Struggling with Stoma Care - Seeking Advice for Pain and Bleeding

Hi all. I'm a bit lost and disillusioned at present. I had a sudden ileostomy last March after being sent home from work feeling sick. I ended up in a coma with sepsis. Blood clots had caused my bowel to perforate. Four operations later, I came around in ICU extremely lucky to be alive. Since then, I've always had trouble getting bags to stick. Despite trying many different ways and products, none have ever been consistent in use. I have now started bleeding a lot from where the stoma protrudes through the skin. This is extremely painful and is making it even harder for me to get bags to stick. I have been back to the hospital numerous times but never seem to get anywhere. I am currently using stoma powder to try and dry the 'moat' of blood surrounding the stoma. Does anyone have any advice on how I can help this wound heal while still wearing a bag? I appreciate any help.

Hi Georgenelly, I'm sorry you're going through this. No medical professional has been able to explain the sudden bleeding around your stoma? Are you rubbing it a lot when you change your bag? That will make it bleed. Otherwise, that is an issue that needs explaining. The barrier wipe/stoma powder crusting technique can help. Using convex wafers and a hair dryer to dry the area around your stoma helps, but you've probably tried those. I had a period of time where I was leaking - I never found out why - but I did try convex barrier rings that helped during that time. I'm sure you'll get some more ideas on here.

Georgenelly,

 

Following on from what Eefyjig has said - it seems maybe there might be 'something' being overlooked -

Scratches my head -

Forgive this, but one question springs to mind ....

 

When measuring your stoma circumference, i.e., the circle you cut [or have precut in form] - whether wearing a single stick-on bag or a wafer, then a bag, or indeed a two-piece ...... The size you have elected to use ------ HOW and WHEN was this measured?

 

My own experience has shown that some 'adjustment' is sometimes required - meaning it can be good to keep some wafers or one-piece directly stick-on bags that have a very small 'starter' hole - so allowing one to cut that desired template to fit one's LARGEST current expansion of one's stoma .... because .... if one cuts the hole or uses a default template [hole] that is as small as when your stoma is at rest and when it 'shrivels' when wiped, for example - THAT in itself can cause the apparent problem of bleeding around your stoma at the interface with the appliance.

 

..... Perhaps just have a go at measuring when the stoma is at its largest .....

 

 

OR

 

 

Conversely, if you have the above - maybe you may need a more snug fit - but at a point whereby the interfacing material can allow for expansion [thereby protecting your abdominal skin at the abutment of your stoma - but allowing for flex of the stoma?]

 

Without pics it is difficult to understand precisely your problem.

 

May I suggest you take pics at all sorts of different times when your stoma/interface is in the bleed situation - but taking pics immediately after cleaning down - and also perhaps taking pics of your removed used appliance so that your stoma nurse - or GP's general practice nurse - can understand what may be happening - [the used backing on a soiled appliance is a good informer - hence taking a pic of this to show photographically - thereby allowing someone to study it and maybe see - in a clean and 'pleasant' manner for the viewer - because not all nursing staff can view all situations of your timeline - only you can photo these]?

 

Just saying - perhaps trying to think 'out of the box' for given you have been back to your hospital - How about you ring the secretary of your original surgeon - or his/her replacement and exchange your pictures - so that a feed of info may help to inform the problem?

 

Hope something here may go towards finding a way forward.

 

Best of luck,

Jayne

I agree with what Jayne says. I used to cut my own hole for the bags, and if it scraped against my stoma while doing activity, I would bleed if I made the cut too close to the stoma.

I suggest trying to cut it just a fraction of a bit bigger, but not too big, or you will have leak issues. Use a barrier ring for cushion. Yes, if you have been to the hospital for this and nothing is found, I would try this to see if this could be the simple fix for you.

Other than that, I'd suggest a stoma nurse as well, as they are the key to figuring out what's going on. If you do not have one close, Convatec has stoma nurses and will do a free virtual visit to assist. You would just need to call them and explain your situation.

Georgenelly, there is a lot to unfold here. Getting the pouch to stick could be that the adhesive for that wafer is not strong enough to adhere to your skin. You can experiment with different barriers once your skin is healed. Your anatomy and the placement of your stoma also could contribute to the failure to adhere. Try not to become frustrated; rather, challenge yourself to overcome it. While in the hospital, it took six weeks to find a solution that worked for me, and I had a very talented ostomy specialist. If the skin irritation is not too severe, stick with the stoma powder using a technique called "crusting."

Prior to putting the barrier on your skin, ensure any adhesive from a previous wafer is removed. Once the skin is clean and dry, apply skin prep—you may not always need this step, but for now, don't skip it. Place a barrier ring around the base of the stoma. ConvaTec's Eakin seals are very good, but in your case, I would suggest you start with Coloplast's Brava Protective Seal since it leaves less residue to clean up. Once the barrier ring is in place, apply "Skin Tac" to your skin to add more adhesion—ensure you have some along the areas where the barrier's tape edges touch your skin. Next, apply the wafer over the barrier ring and warm the entire assembly by placing your hand over it while gently pressing down—I use a portable hair dryer. In addition to the wafer's tape boundary and Skin Tac, you can add a third layer of adhesion using barrier extenders. All three of the major manufacturers make barrier extenders. If the tape edge of the barrier tape is square, then Coloplast makes excellent straight barrier strips.

Bleeding could be a sign that your wafer hole is too tight around the stoma. You may want to also try a moldable barrier. Both ConvaTec and Hollister make moldable barriers.

Finally, how often are you changing your wafer? For now, you probably don't want to go more than 3-4 days between changes.

Words of Encouragement from Ostomy Advocates I Hollister

Hi Geo,

AT is right, there is a lot to unpack here. So first, a couple of questions about things that weren't clear to me from what you said:

• Is your stoma bleeding, or is the skin around your stoma bleeding?
• What is painful, the skin or your stoma, or both?
• Have you been dealing with this issue since last March, or has something changed?
• What exactly does the skin around your stoma look like? Is it denuded and bleeding, or cracked and bleeding, or wet with a yellowish residue?

While you're answering those, I'll look for the link to the stoma problem picture book I've put up here a million times. It's a great reference that will explain whatever is wrong with one's stoma.

;O)

Bob