Broken/raw skin

Hi

 

I need help. Output has been getting under my barrier ring and my skin is stripping. It hurts pretty freakin bad. So I did a change out this morning. I washed it with head and shoulders. I wiped it with calamine lotion. I let everything dry for a while. I used a barrier wipe then my ring. It lasted 5 minutes before I could feel something wasn't right. I was already leaking under my wafer. What am I supposed to do?

 

The Ostomy specialist told me to reach out as soon as I am red and sore. He told me not to wait forever to say something. When I emailed him the picture of it he only commented on the skin stripping but nothing else. No direction. I'm so frustrated today. 

Hi S,

  You need to figure out exactly why your barrier is leaking.  When you removed the barrier could you tell where the leak started?  You'll need to tell us what products you're using...........meaning is your barrier flat or convex, are you using a ring around your stoma and what is your skin like in that area..........flat, rounded, are the skin folds or anything preventing the skin from being flat all the way around your stoma?  Also, is your stoma below, even or above skin level?  Sorry to hear your ostomy nurse is a shithead, but the whole ostomy world is a bit of a clusterf&*k, if you know what I mean.  

  As for the irritation itself.............your skin needs a break (obviously), but will heal all by itself if you can keep it dry and not in contact with your output.  I'm hoping your ostomy nurse explained how to 'crust' with stoma powder.  That will help your skin heal, as will a membrane barrier........but you have to get the leaking stopped or nothing will work.  Shout back when you can.

;O)

 

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The above is instructions found in the index  on crusting techniques.  Someone will come on here with lots more advice for you.  

Thank you. I use a flat 2 piece Mio Click drainable bag with a barrier ring. I was fine until I pushed it 3 days when I knew I should have changed it after 2. The skin to the left that looks raw is now 5x worse and wet. The bag I put on this morning didn't feel right and I looked to see, it already had output under the barrier ring on the raw skin. 

My skin has grooves from stretch marks after 4 pregnancies. It's not flat at all. 

I tried a protective sheet but that won't stick either. It just immediately comes off where the skin is raw. 

The Ostomy nurse did not tell me about crusting or anything. He said less is more. 

 

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Hi S that looks like a double barrel stoma with 2 openings and it should,nt be covered maybe, otherwise the skin around looks good.

How to Manage Emotions with LeeAnne Hayden | Hollister

What is the name of the barrier ring? 

Yur stoma nurse is not street stoma smart. The smarts u get from us usually supercedes whatever the nurse tells u going by a book.. not experience

Hi, thank you for helping! It's a loop ileostomy. Double barrel I assume you're correct but I haven't heard that one yet! 

If I don't cover it...I'll spill output everywhere. Lol. 

I figured it was best to come on here for help! 

I use Coloplast barrier ring 2.5mm and the Coloplast Mio Click 2 piece drainable bag. 

I tried crusting but I don't think barrier wipes are all that great. In desperation I went to CVS and got some New Skin-skin tac stuff. I also got rapid dry wound gel to seal the raw areas. I hope those are ok to try. I did order paste last night and I probably won't get that until tomorrow. 

I had to change it twice today because of leakage. 

This picture was from Monday. The raw areas to the left is double the size now and weepy. I used stoma powder on the areas where the skin is stripping. Not sure if that was correct. 

 

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Okay going by the photo it doesn't look like you have a very flat type area around the stoma, in fact it looks like it's on a bulge. I don't know if this is because of the way you took the picture or perhaps could be a hernia nearby. A hernia will need a belt to push it down so you have a flatter area to attach the wafer to your skin. If it's just flub, you may need to use a stoma belt to provide some downward pressure to flatten the area using the wafer. It hooks to the wafer. 

2: Do not use anything that will leave a residue, oil or whatever on the skin. It will cause the adhesive to detach. You can use a lite amount of soap.

3: Better than soap would be a little antibacterial liquid soap as this will kill the infection causing your skin to weep. It may sting a little and feel tight, but it's a lot better than using alcohol or iodine, that's pretty painful.

4: Don't use stoma powder or skin protectant for now crusting doesn't seem to work and always comes off causing leaks. Next use no-sting paste. Not regular cheap alcohol based paste as that will hurt. Paste is good to fill in cracks and provide filler, but the more you use, the more you need to give it time to set up laying on your back or gravity does you in.

5: Use a blow dryer to ensure your skin is very dry around the stoma. If spew gets into the skin, you need to head to the shower etc. and wash it again as it contains oils and makes bonding bad.

6: Dry the skin thoroughly that when you do a dry finger drag test, it feels dry and even perhaps a little chapped and rough to the touch. Not slippery or damp.

7: Make sure you cut your wafer hole to be just a hair slightly larger than your stoma (oval if oval) as it needs to come in and out into the wafer. Test fit it and make marks (I use a dab of paste) on the edges of the wafer flange and your skin for reference marks.

8: Now doing this laying down so you can get some rest and allow the paste to harden. Use the end of the paste tube to put a thick ring size height (about a 1/4" thick or so) ring of paste around the stoma next to it. You do this holding the tube just 1/4" above the skin surface. If the paste does not stick to the skin, you need to remove the paste and start over until it does stick. Wet paste will not stick and later leak so don't bother.

9: Once you have one paste ring around the stoma. Go around the outside of that one with another at the same height. Now you can put more paste to fill in uneven areas but keep it to the second paste ring area on top of that second ring because it's going to squish and you don't want to cover the stoma.

10: Line up your wafer and apply with gentle pressure. Check that the paste doesn't cover the stoma, just ooze s tiny bit around the edges. At least with a two piece you can wipe excessive paste off before applying the bag portion. I use a one piece so I have to be more careful.

11: Press and hold to get the wafer flange adhesive to bind to the skin all around. Apply extra large barrier strips all around and ensure they meet at the bottom..extra cut piece at the top if needed. Don't cover the hook attachments. Blow dry the barrier strips to heat activate and be smooth.

12: Now lay on your back flat and give that paste hours to set up. Why now I do a bag change at night before bedtime and sleep only on my back using pillows under each arm to keep me there. Later on you elevate the upper part of your body in bed as to keep output from pooling around the stoma as it goes in and out and liquid causing a leak.

13: Diet and portion control is important. Some food cause runaway dirrarea and makes putting a bag on difficult. Also filling the bag up at night causing a lot of bathroom trips. To avoid this eat between am and 2 pm. Then only small snacks afterwards. 

14: If the leak burns hurt a lot, it could be on account of coffee. Seems to cause the stomach to flush, thus acid in your bag and much more severe leak burns. Try tea instead. Many of my problems disappeared when I stopped drinking coffee.

15: You can wash a bag while on the toilet using a couple of drops of antibacterial dish soap and a water bottle. Then followed by a rinse where you lay down on your back to get it up around the top to wash. Then a final rinse. The residue soap usually does a good job of reducing future smell.

Read this list of foods for an Ileostomy 

 

[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. Rinse the bag with a water bottle to remove material around stoma, do not try to push as that can cause a leak 

 

 

[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.

Hi Smnard, you say you're using a flat barrier. Have you ever tried a convex barrier ring? I have always leaked pretty quickly with a flat ring. I would recommend trying a convex one. It just might be the game-changer it is for so many of us.

I'm concerned how this stoma looks.

Either it split in half? Or something looks like it's trying to push itself thru..

I might needs glasses. Sorry.

Your skin appears to be better than mine. Pretty clean and clear. U mentioned  an area was irritated. It doesn't go completely around the stoma?

U and shamrock have these folds..or ripples. It makes adhesion difficult.  He is trying paste to fill in the gaps. 

I would suggest that after yur skin heals.

U also gotta step up , Hon.

That stoma nurse u emailed? Be aggressive with him.  Call him out on yur issues. 

Being yur own advocate is part of our new norm. 

Welcome to the site! Glad yur here.  U will be glad too. 

Thank you for this! It sounds like I'll have a hard time using paste. Crusting doesn't work, you are right. 

My stomach is always pouchy and has flub. I saw there is a Mio flip which is for bellies that are round. I wonder if I should ask for a sample. I always have trouble applying the wafer because I'm pouchy. I'm unsure if I have a hernia🥴 but I do use the belt to help support the bag. The weight of it bothers me. 

I purchased some rapid dry wound gel that seems to work good but that was just a test on my arm. I did get spray on band aid stuff but that shit is gonna burn and at this point...maybe I don't even care. 

No matter what I do...output and bile leaks out, spews out, drips out, flows out. Squirts out. I've tried 7 marshmallows before and it didn't even help😔 Even when I do it first thing in the morning before I eat or drink anything. Sometimes I go through a whole roll of paper towels while I'm trying to get the ring warmed up and stretched. I always precut my wafer. Doesn't matter much because I end up going through 4 rings just to get it right. I waste so much because it gets wet and gross just trying to get on a new appliance. I feel hopeless. My husband keeps telling me that I'm changing it too much but he doesn't understand that I can't wear it for more than 2 days because of the wafer/ring break down. 

Your just going to have to put a water proof chair in the tub/shower and after your hot shower, just sit there with the cool water running over your stoma until it stops spewing. Don't eat or drink anything but a little water in your mouth until you get a bag on. Give it one last wash with antibacterial soap before you step out.

Eating applesauce on a near empty stomach a few hours ahead (if possible) will help..to get the stoma to stop spewing  Sometimes it's meds or something your eating causing runaway dirrarea and this makes it about impossible to put a bag on well..just have to sit and wait it out in the shower. 😢 

So when the stoma has finally stopped spewing that you feel confident walking to your bed to put the bag on..then it should be okay. However take a cup to hold against it in case it suddenly spews, head back into the shower until it's done.

I had malnutrition and was getting a runaway dirrarea situation that would last days, it was from this engineered meal in a bottle that was causing it..had to travel 200 miles to a competent hospital that knew how to take care of ileostomy. 

Still it took all night and into the next day before that stoma quieted down enough for them to put a new bag on me. No food or drink the whole time.waiting. Kept me in for an infection but likely saved my life as I was very dehydrated.

So I know how you feel and unfortunately I don't have any experience with protruding skin folds, only inward ones. 

There is a Coloplast star like wafer design that probably is what you need.

Take this body contour test to see what product they recommend.

https://www.coloplast.us/global/ostomy/ostomy-self-assessment-tools/bodycheck/questions-and-results/#/q/1

 

The eating guide in my previous post will help you select what foods to avoid to prevent runaway dirrarea situations.

Also you should try to eat only when you have a good bag on. Between am and about 2 pm so at night the bag doesn't fill up. Small cookie sized snacks only after 2 pm.

The object is to eat small nutritious meals more often this giving you time to have periods of no stoma activity in case you need to do a bag change.

And it appears your rings are not working, neither will paste, if the skin is oily, wet or has been subjected to other products.

Try to use only the paste and ensure it sticks well to very dry clean skin or it won't work. Neither will rings neither. 

Hang in there, you'll master it eventually but it's not going to be easy. 😊 

You may need to visit a competent hospital ER and staff that has experience with otosmy care. I know I had too. They fixed me up right too. Taught me things, my first hospital didn't do squat. 

You have my deepest sympathy. 😔