Pouching Issues - Bulge Above, Dip Below

So I saw my ostomy nurse yesterday to talk about my issues with pouching, and she sent me home with some samples of the Eakin Stomawrap to try. She fitted me with a new bag, the same Hollister 2-piece model that I currently wear, with the Stomawrap barrier ring. The problem is I started leaking again hours later, just as I did the other week. I think part of my problem is she is evaluating me when I'm laying on my back. My belly looks flat when I'm laying down, but my abdomen is lopsided on the side that has the stoma. I have a small bulge above the stoma and a slight dip below, causing an uneven surface and curving of the plate. It almost seems the barrier ring is making it worse. The leaks always happen at the bottom, where the dip would be. Any suggestions?

 

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Hi, have they tried the sticky stoma rings with convex bags? Mine is an inny stoma, and convex bags are good for me.

I think I have a similar issue going on. My skin is uneven and this causes leaks. I was wondering if the Coloplast Paste would help? I'm currently waiting for a sample from them. I love that they give samples and the follow-up. Anyways, they say on their site:

Fills cavities and folds. Coloplast® Ostomy Paste fills deeper cavities and folds, creating a tight seal between the baseplate and skin.

So did anyone try this or did your ostomy nurse mention it?

Appreciate any responses :)

She hasn't mentioned paste yet. I'll ask her about it the next chance I can. 

I was using a convex flange with a barrier ring before, but she told me to stop and switch to flat because she thought it was causing my stoma to swell. 

I wonder if even using half a barrier ring just on the bottom would help.

I use the paste; it works great for me. I use Dansac Soft Paste. The paste can sting a little bit at first if you have any skin irritation. I have tried barrier rings, but they did not work great for me.

Getting Support in the Ostomy Community with LeeAnne Hayden | Hollister

I had a peristomal hernia pre-reversal and I always had to tear apart my barrier ring and reform it to thicken it/build it up on one side (my hernia would fully retract when I laid down but bulge when doing anything else). I used a convex Hollister 2-piece system and Hollister barrier ring. Never had any leaks - I made sure to hold my warm hands over it for 5 minutes each time I changed my setup. Good luck - you will find something that works!

How exasperating! My belly is, like yours, very different when I'm sitting or standing versus lying. I had the same problem with leaks and full-on blowouts in the weeks after surgery while in rehab. They provided Hollister 2-piece bags and (finally) introduced paste, which wasn't helpful, and the problem persisted. At my first ostomy care appointment, 2 weeks after rehab, my Nurse Saint changed my pouch to a soft convex Coloplast (one-piece drainable Sensura Mio) with a barrier ring. BINGO! Problem solved. This one is not made of fabric on an adhesive but is a very pliable poly material that truly shapes and seals to all my folds and creases. A couple of months later now, and I haven't had a single leak. Don't give up trying new systems until you find one that works.

Do you apply your wafer standing up or lying down? Have you tried a one-piece setup? It looks to me as if your stoma sticks out plenty, and either a ring or paste should fill in any gap or crease with no issue. 🤷‍♂️ And I don't remember… colostomy or ileostomy?

I apply mine standing up. I tried one piece when I was in the hospital but had trouble lining up the hole to my stoma. I have a sigmoid colostomy.

IMO, I'd try a one-piece setup again with a barrier ring. From those pictures, your stoma area doesn't look bad at all as far as crevices, dips, creases, or whatever you want to call unevenness. Having the rigid plastic ring on the two-piece system might be causing some sort of “pressure point” once you start moving around, causing it to loosen enough for a leak to start. 🤷‍♂️

I have a terrible time cleaning that paste off. I am not friends with the paste.

So, not worth a try in this instance? Or not worth it, I should say maybe? Thanks.

There is a huge difference when applying your pouch standing up. I feel as if most home care and hospital nurses apply your pouch with you lying down. I use the Hollister one-piece pouch with the barrier ring. I was also taught how to cut the hole in my bag properly and then apply the ring to my bag. I change my system every 4 days and have never had a leaking or adherence issue. Hope you find success with your issue.

Try the stoma paste. I have a bulge above my stoma and a scar below it, and both cause leaks without stoma paste. Don't give up if the first try or two fail. It took a while, but I can get 4-7 days now using the paste and a flat one-piece pouch with a wax barrier ring.