Acidic Output with Irritated Ostomy - Need Suggestions

My output is so acidic that the edges of my ostomy are bleeding, not to mention the skin around the ostomy is super irritated. :(

What do y'all suggest❓

Thanks, A.O.2596

 

What type of ostomy do you have, and how long have you had it?

If you have an ileostomy, your output will be "watery/liquid-like" and will irritate your skin due to digestive acids.

If your stoma does not stick out far enough above the level of your skin, the output will begin to irritate any skin it touches. A stoma should stick out at least 1 inch.

A convex wafer can be used to push the skin down around a stoma, helping the output flow into the bag and not around your skin.

Consult with an ostomy nurse about your damaged peristomal skin. If your stoma is at skin level, consult a surgeon about revision surgery.

What are you eating that's so acidic? Sounds like a food intake, dietary issue.

What Beachboy said goes for me too.

Can you explain further?

 

Have you spoken to your doctor about this? I'm not an expert, nor a doctor, but I do know there are medications that may help.

Back in 1998, I had Meckel's diverticulitis. That resulted in having some of my small intestines and large colon removed. I did not need a bag, so that was a HUGE win for me. However, things were not all butterflies and roses. My many, many trips to the bathroom were excruciating. The liquid output was bile mostly. This bile is very acidic (eat through a hood of a 50's Chevy... lol). My doc back then put me on Cholestyramine. Magic happened. I still had loose stool and several trips a day for the last many years, but no burning and I could eat. Before, I noticed if I put something in my mouth, something else came out the other end immediately, not soon after, immediately. The medication stopped that as well. It attaches itself and helps the body absorb or nullify the bile.

I have a colostomy now, due to cancer, and I am still taking this. If I do not, my output is all liquid and many times a day. Now I have a thicker output that, as of now (a couple of months in), empties twice a day. Once at 10 PM and next at 3 AM.

Anyway, it's worth a conversation with your doctors. Sending you my best.

Thanks for your reply. I am being careful with what I eat as best I know how. My stoma is pretty flush to my skin and doesn't stick out like most. This is why, I think, the skin around the stoma is so irritated. I also have a “dimple” on one side of my stoma which allows the output to leak into the adhesive, making it necessary to change the “wafer” of my two-part appliance every 2-3 days, which aggravates the skin irritation. I should mention right about now that I have issues with adhesive.
My output is either very “liquidy” or “pasty.” I am assuming it's also acidic since my skin is so red. Do you ever take an antacid? Is it recommended? 

Words of Encouragement from Ostomy Advocates I Hollister

Hey, thanks for the reply. My stoma does not stick out like most do. It's pretty flush with the skin around it. I'm using the two-piece appliance from Hollister. I have issues with adhesives and have tried everything they have recommended, including the convex style wafer, but the leakage is the same as with the flat wafer. I've used the barrier ring, but it's so sticky that I need two or three adhesive remover wipes to clean the sticky residue off. I've just ordered samples from Coloplast to see if the adhesive that they use is better for my skin. Till then, I am wondering if anyone has taken an antacid to reduce any acidity in the output.

Thanks again for your response :)

 

Yes, your stoma needs to stick out more. It is not a big medical procedure to have it done. I would recommend you look into it right away. Your skin will progressively get more irritated. Replacing the wafer too much will also cause lots of skin damage. And in your situation, you'll be constantly changing the wafer due to leaks.

The "dimple" can be sealed using a piece of barrier ring or barrier material. Barrier material is available in a flat, square sheet (you then cut out a piece to place over the dimple, then install wafer). Also, it's sold in crescent shape (like a quarter moon in the sky).

All ostomy supply manufacturers offer free samples. Try out a 1-piece system, different 2-piece types, and different barrier rings. It takes a while to find the system and products that work for you.

Try out skin barrier products. I use 3M Cavilon spray and swabs. Once your peristomal skin (skin surrounding your stoma) is clean, and most adhesive residue removed, you now spray on, or use swabs/wipes, barrier film. I spray Cavilon all around my stoma. The stuff doesn't hurt stomas, so no need to be careful. Don't put on too much, just need a thin film. Let it dry. Now you're ready to cover the dimple with barrier material, or put on a barrier ring, then wafer.

On my wafer change day, I remove everything, take a shower using Cetaphil soap (do NOT use soaps containing lotions, dyes, or fragrance). It's OK to soap up the area around your stoma; water and soap won't hurt it. You can even soap up the stoma itself, though in your case it's nearly recessed into your skin. When you wash your hair, don't allow the rinse water to flow down the front of your stomach and around the stoma. Eat a couple of marshmallows before you shower; it will slow down output. Bring in a couple of paper cups to catch any output. Only clean your stoma with a wet paper towel, gently. Never use toilet paper. Shower complete, pat the area around your stoma dry, don't rub.

Retry convex products, but add an elastic support belt, which will help push the convex down.

There are different kinds of elastic belts.

Thin width, bag retention belts. They clip onto bag tabs. Used with 2-piece systems. These won't help with "push down," but will secure a heavy, full bag from popping off suddenly. I wear a Hollister one of these all the time.

Wider hernia support belts have a plastic ring that pushes down on the wafer/bag flange, maintaining constant, consistent pressure. They have Velcro closures to easily adjust the pressure. This type of belt also pushes in peristomal hernias. I wear one of these when going on long walks/bike rides or performing any exercise. I also have the same type of belt with a "prolapse" strap. This strap goes over the bag, slightly compressing my stoma. It has a Velcro closure to adjust pressure. I wear this to church or going out to dinner. It makes my peristomal hernia/stoma far less noticeable. These types of belts are available in widths from 3 to 8 inches. I'm a little guy, so I have a 3 and a 4. These types of belts would secure a convex wafer down around your stoma. I use Nu-Hope Corporation belts. They have an excellent selection with lots of customizing options. They are located in Pacoima, Calif., USA. I order them from my ostomy supplier: EdgePark. Amazon has many belts available, fairly cheap. I've ordered many different ones to try out.

There are also belts to secure a stoma during sporting activities. One major manufacturer is "Stealth Belt."

For swimming, there is a belt called StomaGoggle. Mainly used to keep wafer and bag dry during a shower, but comes in handy for other gentle water activities.

Most important, get revision of your stoma. It should stick out at least 1 inch. Better too much than too little.

After my ileostomy surgery, I also had a small stoma which did not stick out much. But, over time, it did begin to grow larger. May I ask how long ago you had your surgery? Also, are you drinking alcohol or soda, which are very acidic? We are here to share our experiences and support you. Welcome!!

Hello, 

I have had an ileostomy for almost two years this September, and whenever my skin is irritated or not, I use the antacid on my skin instead of drinking it. When I peel off the previous bag, I use a soft paper towel with clean water to moisten the skin and soften up any residue left over, and then wipe gently to remove any remnants of stuff left over. I let the soft paper towel soak into the skin, and then once I remove any leftovers, I put one or two layers of antacid on the skin as a baseline and spread it out with my finger on a soft towel again to spread it out. Once there's enough for underneath the wafer, I dab off the excess and let that dry for a moment or two. I used to use the barrier sheets because I had two dimples on both sides of my stoma that one side would definitely leak every time I changed the bag but could do nothing about. I had an open wound right next to my stoma, so the wafer would be going into the wound instead of sticking to a level surface of skin, but now my wound is growing layers of skin since the surgery I had last year in February, so the bag now has some more level ground to hang on to. Barrier sheets cut to the size of the dip work well, and I haven't had much luck with barrier rings because it was in the beginning stages when I had a wound to worry about as well. In present times though, I use paste. I use Brava paste to go halfway around the stoma so the affected areas stay down longer than leak with just a bag on and nothing underneath. 

My process takes about 30 minutes or more because it depends on if I do it before breakfast or after an anti-diarrheal pill in between meals or such. Peel the previous bag off, make sure the new bag is warmed up (with a heating pad or hot pack, so it adheres to the skin better), soak a soft paper towel with water onto the skin and let it moisten up the debris, wipe off carefully around the stoma, shake the bottle of antacid and use a dry soft paper towel to apply the circumference of the wafer with antacid liquid. Dab off the excess (and if the skin is red and irritated, it will burn the skin for about 15 seconds or so and then cool it down, like a fresh breeze), let it sit for a minute or two and then put the paste onto the affected areas of leakage (the paste will burn red and irritated skin like it's on fire), use a section of dry soft paper towel to adhere or dab the paste to the skin and flatten it a bit, to the areas desired, and then I use Brava powder to absorb moisture and sprinkle it on, spread it out with your finger, lastly put Cavilon or no-sting skin prep to make the skin sticky to the bag and let that dry. Once the new bag is warm, and cut how you need, make sure it is applied accurately and use both hands to place around the stoma so the bag is still warm with your hand heat for about 10-15 minutes or so. I used to just place the heating pad on top of the whole bag and stoma without hands and it wasn't on correctly, so both hands place around the stoma and make sure the edges of the wafer stay down with warm heat so the bag adheres to the skin better. If the bag is cold, it's a thick piece of meat you just took out of the fridge, but if it's warm, the bag molds and curves better to your torso. To warm the bag, you can use a heating pad on a medium setting or stick it under your leg until the new bag is ready to be placed on. 

Antacid, paste, or anything you put around the stoma will burn the first few times you change your bag, but you'll see an improvement once you put certain measures in place. They will definitely burn at first, but I've learned to try to learn from my judgments and do something sooner than later, lol (I've done this too many times). Depending on where your bag leaks are, my ileostomy is on my right side abdomen, and the wound was about 12” long and had quite a width. So the barrier sheets worked wonders because of the thickness or thinness I needed to fill the gaps. My leaks were both on my left and right side of the center of the stoma because they took out my belly button, so there was something missing my abdomen didn't grow yet. Now that it's getting level, I have more skin to work with, and the gap isn't so deep. My gap was probably 1/8th or 1/4” deep, depending on if I got up from a sitting position or laying down. I can share pictures if someone is interested. It's been a long two years almost. 

Thank you, Angie. 

Thank you for your detailed process. Is there a particular brand of antacid you use?

I've read other ostomates using Head and Shoulders shampoo on irritated peristomal skin.

Good tip on heating up the wafer. I usually press it on my stomach to warm it up, then pull off the backing and stick it on. I have a colostomy and an even skin base, so I don't get leaks, but a well-installed wafer is comfortable.

I'm going to add antacid and H&S shampoo to my ostomy kit.

New guy here planning my very first bag change tomorrow. I plan on using Brava paste around the perimeter of the barrier that attaches to the skin. (I'm using a Sensura Mio Flex.)

Anyway, my question:

Isn't the whole purpose of paste to prevent the acidic output from touching the peristomal skin that might peek out from the barrier ring by filling in that area around the stoma?

Thanks for the recommendations!

I've never heard of a barrier sheet. What supplier do you get them from? Maybe that would help me as well.

Great idea to use a heating pad to warm the wafer! Thanks.