Help with Skin Folds, Raw Skin, and Bleeding After Ileostomy

New here - first post. Just had an ileostomy on March 22. Tried the convex seal (and the Hollister barrier rings) but went through 3 bags a day. Started using the flat wafers and the Hollister barrier rings, which started off okay (a day between changing). Saw the wound care nurse on Friday. There is a skin fold right by the stoma, so it's hard to seal and keep the bag on. We got the prescription powder for the fungus/yeast that is a result of the wound being irritated and the seal not being on properly, so waste gets on the wound and it burns, so we start over again. We use the adhesive remover wipes without the alcohol, Cavilon barrier wipes, the powder (crusting technique), and this wound seems to just get worse. It is completely dry before putting the flange on. I have changed the flange 3 times today and it's not even 6pm. Finally, I just put some antifungal/clotrimazole on it to sit (not ON the stoma, around the stoma/irritated area. Will remove and dry off before applying the next flange). I feel defeated. It hasn't even been two weeks. I know it takes time to find what works, but this seems impossible. Any recommendations for stomas in a skin fold, getting a great seal, and getting this dang fungus to go away so the skin can heal? Please help. :(

I had/have the same problem. I received great advice on here. More than from any nurse/dr.
My stoma is on my skin fold. First, to remove the appliance, I found the Sensi Care Sting Free Adhesive Remover the best to take off my appliance because it's a spray and you just spray on the outside of the adhesive instead of rubbing something else on your skin. This helped so much. Then I try to get as clean and dry as possible. I use the stoma powder, Cavilon, and put several layers. I end with powder. A lot of people say end with Cavilon and we tried that and it didn't work as well. Then I use a barrier ring fitted snug around the stoma. I ended up using the Sensura Mio 16715. This has been the best for me because it's convex but not super hard. My skin is finally healing after 4 weeks. The nurses at the hospital and home health nurse really messed up my skin. It will get better. Keep trying different products and ways until one works for you, and then your skin will start to heal. I felt and sometimes still feel like you do, but it is getting better each day.

Thank you so much for your help! I will try the adhesive remover spray. Because of the skin fold, the wound care nurse said that the convex wafer is best, but it feels like the higher up the convex wafer is, the further waste has to travel to get down into the bag. Right now we're using Hollister 89511, the barrier rings, and some tape around the sides.

I am really waiting and hoping for things to get better. Did you ever use clotrimazole? I will also look into the Sensura Mio!

Thank you for taking the time to respond. It has made my day.  

Your bag looks similar to mine. The convex on mine isn't super high. Another benefit of this appliance is that its adhesive is strong enough and is flexible around my skin fold. So I don't need to use additional tape, which has helped my skin a lot. I haven't tried the clotrimazole. Several different products have been recommended, such as Boudreaux's Butt Paste, Head and Shoulders for washing, and other fungal creams. I'm going to have to order something because my skin is itching bad, but I think it's because it's healing too.  

You might consider pairing an ostomy appliance belt with the convex appliance. Convex appliances often need that little bit of support to stay fully in contact with the peristomal skin. All of the major ostomy companies make an appliance belt that will fit their flange and you don't have to worry about it restricting output. You can request a sample belt from the company most of the time, too.

Words of Encouragement from Ostomy Advocates I Hollister

Hi wacoug,

Sorry for coming to the party late... it's been one of those weeks. You're getting good info and advice, so just a little different take on things from me. You've got two problems... maintaining a leak-free barrier in a skin fold... and getting your irritated skin to heal quickly. Most of the time those two things are at odds with each other. I've found the fastest way to get your skin to heal is to simply expose it to air and let nature do its thing. But that's hard to do if you want your barrier to stay on.

First, the skin fold... have you tried the ostomy pastes? How effective they will be depends on how deep of a skin fold you have, and how much of it "unfolds" as you move. Really deep skin folds are impossible, relatively speaking. If they put your stoma in a really deep skin fold, you should find out the names of the people who marked your stoma location the day before your surgery and kick their asses. Figuratively, of course! Minor folds can be overcome with the stoma pastes. The pastes aren't as durable as barrier rings, as paste breaks down quicker... but the goal here is no leaks, not keeping your barrier on for a week. I've used the pastes with mixed results, but I was expecting miracles and not restricting my movement at all... so I was asking for trouble. You can double or triple up barrier rings too, but I never had to go that route. If you've already found something that works... stick with it. This is just food for thought.

Getting your skin to heal... this is tougher. Like I said earlier, leaving the skin exposed to the air always works. For me, I've found that I can cut the adhesive portion of my Hollister barrier completely off... and the barrier ring adhesion to both my skin and the barrier itself is enough to keep my barrier in place... but I do wear a Hollister belt 24/7. That's a bit daring to try all at once, so I snuck up on it by cutting off 1/4 of the adhesive bandage surrounding the center portion of the barrier first. Then the next change I tried cutting off opposite sides. Then 3 sides. Then all of them. You have to make sure you heat your barrier and ring with a hairdryer pretty good before you hold it in place with the palm of your hand for one minute. Then don't do any cartwheels or backflips for at least a couple of hours. Actually... don't do any gymnastics at all... you're just asking for trouble. Now taking that adhesive removal idea to the max is what the Nu-Hope Adhesiveless Barrier does. See the link below. It's basically a big O-ring that's kept in contact with your stoma by a belting system. No adhesive or bandage on your skin... so it can heal. I haven't needed to try this out, but it would be my go-to product if I was having severe skin irritation issues.

https://parthenoninc.com/non-adhesive-urostomy-system-with-right-side-stoma-and-large-o-ring/

It sounds like you're already making progress... so that's great to hear. Keep us abreast of how things are going for you!!

Regards,

Bob

Hi Wacoug,

I have a urostomy and I am a year and a half post-surgery with still some issues.

I have also experienced the same issues as yourself. I can share what I do (but always in the learning process).

I use two rings, 2 inches and 4 inches, then my pouch. It gives semi-firmness and some flexibility. I was also told by my wound nurse that once one is advanced in the healing process, and if need be and one has a unique placement of their stoma, you can be fitted for a custom design pouch. That is what I will be doing in the near future.

And I agree with another member that mentioned to use adhesive spray. It works best for me too. Stoma powder with 3M barrier film protects the skin around. And NY Stop fungus powder, but never near the stoma or the precious skin around it.

I use 4x4 to hold against my stoma and area when changing my pouch and after a shower until the bag is in place. And I was told not to use soap with fragrance or oils creams because the barrier and pouch will not stay on. Ivory body wash is the best, it has none of the things I mentioned. To clean around the stoma, I use safeguard antibacterial and I use baby wash because of its pH balance. It seems to soothe my skin in that area. I also use 100% cotton washcloth and ones for babies too. Super soft and easy on the skin, I found.

Good luck with the process and I totally feel you on this subject. And thank you for allowing me to share. Take care.

BAYS