to expand into........I don't leave any space. I have to stretch my ring out to make it fit, and I always stretch it a bit short, so when I put it on it's a snug fit. I've only ever had one leak (just the other day) caused by the ring material expanding and blocking my stoma opening. And that's because one side of my stoma (the side with the opening) is flush with my skin, so that side of the ring needs to be placed just right.......or as you said, it expands and can cause blockage. Said another way, if you look at my stoma head-on, the opening is on the far end of a large ellipse, not in the middle. A pic would be worth a thousand words, but it would really gross out some folks......so maybe later. I'm going to talk to a few surgeons about getting it "fixed", but already know they're going to tell me they can do it, but there could be complications and it could end up worse.....so they'll recommend I leave well enough alone. We'll see.

Bottom line........when folks find things that work for them for sealing their stoma to their barrier opening..........I'm all ears. Thanks for posting this.

Regards,

Bob

Words of Encouragement from Ostomy Advocates I Hollister

Thanks Bill and Bob for your thoughtful contributions. Bill, you seem to have everything under control and your experiences are always educational.
Bob, your situation is considerably different from Bill’s and provides a good platform for all to learn from. I’m thinking your “ring” is the part of the wafer through which the stoma protrudes. If I made mine tight around the stoma it would “choke” it, cause cramps and much misery for a couple days. Took me a while to learn that. Based on your previous experimentations I’m pretty sure you tried a convex appliance and/or consulted with an WOCN but I had to mention it. You didn’t write anything about skin protection like a barrier film. Would that be a consideration?
Thanks, again, guys and wish you the best.
Mike

Hi Mike,

Yeah, that Bill sure has it easy... wink, wink. What do you say about the ring choking off my stoma would be true if I had a normal stoma. I'll look later and see if I can find a decent (not too gross) pic of my stoma. The pic will explain all. But for now, think of my stoma this way... instead of my stoma sticking straight out of my abdomen at a 90-degree angle to my abdominal wall... lean it over to say a 30-degree angle so the opening that would normally be in the direct center of the stoma is now pointing to the right. The oval section of stoma you see when looking directly at me is more the side of the stoma, laid over, which forms an elliptical shape. So all along the circumference of that ellipse (except where the outlet hole is at skin level), the stoma skin is very thin... because it's leaning over and not sticking straight out. So the ring can't choke it off. Where the stoma exit hole is, it's at skin level and there is no stoma wall thickness. So imagine grabbing your stoma with your hand and bending it over until the hole points to the right and not straight out of you. Then push your bent-over stoma into your abdomen until the hole is right at skin level. That's my stoma. It's not as bad as that sounds, but it's not what one thinks of when you say normal stoma.

I do use a convex barrier, but where the barrier pushes on my skin adjacent to the exit hole, there's nothing there for the barrier to go around or grip, as there would be in a normal protruding stoma. My skin is just flat in that area with a small hole in it that stuff comes out of. So maybe it would be easier to think of it as a protruding stoma all around the ellipse and then on the one long end, there's an exit hole say at or just below skin level. If I could build up that area with some skin, or tip my stoma to point a little more upward, then the barrier ring would have something to strangle. Right now, the only thing that keeps me from getting a leak is pure adhesion of the barrier to my skin. My stoma is also in a bad location in terms of me bending. If I bend forward too much (like when I was sitting on the ground changing tires on a buddy's car), the skin tends to fold in the abdominal area, which can make the barrier lose contact. The other night, when I had a leak... the ring swelled, like you say, and blocked my stoma opening. So the stoma was shooting out liquid UNDER my barrier ring between the barrier and the skin because the ring blocked the top of the stoma opening. I was sitting there (and I can feel when a lot of liquid squirts out)... and I get that feeling, and then a feeling of something warm running down my side. I immediately knew something wasn't right and jumped up before I made a mess. I can't change my barrier until the morning, so I just cleaned it the best I could, pushed the ring out of the way through my bag, and kept my right side elevated all night to let gravity be my best friend. Slept on my left side and got up and changed my barrier in the morning. It was obvious what I did, and I now pay a lot more attention to how and where I place my barrier ring. I also slice off a small piece of another ring and build up my ring in the area where my stoma exits, creating a higher "wall" on that side. Wow... I'm writing a novel here. Couple more things... I do use a barrier film. After dusting off the stoma powder, I apply 3 barrier film wipes, drying the area thoroughly between wipes. Then I stuff a paper towel in and around my stoma to absorb any moisture/weeping while I place my ring on. Then I pull the paper towel off, stick the ring on, apply barrier, apply heat from a hairdryer over the entire area, and then cover with my palm for 45 to 60 seconds. Then I hit it with a paper towel one last time before putting my bag on (I use a 2-piece barrier). The whole barrier change takes me about a half hour. I didn't describe the skin prep right after I pull the old barrier off and up to the stoma powder, but it involves shaving, hitting the area with chlorine bleach, wiping that off, applying any medication if needed (either Flonase if the skin is in good shape or Betamethasone if it's bad), and then moisturizing outside the area the ring sticks to with O'Keeffe's. And to think the ostomy nurse I met right after my operation told me barrier changes were a snap! Like to "snap" her right up side her head. Ok, I'll go see if I can find a pic of this mess so you'll see what the heck I'm talking about.

Later,

Bob

Hello Bob. Thanks for the brilliant graphic description, which, in my opinion, doesn't really need a picture to enhance it. I too have a stoma that leans over, but that seems to be due to a hard lump on one side. this sometimes sinks below the skin-line and the stoma straightens, but mostly it is above the skinline and pushes the stoma right over. Fortunately, I use a plug during the day, which holds it all in the straight position and pushes the lump back in. However, when I remove the plug the problem returns. I am not likely to try to get anything done about it unless the lump gets bigger and causes problems with output, but it can be concerning at times. 

Best wishes

Bill

So Bob. Don’t waste any time or effort looking for a picture. Your words provided a cinemascopic, 4K, ultra HD representation of every aspect of your condition and how you’re handling it. Wow! It’ll take some time for me to digest this but you certainly have provided tons of valuable information. Don’t discard any of these writings; they might be part of your book. Or movie.
Respectfully,
Mike

I also use moldable Convatec wafers for my ileostomy. My stoma is big, so I cut the wafer hole bigger and squeeze Coloplast paste around the edge of the hole. I smooth the paste with a drop of water using my finger and then apply the wafer. I use my fingers' heat to press it onto the skin and wipe any excess paste off. It works great for me because I have an uneven skin surface, so the paste does a good job. Usually, I change the wafer and pouch once a week in the morning.

So much awesome info on this site. I love it.

Cheers, everyone.

Angela

Hi Mike,

I believe we're up to 8K now, so I guess I need to add a little more to my stoma description. O)

I went online and looked at pics of stomas. I've never really done that before because they just don't look very appealing to me, in general. But now that I realize mine is quite far from "ideal" I think I need to put up a post entitled "Who's Got the Ugliest Stoma?". So I do need to go find those pics. Stay tuned........it could be a very popular post. Or maybe not.

Hi Angela,

I really do need to try some other manufacturer's products.........I've stuck with Hollister because that's what they started me out with after my surgery 5 years ago. I did try the Hollister paste, or caulk as I call it. I thought it would be ideal on irregular skin, but although it goes on like silicone caulk it doesn't stay as flexible. Not even as flexible as the Hollister ring. Sounds like the Convatec paste is a bit different, hence my first sentence. It would be really nice if I could go a week in between barrier changes. At least I wouldn't feel like I'm the largest contributor to polluting the planet with medical waste. Ok, I better go look for those stoma pics, as I know Mike is just dying to see them. Hang in there Mike.........I'm on it!!!

You guys have a great Saturday!!

Regards,

Bob

Hi Angela.  Just wondering if Convatec can provide you with a wafer with a larger opening so you could still take advantage of the "turtlenecking".  But getting a full week between changes with an ileo means you're doing a great job.  Maybe you shouldn't change anything and I should just read and not write.

Keep up the good work and thanks for the advice.

Mike

Hi Mike... Thank you so much for your kind words... I could just stretch the moldable to fit but don't like the tight feeling around stoma base... I guess this way has been working for me for many years so I am too much of a chicken to try anything else.   Thanks again.

Cheers

Angela

Hey Angela, yours is a success story.  Nothing  chicken about that!

Respectfully,

Mike

Hi Bob, the flanges they started me on in the hospital were Convatec but very flat. I leaked and leaked until I felt like jumping off a bridge. Ron, who owns Actional Medical where I get my supplies, gave me a sample of what he called the Cadillac of flanges and he knew his stuff. They work like a charm. I use Convatec Natura moldable flange 1 3/4 in. or 45mm, product# 404593, and Convatec Natura drainable pouch 1 3/4 in., product# 401507. These are opaque so you don't see through them. These ones are 10 in. long. You can get them in 12 in. And as I mentioned earlier, I prefer to cut the hole a bit bigger and use the Coloplast paste spread neatly around the hole edge for extra protection. Take care, Bob.

Cheers,

Angela

Hi Angela,

Thanks for the details. I'm about to start taking my winter vacation (use or lose vacation days at work), and will start going through the catalogs and ordering samples. I'll probably post on here a few topics asking what folks use and why to narrow the field a bit........so thanks for the head start.

Regards,

Bob

Every time I post something, I feel like the site's biggest dummy, but here goes. I have an ileostomy. They removed all but 2 inches of colon. Diverticulitis, massive hemorrhaging, etc. I use a Hollister bag, cut to fit, and a moldable barrier ring. My leaks have always been underneath the entire barrier and extra barrier strips. Any guess what I am doing wrong? So frustrated, I have been using medical adhesive and it still leaks next to my skin. I have had an ostomy for five years, and this has been happening the entire time. I am living with painful skin. Bags last one to three days. Please, what am I doing wrong?!!

Hi Baw. So sorry you feel like a dummy. You’re not! Just by posting here you’re a lot smarter than folks who don’t get involved. If you carefully read what the other folks have offered so far you might be encouraged to try something a little different. All my experience has been with Convatec and hopefully I’ll have no reason to change. It might be helpful to talk with the Hollister folks. It might also be helpful to talk with the Convatec folks and get free samples from them.
Thanks for sharing with us.
Respectfully,
Mike

Hello Baw. When I used to wear bags, I was always having the sorts of problems with leakages that you describe. I put it down to a combination of sweaty/oily skin;ineffective sticky on the flange and the fact that I needed some sort of pressure to keep it in place. I wrote to one company and complained. They sent me a 'special' sample with flanges that had more powerful glue, which did not leak, but I had enormous difficulty in  removing. That's when I decided to make my own baseplates to my own specification.

One of the things I noticed, was that if there was any pressure on the bag, then the leaks were worse. I figured that the bag itself was causing the pressure on the output as soon as it left the stoma, so the the output was able to leak at the area of the hole. One way of avoiding this was to use paste or rings, but it didn't work for me. However, I then found the stoma collars, whch were ideal for guiding the output away from that area. see: http://www.stomawise.co.uk/ostomy-pouches/salts/salts-dermacol. (Thank Bob for the link!)

It still didn't work effectively enough for me, which is where inventing my own baseplates (along with a 90% bend came in). I don't have this problem anymore but I can imagine that the sort of devices I wear would not be suitable for anyone who is sensitive about how these things should 'look'. I am way past worrying about 'looks' and prefer things to work and be comfortable rather than aesthetically acceptable. 

Coloplast have recently brought out a new bag that contours to the body better than the old ones. That would be worth looking into and asking for samples. 

Best wishes

Bill

Hi Baw,

We should be able to figure out what you're doing wrong.......let's start with some info and a few questions. First, is your stoma above, at or below skin level? Which Hollister part number barrier do you use? Have you talked to Hollister about the problem? What is the current condition of the skin around your stoma and under your barrier? Do you wear an ostomy belt? Where under the barrier does your leaking originate, and does the leak always start in the same place? And lastly, please describe your entire barrier changing process.....type of adhesive remover, how you clean and prep your skin, type of ostomy powder and skin barrier wipe, barrier ring, barrier, and anything else you do as part of the process.

We'll get you hooked up.........that's what this site does best! And remember, the only dumb question is the one that doesn't get asked......because if you're thinking it then at least a few others are as well.

Regards,

Bob

Thank you, iMac.

Bill, as usual, you are incisive. I will contact Salts.

Bill, as usual, you are incisive. I will contact the Stomawise folks.

Ok. Here goes. I wear a Coloplast #14411. My stomach is round, openings at the very bottom and protrudes about 1/2 inch. The entire stoma is 1 to 2 inches wide (side to side). When changing, I remove debris with a round cotton pad and follow that with water on a cotton pad. Next, I clean the area with 2 Medline Sureprep barrier wipes. When the area is dry, I apply a bag with a barrier ring attached. The bag was previously sprayed with Medical Adhesive and allowed to dry. I spend about 5 minutes pressing down on the edges of the bag, assuring they will stick.

The bag always leaks on the right side, the side I sleep on. The skin around the stoma has very minor redness. I do not wear a belt. They are ok for a couple of days and then roll up and become very uncomfortable. Thank you for all the help you give, BAW

Hello BAW.

Just a note about the belts rolling up.

I use two belts because they need to be adjusted differently to get an effective pressure top and bottom. For my first atempt at resolving the problem of them rolling up, I enclosed them in material , which made them a bit like a wide belt. This worked quite well but not as good as my second attempt, which used an adapted, stretchy hernia belt. Instead of using the whole of the narrow belts, I sewed the short ends to the ends of the hernia belt. One end was really short and the other end had enough space to adjust the top and bottom to suit my needs.  I have been using this new design for about 18months and it is working well, as well as being comfortable to wear and no roll-up. I also changed the hooks on the end of the belts because I found they were not secure enough when sleeping. I now have the much longer/larger brass hooks that are normally used for hanging pictures.  These are much more secure than those silly little plastic things that come with the belts. They also have the advantage of being 'flat' which the usual hook&eye ones are not. This allows them to be worn against the skin without causing any problems. 

I hope this is helpful if you ever feel the need to wear a belt again in the future.

Best wishes

Bill

Thanks, Bill. Unfortunately, I hate sewing and am lousy at it. I even wait as long as possible to sew on a button! Makes me sound like a real slob, huh.  

Hi BAW, nbsp

Thanks for the info. A few things jump out at me........but before I go there, I forgot to ask you one other question. Where is your stoma located in relation to your belly button...is it directly in line with it (left to right), slightly below it, or slightly above it? Now.......what I noticed.......first, you attach your ring to the barrier and then put the barrier on. Ok, how do you get the ring to tightly hug your stoma doing it this way? I would think putting the ring around your stoma first would get you a much tighter seal than by attaching it to the barrier. The second thing is you said you sleep on your side your stoma is on. I never do that. When you do that, you end up flexing your abdominal skin in ways the barrier can't deal with, and it will leak. Try not sleeping on your stoma side. Now, the reason I asked about where your stoma is located is that there's a natural skin fold line right across your belly button. If you bend over a lot and your stoma is on that line, your barrier doesn't have a chance. I learned this when changing tires on my car when I sat on the ground with my legs under the car, and I lifted the tires onto the rotors. So check and see how you bend and let me know your stoma location.

Regards,

Bob

Thank you, Bob. You really know your "stuff". I think, perhaps, that I am unhelpable. Here is my sob story but first, I will begin placing the ring directly around the stoma. Now the sob part. 2 years ago, I had pancreatitis. My pancreas still produces insulin but not digestive enzymes... I must take pills before eating to make that happen and the results are unpredictable. I did spend 6 months in dialysis because my kidneys completely shut down after the pancreatitis. Miraculously, the kidneys healed enough to stop dialysis but I still must be careful and there are things I cannot eat... lots of things. About 6 months after dialysis was ended, my neurosurgeon agreed to fix my neck. Previously, he had repaired spinal stenosis that caused falling without warning. For example, it is really fun to fall over backwards when climbing up stairs. The unsolved neck problem involved constant neck pain and sudden debilitating headaches. The surgeon explained that, technically, my head wasn't attached to my body... lots of disconnected and broken bones. They performed a 7-hour surgery and rebuilt my neck. Lots of hardware inside, limited movement of my neck left, right, and back.

The moral of this story is that I can only sleep one way and on my side. Consequently, my stoma sits about 3 inches below my belly button. Thank you all again for trying to help. I can certainly see where the suggestions would have been helpful.

BAW

Hi BAW,

Thanks for the explanation, but I'm not giving up on you yet. And no, falling backward while climbing stairs doesn't sound the least bit like fun. That must be one very strange feeling. Ok, so you have to sleep on your side, and it's the side with your stoma. Now don't laugh....but have you ever tried sleeping vertically (standing up)? No, I'm not kidding. Since you stand all day I would assume sleeping vertically would be possible with your neck issues.......no? I knew a guy with major back problems and the only way he could sleep was standing up. Ok, not actually standing, but he had a padded board that leaned back slightly that had an inverted "U" that went between his legs.....like sitting on a saddle. It did take him a few weeks to really get the hang of it.......I guess if someone woke you in the middle of the night you'd be startled and try to "get out" of bed.......only to find you're already standing. My oh my. Would something like that be possible for you? Did you stop laughing yet?

I also Googled "beds for people with spinal problems" and see there are a myriad of options ranging from a harness you wear that suspends you from the ceiling, so another form of vertical sleeping, and then the more interesting type you might like better. I don't know what they're called but instead of a single flat mattress the bed consists of a series of short wide square-ish pillows that can be removed from their positions. I also saw an air mattress made of small square pillows, where you just remove the ones where you don't want support. Now if you don't want to invest in something like a new bed you can do what I did. Go out and buy a 4" to 8" foam mattress topper...you can find them on sale for 40 or so. Figure out where you don't want pressure on your body when sleeping and simply get out the electric carving knife and remove the foam from that area. Start small and work your way bigger, cuz you can't put the foam back once you cut it out. In your case you just don't want any pressure within say 6" above and below your stoma that would distort that skin under your body weight and the mattress and cause a leak. I would think any back doctor would have some similar suggestions about a suitable bed that would let you lay on your side, but not have any pressure near your stoma.

It may be that just getting your ring tighter around your stoma will solve the leakage problem and you won't need a different (or modified bed), so obviously try that first. Let me know what you think, and no cursing. In the meantime I'll start thinking about a Plan B.

Regards,

Bob

Hi BAW,

You're a real trooper! I sure do believe you trained horses. I get what you're saying about getting hubby onboard and your expensive mattress. I have a queen-sized bed and my girlfriend at the time didn't want to sleep on the mattress pad.......so I just bought a single (full?) sized topper for my half of the bed. But I did feel bad cutting a big hole in it. The other thing I was thinking about.......and I don't know your insurance or financial capacity.......but you could just change your barrier every morning. When my skin around my stoma was in pretty rough shape, I was changing my barrier every morning, which did allow my skin to heal. I reused my bags to keep costs down.......so you might want to consider a daily barrier change, at least to buy you time to try some other things to get a handle on leaks. Just a thought.

Regards,

Bob