Managing Stoma Noise and Barrier Ring Concerns

Hello, 4 days post op with a loop ileostomy. I've been waiting for my surgery for a long time so I was very ready for it. I'm recovering really well. 

My issue is the noise this thing makes when it's putting out. I work in HR and I cannot imagine sitting in my office with an employee with this thing (my Beenus...kinda like the extra skin on your elbow-weenus) sputtering out fluids and air every 5-10 minutes. 

I'm also so very nervous that I'm not covering my skin properly. When you use a barrier ring before placing your wafer down, does the barrier ring fit snug around your stoma? I'm so afraid of my skin breaking down because I'm not doing things right. 

 

Thank you for your help

 

Oh, for sure, just be a little patient; less than a week out. Things will regulate in a few weeks, but you can do many things to keep the noise down, the first of which is clothes. Eating thick foods will help lots too, like scrambled eggs, potatoes, tapioca, etc. I have tried in 35 years just about all products, and I have found the Convatec flexible flanges the best to stay on and still be flexible. Others I find allow too much to leak under the wafer and cause skin irritation (with liquidy ileostomy). A dermo doc also gave me something a while back that changed my life for irritation. It's called Luziq or Betamethasone Valerate. It's a topical "steroid" of some kind, and I put a light layer on for each change, and I haven't had irritation in at least 10-12 years (except for a few small incidents). Not all insurance covers it, but it has to be the foam because it's greaseless and allows the flange to stick well.

35 years at this... happy to answer any questions anytime!

Hello,

Noises will happen.  I tell everyone up front:  I have a colostomy, it makes noises.  Had my teeth cleaned last month.  My little stoma beast was tooting away.  The Hygienist just chuckled. 

I've had it happen in work meetings, out at dinner with my wife and friends.  It is.. what it is.  I don't let it bother me.

First I put unopened barrier ring container between my legs for a minute to warm it up. Then remove the ring.  I cut the ring through one side.  Straighten it out like a ribbon.  Then squeeze and stretch it.  Starting at the middle, bottom of my stoma, I place the middle of the stretched ribbon edge there, right against the edge of the stoma.  Then fit and press the ribbon up and around the stoma sides, so the edge of the ribbon is right against the stoma edge the whole way.  Ending at the top of the stoma.  Does not matter if the ribbon overlaps, just press it together.  If there's a small gap, just push the ends till they stick together. 

Hold wafer with plastic backing still attached against your stomach, opposite your stoma, for a minute to warm it up.  Then pull off backing and install over stoma/ring.  Use hands to gently push down wafer for a minute.  Change hand position, hold again.  

Use of a support belt for 30 minutes is recommended.  

This works for single piece and 2 piece ostomy systems.

Yes, your barrier ring should be basically right up against your stoma. But not strangling it, if that makes sense. 

Noisy stoma is of the result of gas produced by digestive enzymes breaking down your food..it cannot be helped much.

However there are certain foods that produce or reduce gas. I'll give you the list at the end of this post.

 

Yes if your using a ring you stretch the hole to just be a hair bigger than your stoma place it on and press the edge down and right up next to the stoma but not on it.

Proper skin preparation BEFORE applying a ring or paste is vital for a good seal.

This is what I do.

1: Shower and sideways scrape using a soft flat something to remove any residue from around stoma.

2: Wash area with antibacterial soap once, it's going to sting but necessary to kill any infection which causes the skin to weep, ruining the seal. (If no burns, then only use Dove like moisturizer soap as there isn't any infection.)

3: Rub in some conditioner and this should stop the stinging. Then wash again using normal soap to remove surface coating of conditioner. And the same after any spewing if it occurs. Wait in shower until the stoma has quieted down. Final wash and rinse.

4: Dry off thoroughly and blow dry the area until skin around stoma is very dry and rough feeling.

If you have bleeding or scabs, this has to be stopped first using a product like Medline Marathon.

5: Apply a very light dusting of stoma adhesive powder to skin burns so that's it's covered, but just about invisible. Dry brush off excess as it will come off if you don't and ruin the seal. 

6: Lay on your back. Apply skin protectant by spraying into cap and pouring around stoma then spreading it out to cover all adhesive areas. Blow dry well and repeat with another coating.

7: If you have scabs, dips and uneven skin around stoma, belly  fold, you will need to use no sting paste instead of a ring. Squeeze a thin coat of paste around stoma to get it to cover 1/2 around it and ensure it's sticking hard to the skin. Having skin bone dry and rough works. If not remove and repeat steps above until it does stick. If not everything after that is a waste.

8: If spew gets into your skin, you need to head back to the shower and start over. If you catch the spew before it gets off the stoma then that's okay. But be warned that scraping the stoma with toilet paper will cause it to bleed and getting a bag on just about impossible. You need to dab, not wipe. Also never wipe wet around a stoma, always dap dry with a new dry spot of toilet paper 

9: Now you should already have your wafer stoma hole cut to the near exact dimensions of your stoma. If oval then oval. It needs to be just a hair bigger, not rubbing up against it or it causes a granuloma and they are painful and problematic. Bend any sharp edges inwards around wafer hole as not to dig into the skin.

10: Now if you look at your wafer you will see a flat area that makes contact with the skin around the stoma. This area needs to be covered with paste sort of evenly. If a ring you apply that to the skin surface first and press the edges down and right to the sides of the stoma all around. With paste when you apply the wafer you press through and down but don't want the paste to cover the stoma or the wafer hole, just barely appearing around the wafer hole edge.

11: Stomas extend in and out of the body, so it has to go through the wafer hole and deposit the output. Too small of a wafer hole, wafer hole not exactly aligned to stoma when applied or paste covering the wafer hole can all cause issues with the stoma pushing the wafer off and causing leaks. Other issues like ballooning or pancaking can cause the wafer to detach as well. With a small amount of paste around the wafer hole edge, protects the stoma from hitting the sharp wafer edge.

It will take some time and in the case of scabs, frequent bag changes until the skin around the stoma is healed up. Then you'll get better and better bag wear times, like even up to a week on each wafer. Once you find the right product and master your application process. It's NOT easy, may take up to a year before you perfect things.

At first learn to sleep only on your back with upper part slightly elevated using pillows under each arm to keep you from rolling into one side.

Eat am (after a bag change) to about 2 pm and then only two small cookie sized snacks until morning. This will keep your nightly bag dumping to a minimum so you can get some sleep.

If you need a bag change, but it's not a big leak and can wait a bit, eat some applesauce and that, on a near empty stomach, should stop output from coming out long to shower and get a fresh bag on.

If you take a dump, use a little bit of liquid antibacterial soap and some water to rinse the bag. Once clean then leave a little soap and some water inside, it will mix with the fresh output and kill the smell for the next dumping.

You can also use antacids tablets predissolved in water bottle as well, but leaves a bag residue. But good for the car trips.

Hopefully all this, although a lot to take in, will get you started on the right path. There is a LOT to learn, so don't be afraid to ask more questions.

Good luck 🍀 

 

[b]Signs of a clogged stoma.

[/b]

No output or only watery output under pressure for a few hours after eating. Could be caused by a covered stoma by improper application of an appliance, typically hole is cut too small or too much paste. Also could be caused by eating hard food. Seek treatment by an emergency room, remove appliance if necessary and wait. If clogged a severe pain will eventually appear which hopefully will clear itself. If not a trip to surgery would be necessary. Unfortunately very high and frequent output will ensue after clearing for quite some time which will likely making putting on a replacement appliance difficult. Use stool thickening tactics (below). If going to an ER, bring your own otosmy gear and a change of clothes as hospital likely doesn't carry or doesn't know how.

 

[b]What is "pancaking?"[/b]

 

Pancaking occurs when a vacuum in the bag (likely do to a clogged filter) or super thick stool blocks stool from depositing to the bottom of the bag. Thus can force bag off and cause leaks. Controlling what one eats and by mixing and consuming stool thickening and stool softening foods at the same time to get a balance.

 

 

[b]What is "ballooning?"

[/b]

Ballooning occurs when foods eaten produce too much gas and the filter gets clogged (likely due to laying down) and thus forces bag off and causes leaks.

 

These two conditions can cause premature bag replacement and leaks which burn the skin. It's better to replace the appliance if there is any continuous stinging pain, don't just live with it. Keep an eye on your otosmy supply and have ample reserves.

 

I've found that caffeine, in coffee, tea and even chocolate causes diarrhea and can assist in controlling flow so stool is more liquid..however coffee makes output very acidic making burns worse. Dried Chinese Crispy Noodles, Cheerios or applesauce (peeled apples) are the exact opposite, a stool thickening food. By mixing these with other foods one can manipulate their stool output and counter the issues above. Also the severe thickening helps in cases where one has severe diarrhea and unable to reattach a new bag due to high flow.

 

 

[b]Eating Guide

[/b]

 

Partially copied from my nutritionists guide. Ileostomy Nutrition Therapy from the Academy of Nutrition and Dietetics. (This handout may be duplicated for client education.)

 

My recommendation is to see a nutritionist for the full guide as not all can be pasted here

 

I've added my own observations to further clarify 

 

Chew all foods well to the consistency of paste.

 

[b]Foods That May Cause Blockage (very bad avoid!)

[/b]

Apples, unpeeled (unpeeled and applesauce are excellent thickeners, don't eat the core, chew well)

Bean sprouts

Cabbage, raw

Casing on sausage (inside fine if no tough parts, avoid swallowing if a chunk is felt)

Celery (avoid)

Chinese vegetables (stir fried crunchy, too hard, need soft veggies with no skins)

Coconut

Coleslaw

Corn (grits also, corn anything doesn't seem to dissolve in stomach)

Cucumbers (skins bad, inside chewed up good seems okay, no seeds)

Dried fruit, raisins

Grapes

Green peppers (red, yellow also) pureed or very very small seems okay in small amounts 

Mushrooms (doesn't dissolve in stomach) pureed or very very small seems okay in small amounts 

Nuts (totally avoid)

Peas (mushy interior okay, like pea soup, skins a problem)

Pickles (skins a problem, inside if chewed up good seems okay, seeds not)

Pineapple (liquid okay, mushy parts fine, hard parts not, tricky)

Popcorn (totally avoid)

Relishes and olives

Salad greens (diarrhea nightmare too)

Seeds and nuts (avoid)

Spinach (doesn't digest, pureed perhaps)

Tough, fibrous meats (for

example, steak on grill, well done, tough parts especially)

Vegetable and fruit skins, (any avoid)

Whole grains (no grits, oatmeal seems to be okay, Cheerios is an excellent thickener)

 

 

 

 

[b]Foods That May Cause Gas or Odor

[/b]

Alcohol

Apples

Asparagus (stink)

Bananas

Beer

Broccoli (clog hazard)

Brussels sprouts (clog hazard)

Cabbage (clog hazard)

Carbonated beverages

Cauliflower

Cheese, some types

Corn (clog hazard)

Cucumber

Dairy products

Dried beans and peas (clog hazard)

Eggs (don't digest in stomach)

Fatty foods

Fish (cooked salmon in small portions may not, nor stink)

Grapes

Green pepper (red and yellow also, clog hazzard)

Melons

Onions (clog hazard)

Peanuts (clog hazard)

Prunes

Radishes

Turnips

Soda and sipping using straws, (drink from glass instead)

Seafood (oh God does it stink!)

 

If your having pancaking issues a small amount of something above (like having a soda during a meal) could introduce some air into your diet and thus into the bag. Also by avoiding too much thickening foods by themselves which often contribute to pancaking.

 

 

[b]Foods That May Help Relieve Gas and Odor[/b]

 

Buttermilk

Cranberry juice

Parsley

Yogurt with active cultures (Greek yogurt)

 

 

[b]Foods That May Cause Diarrhea (looser or more frequent stool)

[/b]

Alcohol (including beer)

Apricots (and stone fruits)

Beans, baked or legumes

Bran

Broccoli

Brussels sprouts

Cabbage

Caffeinated drinks

(especially hot)

Chocolate

Corn (in my experience corn anything doesn't digest in stomach, just passed through and out, kernels/popcorn will clog)

Fried meats, fish, poultry (KFC, supermarket rotisserie chicken very bad, anything soaked in brine)

Fruit juice: apple, grape, orange (small amount okay)

Fruit: fresh, canned, or dried (small amount okay)

Glucose-free foods containing mannitol or

sorbitol

Gum, sugar free

High-fat foods

High-sugar foods

High salt foods (KFC, supermarket rotisserie chicken)

High seasoned foods (blackened)

Licorice

Milk and dairy foods (small amounts okay)

Nuts or seeds (bad, clog hazard)

Peaches (stone fruit, one rarely okay)

Peas

Plums (stone fruit)

Prune juice or prunes

Soup

Spicy foods

Sugar-free substitutes

Tomatoes

Turnip greens/green leafy

vegetables, raw

Wheat/whole grains

Wine

Rice (1/4 cup in mixed in food okay), refried beans (1/4 cup okay) pasta (one cup max).

Any foods soaked in brine or fried (rotisserie chicken, Kentucky fried chicken etc)

 

 

 

[b]Foods That May Cause Diarrhea (looser or more frequent stool)

[/b]

Alcohol (including beer)

Apricots (and stone fruits)

Beans, baked or legumes

Bran

Broccoli

Brussels sprouts

Cabbage

Caffeinated drinks

(especially hot)

Chocolate

Corn (clog hazard, even grits, doesn't digest)

Fried meats, fish poultry

Fruit juice: apple, grape,

orange

Fruit: fresh, canned, or

dried

Glucose-free foods

containing mannitol or

sorbitol

Gum, sugar free

High-fat foods

High-sugar foods

High salty foods

Licorice

Milk and dairy foods

Nuts or seeds

Peaches (stone fruit)

Peas 

Plums (stone fruit)

Prune juice or prunes

Soup

Spicy foods

Sugar-free substitutes

Tomatoes

Turnip greens/green leafy

vegetables, raw

Wheat/whole grains

Wine

Soylent nutritional drink 

 

 

[b]Foods That May Help Thicken Stool

[/b]

Applesauce (unpeeled apples, no cores)

Bananas

Barley (when OK to have

fiber)

Cheese (cheese food may be a clog problem, use real cheese)

Dried Chinese Crispy Noodles (severe thickening, mix with other food that causes diarrhea)

Marshmallows

Oatmeal (when OK to have

fiber)

Pasta (sauces may increase

symptoms) (in my experience more than a cup of pasta causes diarrhea)

Peanut butter, creamy only, nuts clog (makes skin oily)

Potatoes, no skin (skin clogs, more than a cup causes diarrhea)

Pretzels (salty may cause more flow water consumption)

Metamucil, mix or crackers (mix in cup of water and drink before it gells up)

 

I'm adding to this list based upon experience.

Stories of Living Life to the Fullest from Ostomy Advocates I Hollister

Hi Smnard,  Fellow permanent loop ileo here.  The noises are probably caused solely by gas, but could also just be your body getting used to its new normal.  It's early days and things may settle down.  If the gas continues, look at your diet for the culprit, lots of gas producing foods out there.   I eat lots of cruciferous vegies, and things like onions, garlic and beans, all gas producing foods, but also foods that are good for me and I like, so I choose to pay the price.  When it comes to your barrier ring, yes, fit it snugly to your stoma, but not strangling, and when it comes to skin preparation, I always follow what my favourite ostomy nurse taught me, and has worked best for me.  That is 'keep it simple', the best surface for your barrier ring and wafer to stick to is clean dry skin, nothing else, no powders or sprays, just good clean dry skin.  This is if your skin is healthy and intact, no irritation or skin breakdown.  The powders and sprays are meant to address skin damage that makes it difficult for the appliance to adhere properly.  I use a Salts aloe barrier ring and a Hollister appliance, and I get a solid seven days between changes and could even push it further.  If you haven't already, try different products, as again everyone is different, and an appliance that works great for one ostomate, will fail quickly for another, so try them all.  It's worth it to find the system that works best for you and can improve your quality of life.  Good luck.

Terry

I just said to my husband today that I think I might cut the ring and wrap it around my stoma but I was afraid I'd be compromising the integrity of the ring. I'm so glad you just confirmed that is a good idea. Thank you so much! 

This reply is so helpful. 

It's amazing how well rings can seal.  In the beginning, I stretched rings too much.  Tore a few rings into multiple pieces.  But still placed the pieces, overlapping each other,  around my stoma.  At wafer change time, I looked at the sealing side of the removed wafer.  Ring seal was even all the way around with no breaks or leaks.  I use Coloplast Brava rings.  

This is a lot to process. 🥴

Thank you for this!

New stoma can be very noisy...if it is too loud, gently muffle the noise with your hand or use a thick sweater while in the office. I have worked in the land of cubicles, and sometimes my stoma would make a loud honk. No one said a thing, or I would just say I am hungry or my lunch did not agree with my stomach. Nobody knows.

If I'm afraid the barrier ring was not applied correctly, can I redo the whole dressing?

Is it worse for my skin and stoma to change it too much?

My nurse is coming for the first visit tomorrow. Should I wait for her to take it off and redo?

Since my mishap yesterday, I only have 1 more barrier ring and 2 barrier sheets to work with. My first shipment was ordered on 11/08 but has not arrived yet. I have samples coming soon too. I know I prefer Coloplast.

If you’re not having an issue right now, I’d wait for your stoma nurse. If you’re having issues right now, I’d redo it. 

If you're in pain from leakage, then yes.

If not and can wait until the stoma nurse arrives to redo it and teach you, then wait.

Call your stoma nurse and see if she will bring some emergency supplies to hold you over until your shipment arrives.

If not, you can also order from Medical Monks and have them ship it overnight. They don't accept insurance.

As far as frequent bag changes, it's best to ensure a good bonding and seal so you're not running out of supplies, but initially, you might use a lot more at first until you get the hang of things and scabs or wounds heal up.

Usually, one or two wafer changes a day at first and then fewer and fewer until about one wafer every 3-7 days. Usually, around the 7-day mark, it's getting pretty gnarly and despite not leaking, you may just go ahead and get a new one on.

The thing is to ensure you keep inventory and PLENTY of backup stock on hand.

Sometimes you may have a body change or something like making mistakes that you'll go through a wafer a day until you realize what the problem is.

I like Coloplast myself; I don't have any allergic reactions to their products unlike Adapt or Hollister. Plus, I like the Velcro release instead of clips.

Keep asking questions; this is by far the most helpful forum I've seen yet.

Hello S

Four days is way too early; your plumbing is still having a stroke trying to work out what's going on. It should calm down over a few weeks once it finds its way. Don't be concerned, although coffee will probably produce the same results, like spit through a Bugle for me 🤣

I always rip the ring into a ribbon as described and stretch it a little. You want that barrier to be hugging the stoma gently. Any skin between the barrier and the stoma can otherwise get heavily irritated by output. I tried to stretch the barrier ring and not rip it because that's how I was trained by ostomy nurses. However, ostomates online gave me this tip a few months post-op and it changed everything!!! Sometimes you need someone else who lives with a bag to help!

 

I was going to comment and say that a new stoma is super loud! It chills out. When gas comes through, it really tickles my stomach and while it's loud, I can't contain the giggle or smiles. The first month or so, I remember thinking, is there a noise cancellation device for this thing!? It gets better.

My stoma loves to be loud when I eat. I've adapted to playing background music so it's less obvious. In public, at times it may make a strange noise, but no one around us knows that noise. It's more a mental adjustment to this. A trade-off for me of being in the toilet 24/7, and I'll take the awkward moments for that blessing.

 

Feel free to reach out anytime! I do advocacy stuff online right now while I'm dealing with other health issues. So I'm always honored to help anyone, especially in the early days with a stoma.

 

One thing I can say is I was terrified doing my bag change. By 6 months of ostomy life, I got it down. If the stoma moves, prepare for it to spit. You will find some products are perfect for you and then they aren't anymore. That's okay and normal. We all have our own perfect. So my system right now is Coloplast and Hollister products because my sensitive skin reacted to everything else. As our bodies change, our products can too. All the companies are amazing at sending samples. I encourage everyone to reach out to companies with complaints so that they can improve their products. Having the support of others who have ostomy bags of any kind is a tremendous help! So you're doing excellent right now!!! I'm here for you!!!

Yes, it is way too much to process; it takes 5 minutes to scroll down the page. IGGIE