DIY Silver Nitrate Treatment for Stoma Granulomas - Tips?

Advice?

Instructions?

What I read is you protect other areas and hit the granuloma for 5 seconds once a week during a bag change. Is this right?

Any adverse effects? Bleeding, pain etc.?

Anything I should put on afterwards?

Anything going to be a paste adhesion problem?

Thanks in advance. 😊 

Have your doctor do it is my advice. I have had silver nitrate applied many times on my abdomen after surgery, and watching what it does is a trip. I wouldn't mess with it unless instructed by your doctor to do so.

Well, this is a stoma granuloma and it's very small. I edited the headline to correct it.

Supposedly, it's so simple that an ostomy nurse does it, then the patient performs further procedures on their own.

So, since it's so simple, I just need to know if others have been doing it themselves and what to do and not to do.

The silver nitrate sticks are already on their way.

I didn't say not to do it because it's complicated; I said it because you don't want to cause any damage. That was just my opinion, as I have had a lot of it used on me. Be careful and good luck.

Has your ostomy nurse suggested this is something you should do on your own? If an ostomy nurse is qualified to do it and then a patient can do it on their own, it suggests a professional should do it first.

Words of Encouragement from Ostomy Advocates I Hollister

That's also what I was trying to say: get the GI ahead first and have them show you what to do and get the okay to do it by yourself. A small slip or too much of a heavy hand with that on the stoma and you have bigger issues than a granuloma. But I wouldn't trust a stoma nurse; I would go to my actual surgeon. That's me though; I don't trust stoma nurses, and at the end of the day, we know a lot more than they do.

According to a few pdf's on the subject it's just a matter of protecting areas from accidental hits and hitting the graneoluma for five seconds once a week during a bag change.

Once taught the patient can then do it themselves. 

My graneoluma doesn't bleed and it's just a very tiny pimple on the skin around the stoma. But it's an annoying pimple.

I've taken steps to prevent it from being irritated further, it's not from output, rather from below and by previous belt and wafer hole, which I have remedied with lots more paste and no more belt.

But this last little bit just won't go away and despite it hurting less I'm looking at making a bit more sure it's gone.

I don't see the sense in wasting a lot of money and time seeing a otosmy nurse then quick slapping a bag on when stoma may not be cooperating.

I have a very special routine that I use to ensure a clean, dry and durable bag application..if not with my belly fold and near flush stoma, pops off 20 minutes later when driving my car.

So you see why I'd rather do it at home where I have all the necessities like a blow dryer, antibacterial soap and a shower to run back into just in case the stoma starts acting up.

Plus the dam offices make you wait hours sometimes to get in, my bag cannot handle sitting in a waiting room chair for anymore than a few minutes. Which means I will need to drag in a padded stool where I can straddle it and not cause the wafer to pop off.

Now if anyone has any recommendations for a flexible wafer and bag system instead of a stiff convex and something that doesn't harden up like paste, but sticks on extremely well and hard to get off, then I'm all ears.

So far anything I see wafer and bag speaking is hard and designed for those laying on their backs, not for bending or movement.

I tried a protective sheet without paste and the stoma output went right through it like nothing.

So unfortunately I'm stuck with paste being the only stuff sticky enough (I use Bravo no sting paste and it's really sticky stuff) and deflects output well but the problem is it gets hard and tears the skin because of wafer stress caused by sitting, namely driving which I have to do.

Hi there, I was just giving my opinion. I understand not wanting to go to a stoma nurse; I have my own opinions and experiences with that, one of which I don't trust. I was saying go to your surgeon so they can first show you how to do it properly without burning your stoma and other areas of your skin. Trust me, it doesn't feel great, and you need to know about the silver nitrate as well. It turns grey after being put on, and if you don't wipe it off, it burns things off, which is why I said what I said. I'm just trying to help so you don't have a bigger issue on your hands.

And trust me, I know it sucks having them only have convex as a solution to a retracted stoma. Have you talked about getting a revision? Unfortunately, if the convex doesn't work, that's the only other option. If you are completely flush with the skin (I have had several of mine retract completely), barrier rings and the skin barrier sheet won't work; it's too thick and, like you have already seen, doesn't work. Have you tried Brava strip paste? That's what I had used before I had revisions. You don't have to wait for it to dry; it holds up better than regular paste, and you can break off a piece and flatten it to how thick or thin you need it, or roll it, etc. It's moldable. I agree with you on the convex being so rigid. I think they can make some major improvements. The most flexible wafer you will find will be a one-piece flat in Coloplast.

Brava strip paste?

I'll check it out. Thanks.

BTW, my stoma is near flush; it's about 1/4 inch on one side and about 1/2 inch on the other side.

If I ensure the Brava no sting paste is adhered well to the skin around the stoma, it usually holds very well. It's just that it hardens up and isn't flexible like painter's caulk would be, and thus causes shear damage.

That and the darn stiff convex too, although I do weaken it horizontally to fit my belly fold and create some flexibility.

I really need something else, like a protective sheet that's output proof married to a flexible bag. Then everything is flexible and the skin is protected.

Actually, I am glad you asked. I was going to say something, but I didn't want to throw so much at you. The best I have found is the Liquid Skin Protectant 3M Advanced or Marathon. 3M worked better for me, but everyone is different. Heads up, they are a little expensive. You can find them on different websites; Medical Monks sells them individually and by the box, Vitality Medical, Carewell, and more places.

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I have already tried those and they are unnecessary at my 1+ year stage. Yes, at first, when the stoma was newer, it had scabs, bleeding, and larger burn areas, but now I just have little burns around the stoma from hardened paste tearing the skin when the convex bends.

I noticed Hollister just came out with a flexible convex wafer for belly fold types which may work, but the problem is the paste still gets hard and isn't flexible.

So without a flexible paste, I don't see how it's going to work, but I'm going to order some samples to try.

Some of my Coloplast convex wafers are a bit more flexible, but not the bubble; it's still stiff. So I weaken it to bend myself. But even with that, I still get shear effects from the paste.

A few times I've used protective sheets, used a tiny bit of paste skin down and along the hole edge, then surface coated the sheet with paste, then cut a 60mm hole in my wafer which of course made it very flexible. Then I married it with paste and that seemed to work except it was a lot of effort.

It's just to protect the skin from your output. It's never too early to use them if you need protection for your skin. But as I said in my last post, you can try strip paste to see if that helps you. When I used the strip paste, I put it on my wafer around the cut hole, and I would flatten it to however thick or thin I needed and wanted it. Question... Is there a roll where your stoma sits? If so, that could be why the convex isn't working right.

What I'm doing now, because the convex and belt were causing a granuloma, is:

1: Washing the area with antibacterial dish soap and then conditioner just once, followed by moisturizing soap after that and after any spewing. I find antibacterial soap much less painful than alcohol or iodine for sterilizing the burns from infection, which causes weeping and separation from the paste.

2: Blow drying well and applying two coats of skin protectant (I use generic Flonase as it stops the stings).

3: Placing a ring of 50/50 cut moon barrier strips 1/2" away from the stoma and another coat of skin protectant around the stoma. This is designed to protect the skin from a blowout. It's expensive but works. Dry extremely well at this point, perform a finger test to ensure it's bone dry and not slippery or wet.

4: Applying olive oil-based lotion on scar tissue only, filling the belly button hole with toilet paper to level it, and placing thin cardboard strips over scar tissue and belly button hole. If not, the adhesive causes intense itching from grabbing it.

5: Precutting the wafer hole, weakening it horizontally for the belly fold.

6: Applying a ring of paste around the stoma and pressing down around it so it sticks to the skin. Put another ring of paste around the first one. Then remove the backing and cover the flat area of the wafer with yet another ring of paste. It takes about half a tube. 😆

7: Lining up and gently applying, pressing down around the stoma but not causing the paste to stick out much past the edge of the wafer hole. Barely have wafer flanges touching the skin. Press those into place. This creates a wall of paste with an elevated convex which, of course, needs more time to set up. But it's been protecting the granuloma.

8: I put extra-large barrier strips all around to secure the mess into place, then blow dry to heat activate. Then I lay and wait a few hours for the paste to set up.

It's kind of weird but it works, with 5 average day bag wear times usually. It's on solid and I don't have to use a belt, which was causing the granuloma issue. In fact, I was told to do this very thing by my ostomy supplier and we laughed because I was already doing it. 😆

So if I get a blowout, like the wall of paste fails for instance, there is this pouch area that catches it before getting all over the place.

The thing is though, it makes the area extremely stiff and sitting in a chair or driving (not straddling a toilet or stool) seems to cause stress issues from the paste on the skin, then leaks can occur or not. Sometimes they don't. I can't feel the difference so it's tough to tell.

At night, lying only on my back, everything is fine. It's when I get up and move around, sit in chairs especially, that aggravates it, causing the wafer to pop off or get irritated.

So I definitely need some sort of flexibility from both the skin adhesive material and the wafer. But the adhesive has to be very strong, so that only adhesive remover is going to budge it. So that all three; skin, adhesive, and wafer, move as one.

If I can accomplish this, I would then consider a two-piece with a lock (none of this Hollister click junk, I had to super glue theirs together as it was always parting).

So Hollister has a new flexible wafer, but it's a click two-piece which I would have to turn into a one-piece.

So now I need something like a flexible paste (no sting), similar to painter's caulk.

I was thinking of using painter's caulk on top of a thin layer of ostomy paste, but the set-up time could be many hours as it cures much slower.

So the problem I see now is the paste not being flexible. I tried rings and they just fail quickly, lacking sufficient adhesion strength.

Rings are too low for my needs, but I may try them if I can get the wafer to fit and flex with my belly fold. See if they are strong enough.

Where can you get silver nitrate? I used to get those all the time before I had my stoma revision done. The doctor did it in his office; it was no big deal. I'd have no problem doing it on my own. I'm with you, waiting for an appointment and then spending all that time at the office.

May I ask why you are using conditioner and moisturizer around the stoma area? That can cause problems with your adhesive not sticking or getting a tight seal. And in my experience, if you have a roll or fold that your stoma sits into or on, the convex isn't going to wrap around it and stay put. Which sounds like why it pops off in places. Have you tried the SenSura Mio Flip so it can go around that area and stay put? The strip paste is flexible and moldable so you can shape it or flatten it however you want. It's worth a try to call for a sample.

Yeah I only said about a stoma nurse because she was saying something about that. I think yeah the GI or surgeon would be best professional to trust. I don't know a lot about granulomas but I do know that it is best not to take some things into your own hands.

I'm the type that wouldn't even trust the GI, probably because I have spent over 15 years with a GI, so I know what they are better and more knowledgeable at versus a colon surgeon, who is way more in-depth and knowledgeable about the ins and outs. That's me personally. And at the end of the day, to each his own; we can only try to help, which is all I was trying to do. I hope they can find the answers they need and everything goes well.

I have used silver nitrate sticks on my own for several years now. A stoma nurse showed me how. You just have to be careful. I rest my hand on my stomach and lightly touch the granuloma. Sometimes it does hurt for a little bit, but Tylenol helps me with that. I buy the sticks on Amazon, about $9.00 for a dozen. It takes several applications for them to go away, but it's the same with seeing a stoma nurse.

That's exactly what I use... I don't have any issues... and yes, you won't need any paste; it WILL stick to you... ☺️ It'll be just fine once you get comfortable with the change.

Well the antibacterial dish soap and regular soap by themselves tends to irritate the skin under the appliance later.

However I need to kill any infection in the burns or it keeps on weeping. So the antibacterial dish soap first which stings, then after that subsides then rinse and massage in conditioner and that stops the remaining stinging, but can leave a surface coating of conditioner that will cause adhering issues, so that's washed off using regular soap.

I've learned to do this only once, not every time a spewing occurs. After that I just use regular soap.

Most just use moisturizing soap only like Dove, but perhaps they don't have burns that need to be sterilized of its infection from digestive enzymes.

Then dried very well stoma powder very lightly applied and dry brushed removed.

Then I use generic Flonaze as a poured on skin protectant, rubbed in (because it contains cortisone I believe) that immediately eliminates any residual burn pains. Two to three coats and dried well after coats.

What this does is provides more time when a leak occurs from damaging skin. Instead of it burning right away, it's a small ache or itch instead. Let's me know but damage is minimal.

Then no sting paste, a thin coat just to protect the skin, then cut moon shaped barrier strips on top next to stoma pushing the paste down around stoma so it adheres well to skin.

I have barrier strips covering further out, then two rows of paste around stoma but not too close, then the convex wafer with the flanges barely touching skin and pressed down. Then olive oil lubricant on scar tissue covered by thin cardboard. Then external barrier strips all around to hold the whole mess in place all neat and professional like.

The paste creates a wall and allows my graneoluma to no longer be irritated, which it's almost gone now.

This is my new current method.

Just putting paste on the back of a wafer and sticking it on (aka quick slap) doesn't last very long and often leaks.

With this process I get up close and personal to ensure the paste is adhered well to the skin.

Everything is fine for days on end, no pain or leaks even laying on my back with output all around the stoma.

It's when I sit in a chair or drivers seat that issues develop. Straddling a stool or toilet is fine, because I'm not bending my belly fold.

The problem with this method is it's very stiff. Thus wafer and paste shearing occurs which causes leaks when bending.

Paste gets hard and less flexible wafer isn't flexible.

I only use Dial antibacterial soap, the gold bar old school. Anything with moisturizers and oils will cause residue on the skin and problems with the wafer sticking. We all have our different ways. We all have what works for us.

I hope so too. It is my hope that everyone who comes on here finds some kind of help. Advice or something to think about. 

Yes, it's an adjustment issue, depending on how raw and dry one's skin is.

That's why I rub conditioner in, then wash the conditioner off the skin surface.

I only do this if I have burns that need disinfecting; otherwise, I use Dove.

When blow drying, I ensure the skin is very dry and sort of chapped; this really holds the paste on well.

If the skin is too wet, oily, or smooth, most likely not.

That's what I thought; I've been reading up on it. It seems the water amount dipping the tip is what controls its intensity.

Also, one needs saline around to rinse and stop the process.

Came with instructions, somewhat.

Yes, I do this myself in the UK, so I buy the vet pen, which is the exact same stuff. I was told by a stoma nurse (off the record) to make sure it's 95%. I do this when needed and have never had an issue.

I don't understand what a stoma granuloma is and what silver nitrate will do.

What a palaver??😳

What a palaver??😳