Dealing with Leakage and Wound Issues with Loop Ileostomy

Hi everyone,

I'm new here, so apologies if this isn't the right forum to ask about this—I wasn't sure if it should go here or under Ostomy tips. I guess it's kind of subjective?

However, I really need help. Lately, I feel like I'm losing my mind. I have a loop ileostomy which I've had for around a year with no issues. A few weeks ago, though, things took a turn for the worse. I developed a small blemish which quickly turned into a full-fledged wound around the four o'clock region. I've been in contact with many ostomy nurses as well as a wound clinic, and eventually, this led to me having it injected with steroids and cauterized under the same surgical team that did my ileostomy in the first place.

So, it's much less painful and bloody, but now I have another issue. They warned me it may get a bit larger before it gets better since the procedure is a lot for it, but now it reaches all the way up to my stoma. This has made it nearly impossible to avoid it leaking into the wound. This is now the second day in a row where it leaks under the Duoderm covering the wound, eventually spreading all the way through the wafer. I really am at a loss. I'm so frustrated and tired, and I can barely even make it to work anymore because something inevitably happens almost every day. I don't do anything social anymore because I'm worried about an impending disaster, and I'm in grad school yet have a hard time getting anything done because I've been so anxious. I just don't know how to avoid this. And obviously, if it keeps getting stool in it, it will not heal.

I use:

1. Adapt Adhesive Remover
2. Coloplast Mio Flex 2 piece barrier/pouch, Convex
3. Eakin seal (which I've been flattening a bit to relieve pressure, which I think may have caused the wound in the first place, but I literally cannot not use convex, as it leaks immediately)
4. Cavilon spray
5. Some powder around the stoma as well as some paste to fill a divot I have on the other side of my stoma
6. Puracol Plus silver dressing + Duoderm on the wound (I've tried both thin and thick Duoderm to see if either relieves leakage, but they're the same)
7. A belt

Has anyone else dealt with this, and if so, do you have any tips or advice on what I should use?

First of all, welcome to the site. I am sorry you're going through all of this. I'm afraid the only advice I can give is to make sure that your skin is clean and completely dry before putting your bag back on. I think you need to go back to your WOC for a check-up. I think sometimes less is more when you are applying your bag. Hopefully, more people will have better advice than I.

When I was having problems with leaks, I used Coloplast's barrier sheet. It is large and square and may prevent leaks from getting into your wound. Barrier extenders may also be an option. I talked to Brian at Coloplast. He was an ostomy and ileo user and provided me with valuable hands-on experience. Good luck!

Good luck finding answers here. If your nurses and doctors are puzzled with a history & physical exam, it is doubtful we will find a solution. I wonder if your doctor is considering pyoderma by injecting with steroids. Maybe fresh eyes might help by seeing a dermatologist?

Hello and welcome,

What a mess you have to deal with.

I had a hole open up at the bottom end of my surgical incision about 2 weeks post-op. It got pretty large. My surgeon instructed me to wash out the hole with Vashe, then pack it with silver alginate, and finally cover it with medical tape. I did this every day for 6 weeks. And it closed up and healed. I think what I had is called a fistula.

You should, if possible, seek a second opinion. Getting stoma output in the wound could cause a lot of trouble.

Getting Support in the Ostomy Community with LeeAnne Hayden | Hollister

Oddly, I just tried a barrier sheet today. So far so good, but it usually leaks after 24 hours, so I'll see if it holds past then.

Yeah, they referred me to a dermatologist. I need to set up an appointment. However, they cultured it when they did the steroid injections and it didn't come back as indicative of pyoderma. They were considering it though. It's hard. It doesn't look like pyoderma to me. I *think* it's an ulcer.

Oh yikes, that sounds painful. I had fistulas in my J-pouch before it failed and it was pretty agonizing. I'm glad it cleared up for you. I haven't tried Vashe, so maybe I'll look into it. The silver has been a staple for weeks though.

I've gotten too many opinions to count at this point. Most of them don't even seem to know what to do for me. The wound clinic literally told me something along the lines of "It's fine if you want to do more follow-ups here, but we don't know how much we can do for you." Every ostomy nurse suggests something different, but I think it's just something I need to figure out for myself using various pieces of advice at this point.

Hello C

There have been some on here who place a small piece of micropore tape directly over the wound/inflamed skin first, then continue with the rest as normal. The tape sticks to the skin then your setup sticks to the tape. It's cheap and easy and works well for some until the problem subsides.

Have you investigated hyperbaric oxygen wound therapy? All wounds need oxygen to heal.

Installing the wafer covers skin around your stoma, decreasing oxygenation and prolonging wound healing.

Recently tried the Skin Tac wipes (white box with teal writing) and they work better than the Bravo adhesive wipes I was using. Don't know if this info will help, but I hope it does.