Wafer belt tabs

I had a ileostomy 4 weeks ago.  I'm using a convex wafer and I'm experiencing  pain at the top and bottom of it. It pushes in and hurts.  Can anyone give me some ideas how to stop this or explain why it is happening?

Hi welcome. The  more experienced will chime in. I understand u have ileo..and use convx type wafer.

Is your stoma flush to skin? Why are you using the convex and not a flat type wafer?

Just 4 weeks old I'd say some pain will be normal as body adjusts. If it servere, go to E.R. 

Hello,

Why are you using a convex wafer?  Is your stoma too close to skin level?  A stoma not sticking out enough will cause trouble.  Irritating output will get on your skin, instead of dropping into the bag.  

It will take time for you to recover from surgery.  Then more time for your body to get used to your new normal.

If your stoma sticks out at least 3/4 of an inch... there's no need to use a convex wafer.

If your stoma is too close to skin level, revision surgery is needed.  Your stoma can be pulled out to proper length.

If you just got your ileo 4 weeks ago I wouldn't use a convex wafer. Your still healing and that's putting to much pressure around a new stoma. 

My surgery was less than 4 months ago. So I recall being new. My urostomy was skin level so they started me with a convex wafer from the beginning.  It did hurt a little at first but that quickly passed (or I learned to ignore it). By 4 weeks in, I was definitely not still having pain. 

As others have said, it may be you're still healing (everyone is different so your progress may vary from mine.)

Switching to flat may help if your stoma sticks out enough.

Someone here has talked about flexible convex vs hard convex. I actually don't know which brands are flexible but trying a different brand of convex might make a difference.  

Living with Your Ostomy | Hollister

A convex is designed with a bubble around the stoma hole to provide downward pressure (with the help of a belt) around the stoma to force it up and out more and to assist those with belly folds right where the stoma is.

Unfortunately the bubble is often stiff but can be weakened horizontally to fit a little more snuggly in a belly fold.

You shouldn't be feeling any pain from the convex itself, rather you have a leak at the top and bottom and digestive enzymes are eating your skin causing pain.

Convexes are used for near flush stomas and belly folds mainly.

I have the same problem and I don't have a fool proof easy method but can set you on your way.

When cleaning the stoma area in the shower, use liquid antibacterial soap only and after each spewing if it occurs.

Once stoma has quieted down, blow dry the area well. Apply nothing.

Go lay down on your back, have fresh dry toilet paper available to dab up moisture and stoma spew, but if it gets on the skin you have to wash the area with soap again as spew contains oils and will make putting the adhesive paste on impossible. You need clean, dry, oil free skin so the paste will stick.

Cut your wafer hole to match the shape of your stoma and just a tiny hair bigger. Test fit and make marks on flange edge of wafer and your skin to match up to later.

Weaken your wafer bubble horizontally some so it bends and is curved a little bit.

Use no sting paste and mix in a tiny bit of stoma powder to get it to activate. Spread a thin coat around the stoma to about 1/2" out, same size as your convex bubble. Focus on wounds first so to ensure it sticks, if not remove and discard wet paste and blow dry and try again until it does. This method avoids wasting paste, rings and wafers. Use a flat type stick to apply paste as it will stick to fingers and everything else. Wipe off stick using toilet paper and discard.

Dab the stoma, never wipe wet or press hard as the stoma is fragile and will bleed easily, making putting a bag on nearly impossible until it stops bleeding.

Next put two rings of no sting paste around the stoma about 1/3" away from it. Score two groves in the top of the paste rings and put some stoma powder in there and mix it in some.

Peel backing off wafer and apply, gently pressing down and pressing adhesive flange onto the skin and hold. If done right the paste shouldn't be covering the stoma, just appears around the edge of the inside hole.

Apply extra large barrier strips all around centering over the wafer hook area (and under the hooks) and meeting at the bottom. Top can have a small gap you can fill with another cut piece. 

Now you need to wait awhile, even a few hours sometimes, on your back, for that paste to properly set up. If you go vertical too quickly with unset paste it runs out and leaks. Adding stoma powder into the paste will make it set up faster.

After awhile the paste will set up and feel rubbery or hard through the appliance, not soft or squishy. Now apply your belt with a gentle pressure.

Sleep only on your back with the back slightly elevated and a pillow under each arm to train yourself to stay on your back. Rolling on the left side causes blowouts and on the right causes graneoluma because the wafer digs into the skin. It's the belt doing it, why you need to remain sleeping on your back.

Eat only foods that turn into liquid upon exit of your stoma.

 

[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.

Thank you all for the comments.  My stoma is shorter on one side than the other.  It is less than  1/2 inch on the side that is lower.  I tried the flat wafer, but I kept having leaks.  My stoma is in the fold.  The stoma doesn't hurt . . . The pain is on the outside.  It feels like a bruise on the top and bottom. The wafer is 44 mm and hard in the middle and  flexible on the outside.  It is a Hollister 11504 (25 mm stoma). Should I try a larger wafer in diameter?  When I took the Hollister test to determine what type and size it said 44 mm and convex.

You have a leak at the top and bottom caused by the belly fold causing the adhesive of whatever (ring or paste) to separate allowing digestive enzymes to contact the skin. It's painful.

You have the same situation as me with a near flush stoma and a belly fold.

I'm sorry to say this is an extremely difficult situation to resolve and I've been trying for the last year. Sometimes I'll get 5 days out of a bag, sometimes only a day. 😢 

All I can do is pass on what I've learned but you (and I) both need stoma revisions where they pull it out further.

But if you weaken the bubble of the convex that should help some.

ileostomy here (4 years).  My stoma is not flush with skin but at times will retract a bit.  I did have issues with leakage around the bottom of my stoma causing skin issues and irritation.  I tried a convex barrier but it was uncomfortable…what I have found thru trial and error…if something is uncomfortable in terms of our baggage then don’t do it and research alternatives. What I have also learned is a good seal around the stoma helps tremendously….for me, this means assuring the hole around the stoma is a proper cut/fit with no regular skin showing.  An ideal fit with ideal products result in not even remembering you are carrying excess baggage-well maybe, at least there should be no discomfort.…this has been the case for me.  Good luck in your search and you have come to the right site to gather information….remember to use your own good judgment !!!  jb

I don't a convex wafer cause it felt the same as you did.  So i went to the flat wafers and it work great and didn't hurt.

So, you're not cutting the wafer hole manually... you're using a wafer with standard sized holes?  Many stomas are egg shaped.  So a round hole will not work well.  

My stoma is egg shaped.  After cutting my wafer, the hole looks like an egg.  Carefully measure your stoma, looking in a mirror.  Measure top to bottom.  Then side to side.

For reduced leaks and skin irritation, the wafer hole should closely align with stoma shape, all the way around.  You don't want the wafer hole to exactly fit over the stoma.  A small gap should be created while cutting the wafer hole.  This provides a little space for stoma expansion.  Stoma's are always "on the move" because of Peristalsis.

 

There is no reason you can't use a convex appliance if it works for you, I went to one at either two or four weeks but I cannot remember which. It only places a little extra gentle pressure on the skin, just be aware you are still healing around the edge of the stoma. The only issue I see is your stoma is in a fold and the convex base may be too rigid even though they are quite soft.

Thank you so much for sharing. Hope you have a great day.