Questions about stoma care, supplies, and diet for ostomates

When I was first marked for an ostomy, the nurse asked me if I knew what I wanted. I said no, and she asked if I wanted her to select products for me. I said yes because she had me slightly overwhelmed. The supplies I use are:

11203 Hollister CeraPlus Up to 1-3/4" Cut-to-Fit Flat Skin Barrier with Tape, 2-1/4" Flange Red

8805 Hollister Adapt CeraRing Barrier Rings

18193 Hollister New Image Lock N Roll Drainable Pouch with Filter, 2 1/4

The surgeon who created my stoma originally cut a bigger hole, I assume he didn't like the size, so he stitched the left side of the hole shut. When I was first being taught how to change my stoma, I had a little gauze called Aquasol that had to place over those stitches before placing barrier ring on top of it. The ostomy nurse training me made a comment about she didn't know why he created my stoma oval or that it wasn't protruding. It does protrude somewhat now.

I guess my first question is what is the difference between a protruding stoma versus a flat or concave stoma?

At chemo a few weeks ago, I met a lady that had a stoma, her stoma was flat, and they were only using the cut to fit skin barrier on her stoma, and she was very inflamed. Is that more the norm?

The reason I ask is because I have a home health care nurse that was an ostomy nurse and she said I should stop using the barrier seal and use only the wafer, and I told her I tend to have blowouts occasionally. I pointed out that most of my blowouts head towards the wound so the barrier is extra protection. Am I wrong in my understanding of how the wafer works without the barrier?

I've noticed that I have a bad habit of not walking upright since I have the ostomy because it always feels like it's going to pull off, the right side by where I tend to have blowouts is sore at times and feels like it is ripping there quite often. It hasn't. So far, it's ripped my skin on the top and where the stitches were. Any suggestions on how I can feel more confident that it is not going to rip off my skin?

My nurse suggested the belt after my wound is healed but currently he said that it will irritate the wound. Chemo has suggested that I never use a belt because I will weaken the structural integrity of my stoma. I think I prefer to get the opinion of those that have an ostomy.

Last of all, food ideas please. Chemo wants me to get lots of protein for healing. I can't have beef due to the gall bladder. I also can't have much fat or dairy. Before the ostomy, I ate a lot of beans, spinach, kale and I'm told not to eat that. Honestly I don't think there is a day when I do not have some gas with the ostomy. I am chickened out, tried numerous protein shakes. I keep looking for recipes for ostomates and I can't find anything. Any suggestions would be so greatly appreciated.

Hello gairdinspreagtha.
Thanks for your questions, which are very sensible and pertinent for your situation. 
The first thing that I would contribute is that there are often many different perspectives on both questions and answers regarding stomas. The medical professions tend to think of it from a slightly different perspective to those who have to live with it on a daily basis, so their advice is not always ‘right’ for everyone (neither is the advice from anyone else!). 
I find that I need to experiment for myself to find answers to these sorts of questions. However, let me try to address a couple of your questions.
The first is regarding the difference between protruding and flat stomas: On the face of it, this is quite a straightforward difference in that one sticks out and the other doesn’t. I have the feeling that this is not entirely what you meant by your question, and it might have much more to do with how people ‘manage’ each type. This too has many different answers, some of which can be found in past posts (See ‘Collections->Premium Content->General Knowledge’ at the top of the page). Your instincts about using a barrier seal seem quite reasonable to me, but there are other ways to help prevent blowouts such as taping the wafer and using extra glue.
Now we come to using ‘belts’: There are various types of belts, some of which are primarily for hernias and others simply hold the baseplates more firmly in place. 
Some devices have their own hook& eye system built in. These can accommodate either one belt or two, depending on your needs. 
I have made my own baseplates to use two belts because of the shape of my abdomen. However, in the past few months I’ve been trialling a modified version of a baseplate (what they call a pressplate ref:12820) which is made for both irrigation sleeves and/or bags, made by Coloplast. It only has one belt and, with Probond glue as an additional precaution, it seems to be working quite well so far. (If someone told me that belts would weaken the structural integrity of my stoma’ I would be very sceptical and probably ignore that advice).
As for food: Mine is a vegan diet so I cannot really comment reliably upon other foods. There are plenty of dietary suggestions on the past posts (see above). 
But most people on here in the past have simply suggested trying out whatever you like in small amounts to begin with and see what happens. The basic message with food seems to be to chew it well.  As for gas, I gave up trying to stop it happing. Nowadays I wear a stoma plug (also by Coloplast) which is made of a porous material and simply lets the gas out freely.
I hope you find these comments helpful.

Best wishes

Bill

1) Protruding— stoma sticks out past your skin. Flush- stoma is even with your skin. Concave- stoma is below skin level.

2) A barrier ring will help by giving more adhesion around your stoma.

3) Get some sort of belt to take the weight of your bag off your skin. There's quite a few types of belts/wraps to accomplish that.

4) Protein is basically what heals wounds. I got preached at constantly to take in as much as possible. The vegetable proteins you mentioned will cause gas. How about pork or fish? Chicken is about the best but I understand about being tired of it. What you personally can/can not eat will determine how you get your protein.

Hi there,

I hear you on the chicken lol. That's a lot of what I eat. I eat eggs too, scrambled, and I mush them on my plate first then eat them. I also get a lot of my nutrition and protein from drinking instant breakfast twice a day with skim milk. It is loaded with vitamins, nutrients, and protein, and you can get extra protein if you wanted. I also take a liquid multivitamin.

Question: with your products, have you tried other brands to see if they work better for you?

When I first got my ileo, I walked funny for a while. I was afraid it was gonna fall off. My first doctor made my stoma flush and oval. How long ago did you get your stoma?

You didn't mention what type of ostomy you have. My stoma is flush, since I have a colostomy, they created it that way because I irrigate. Since you are on chemo, I assume you had cancer? Do you have any descending colon left? If you do, it's quite possible you would be a candidate for irrigation. Ask!

Getting Support in the Ostomy Community with LeeAnne Hayden | Hollister

I got my stoma on July 22nd, 2022. Almost 4 months ago.

Unfortunately, my body rejects eggs. I will definitely look into the instant breakfast.

I'm not sure if this answers your question. My stoma now protrudes. I don't know about the descending.

Yes, I was attacked by cancer. That's how I word it lol. My ostomy was never meant to be permanent, but I've also been told that sometimes they cannot be reversed despite the best intentions of the doctor.

What is an irrigation system?

I looked up the pressure plate you mentioned. Does that go on top of the ostomy and the bag pull through the hole?

You also mentioned you have made your own baseplates, what did you use and how did you make them?

Also, don't you have to have a premium membership to view premium content?

hello again. 

(1)The Coloplast baseplate I use has an inbuilt ring on the outside to attach the relevant bag (or sleeve). It would be classified as a two-piece device. I like to have the hole to fit close to the stoma, so I adapted it and infilled their rather large hole with some plastic sheeting and a hole more suited to my needs. This also allows me to use more surface area for Probond (prosthetic) adhesive, which holds it all in place and has never let me down.
(2) My own baseplates are made of plastic sheeting 'borrowed' from facia boards or skirting boards. They are cut, shaped, and drilled to my own measurements and two lugs are attached to each side to take the belts. I need two belts because the top one needs to be longer than the lower one to fit the shape of my body and provide even pressure in that region. I then simply attach a manufacturer's bag or two-piece baseplate to mine and they last for months before needing to be changed. If you want an idea of the size of my baseplates, they are usually about 120mm x 76mm and the hole is 35mm to suit my stoma. I also add a small length (20mm0 of plastic waste pipe into the hole so that I can attach a 90% bend as and when I need to guide the output down into the bag/sleeve without it pancaking. But this last addition is not strictly necessary.
If you want to see a picture of the device, there is one on my profile.

(3) I don't think you need premium membership to view the premium content. I would just try it and see what happens. If you cannot get on it, contact admin and see what they have to say. 

I do believe that these devices are best when they are tailor made to suit the in dividual, so DIY skills are quite handy - unless you have a friend who can DIY and take instructions.
Anything else - just ask.

Best wishes

Bill  

   ice

Belt information: Hi, first off must say I only have a urostoma having lost my bladder to cancer 10+ years ago. I never had an ostomy nurse so had to work things out for myself. I did get a hernia about the size of half a large grapefruit over the years, starting about a year after my operation. My operating doctor on my last visit with him said no problem.....just don't get fat, I'm not, I weigh the same as I have for the last 50 years. (I'm 80 yrs old but enjoy a very active and healthy life.. even shovel my own snow.)

So enough about me. I use Hollister appliances. I fully believe in CeraPlus. I used to use a 1405 skin barrier, which lasted 3 days. I switched to 1105 which is a CeraPlus product and is a similar product but I now get 7 days comfortably. I also use a Nu-Hope belt both 4" and 5" having gone from 4" to 5" in the last year or so. (Be sure to use a small hair dryer and paper towels to be 100% sure your skin is dry!...when applying your appliance, or it may not stick on as well as it could.)

Here is the important part! I for sure always wear the belt for the first day after I change my appliance. That is to help the barrier ring stay tight and no leaks. Most importantly, when I put it on the barrier ring I always make sure I raise it as high as I can on my back. That way I get more lift and not just horizontal pressure.

Sadly, there is no scientific proof that a belt is of any value, but it sure makes me feel better and more confident.

Jim..... in Canada

That makes so much sense. Thank you so much.

I don't own a hair dryer but my ostomy nurse showed me how to use a heating pad.

Thank you. Going to look at your profile.

Hiya:

First of all, most hospitals use Hollister products as Hollister seems to have a contract with most of the major hospitals. I personally had horrible problems with the Hollister gear that they sent me home with from the hospital. A dear friend of mine (who is also an ostomate) hipped me to Coloplast products--I use a 2-piece convex product. I also use a ring and barrier strips (just to make me feel a little more secure). Keep in mind that you are very new to the ostomy world, and the size of your stoma will change over time. When you order your supplies, they usually will come with a measurement guide. I had to cut my wafers in the beginning until my stoma got to be the size that it basically is now, then you can order pre-cut wafers which are a godsend! I have lots of ideas of what you can eat, but keep in mind that everyone is different. For protein shakes, I have found Pure Protein protein shakes--loaded with protein, low in sugar, and they taste really good--you can usually get them at the supermarket, Walmart, or online too. I remember times before my surgery that I basically lived on Gatorade and protein shakes! Anytime you have any questions, please feel free to reach out--hugs

Thank you so much. Could you share the protein shake brand? So far I'm stuck trying to split a pea protein with soy. Both I react to.

I tried soy milk a couple of weeks ago because it has protein but it wasn't my friend. The same with soy yogurt, so I just eat a low-fat version but not daily.

I drank Pure Protein for a while as they do taste good but switched to using this. I get the chocolate and it's very good, no gritty taste, tastes just like hot chocolate (except cold).
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Is whey a dairy product?

Ooops. Yeah, it is. I forgot you said dairy is a no-go for you, sorry. It comes from making cheese somehow. &zwj

I was thinking it's the clear liquid you can skim off cottage cheese or yogurt. Gallbladder cut my diet in half. I feel like ostomy cut what was left in half.

I'm from Nebraska originally. I grew up on Nebraska beef, where our cows used to be fed sugar beets. I love beef and never have been a fan of chicken. I grew up with gardens and canning every year. I love most veg, but that's limited also. Although I heard some ostomates can eat lettuce, spinach, and broccoli.

The hardest food I had to give up was dairy and eggs. It's like one day they are your friend and the next day they knocked you to the floor.

I haven't tried whey to see if I could handle it. I've assumed no since pea protein and soy hasn't been a friend.

Good news is, I heard from my doctor today. I think yesterday's pain was enough to get me past the fear of gall bladder surgery, perhaps that won't be an issue in the future.

You're gonna make finding your protein foods/supplements difficult, aren't you? Back to the drawing board......

Yeah, it's a challenge.

Hi Texas lady,

I will share some of my experiences. I've had a stoma since October 2017.

Mine is also a little on the oval side, and goes from flat to maybe 1/8" higher than the skin surface. I don't know if it makes much difference: protruding or flat. Probably each doctor's preference.

We not only use the barriers, but my wife adds 3M surgical over the barriers. I just had an explosion in my sleep last night (that happens after a day or 2 of constipation). Thanks to the barrier and tape (and, I wear a different brand of Depends - I managed to become incontinent in the past couple of years - that's the worst) I didn't soil the cover sheet or blanket. I don't care what any nurse or doctor might say - I will use barriers and surgical tape.

I have a belt and cut a hole in where the ostomy bag is. I use the belt for back support more than anything. Ever since the cancer treatment (chemo pills, radiation, surgery, chemo by needle) my standing stability has been a problem. So, I use a cane just in case. I have fallen at home and cut my left arm from wrist to elbow. But, it wasn't that bad and there are no scars.

You are in the learning/experimental stage. Try different barriers, bags, etc until you find what's comfortable for you and you alone.

BTW, my daughter, husband, and 2 young boys live in Copperas Cove - hubby is stationed at Fort Hood.

Can't help with food. Breakfast could be Cheerios, corn flakes, biscuits and gravy, eggs.. The rest of the day fish, chicken, pork, lots of hot dogs (HaHaHa).

Best of good luck,
Rod

Thank you so much for sharing. I never thought about cornflakes. Friday, I went to the hospital due to pain. I'm supposed to have chemo tomorrow if I'm released.

It does take a lot out of you at times. That fall you took sounds horrific. I'm still rebuilding muscle, at home I don't use my walker but I'm careful. I've noticed I will plant my feet a bit wider when walking on weaker days.

At the moment, my ostomy isn't putting anything out. Really good advice on how you deal with incontinence. Thank you so much.

Hi

If you have a flat or concave stoma, you could look into a convex type of pouching system. I think a protruding stoma is best to prevent leakage. Mine protrudes but sometimes has a mind of its own and retracts. I think it does this mainly if I am dehydrated.

You can and should contact each of the ostomy product suppliers. They will be happy to discuss your personal situation and send you free samples of their products to try. Coloplast and Convatec are two that come to mind.

I like the idea of eating scrambled eggs or fish. I usually have on hand a protein drink called Premier Protein that has 30g of protein and only 1g of sugar. I buy it at big box stores including Walmart. There is also a FODMAP diet that you might want to look into. But, again this is a try and see what agrees with you.

I highly recommend a belt or a wrap. A wrap goes around your body and there is usually a pocket that the pouch fits into. You can even find underwear like this through Ostomy Secrets. Plus the different vendors will also send you sample belts to try with their products.

I hope this helps. Best of luck to you.

Connie