Seeking Advice for Managing a Challenging Stoma Shape

Hello everyone,

Since English is not my native language, I would like to apologize in advance for any grammatical mistakes.

 

I would like to ask for help taking care of my mom's ileostomy. She has a stoma with, what I consider, a shape made for troubles. Mostly, because her output comes out for a hole located in the side of the stoma AND at skin level. 

I've attached a sketch with the hope of making it clear:

This has taking us to the point with she has a tiny little area of skin located just 0,5 mm (or less) below the exit which is irritated to the point of bleeding. Even if we don't suffer with leaks per se, just because I do not know how to protect this spot SO close by to her output.

We've tried without success both Brava Moldeable Ring (2mm) and Eakin Rings (50mm). Neither of then prevented the output for reach the skin near the exit; in fact, both swelled making keeping clean the stoma more dificult throught the day.

Currently, our daily routine (skipping the steps regarding taking off the previous wafer and washing the stoma) is as follows:

1st.- Apply Powder over the stoma and the surrounding skin, leave it to rest 15-20 secs and blow the excess.
2nd.- Spray a generous amount of Skin Barrier over the stoma and the sorrounding sking. Wait 30-60 secs. In our experience, a single crusting works better than repeat the process two or more times.
3rd.- Appy the wafer cut with the stoma shape in mind AND with a small extra aperture for the stoma's "exit". Then, press with a warm towel for five minutes.

(I have to say that I've learnt everything in amazing communities like this one, for what I'll be forever gratefull).

Anyway, this method allows us to keep almost everthing in great shape with the exception of that tiny area.

I would heartly thank any advice.

Kind regards.

I had the same sort of issue when I initially had a "loop" ileostomy. The skin around the stoma was never able to heal because, of course, it couldn't totally dry. I used the Coloplast Deep Convex one piece appliance. I used the barrier spray 1st, then the powder and topped off with the spray. I quit using the moldable rings because it made things even worse. I did try using the 4x4 skin barriers and cut them to the shape of my stoma (closer than the flange) and big enough for the appliance to stick to IT. During a hospital stay, the nurse talked me out of using it - she said I was defeating the deep convex. 

I hope your mom gets relief... I know I was never able to get the skin completely healed. I had a revision and they removed my colon in June. This time the stoma is above my skin -- a perfect little rosebud :) The skin was healed with 2 months. It feels so much better!

Good luck, Vicki

Hello,

I have an end ileostomy so I am not familiar with loop.  But, why do you change everyday?  My wafer stays on for at least 4-5 days.  

Have you tried to use a product called Duo-Derm?  There are several brands out there but basically it acts as a second skin to which your mom's wafer would stick to. It will allow the area to heal.  If you can get a template made of the exact shape and curvatures of your mom's stoma you could cut out the duo-derm so that it only allows the stoma to be uncovered.

Do you have access to an ET or Stoma Nurse?

I hope your Mom gets relief soon.

Cheers,

Brenda

 

I have not had skin issues at all but my nurse did say use the skin barrier spray and then the powder. I tried the towelettes too but not having any issues, I do not know how well either really works. I do know that using a two piece appliance system really cuts down on the amount of times you change so you irritate the skin much less. I have recently changed to them and only change the flange ever 5 or more days now. Every little thing helps I guess! Good luck in finding what works for your mom.

Puppyluv 

Hello,

I just wanted to add that I was dealing with quite a bit of leaks initially.  I too was using the Brava moldable ring and then switchedto Brava Protective ring (#12035) and it seemed to mostly solve the problem.  I hope this is helpful to you.

 

 

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