New Ileostomy Question on Leakage

Hello all,

I'm three weeks post-ileostomy surgery. Most things are going well: eating, staying hydrated, etc., except I tend to have leakage around the wafer sooner than expected.

 

I'm using a Hollister 2-piece and changing the bag out 2-3 times a day. I cannot roll the bottom of a drainable bag. Anyways, I've been having to change the wafer almost every day. It seems the excrement gets between the paste and wafer, then leaks out.

 

Clean it well, dry it, skin prep/barrier, paste, install, hug it for 30 seconds.

I have started cutting it just big enough to fit without rubbing.

Do I need more paste?

Does my stoma not stick out far enough?

Hello,

Lots to think about with this. I can just give my experience.

A ring will work better than paste in my opinion.

Hollister CeraRing, Adapt ring, etc. They do way better than paste.

A

Hand lotions on your hands can cause problems because they get onto the bag or area.

Some shampoos and conditioners in the shower can cause issues with the seal. The moisturizers in them get into the bag and area in the shower.

What soap are you cleaning your stoma area with? Dial or Ivory with no scent or moisturizers is what I was told by my nurse.

Are you getting all the old adhesive off before applying a new one?

My regimen is:

Take the bag off with an adhesive remover wipe. DO NOT JUST PULL IT OFF!! Go slow so you don't rip the skin. If you rip the skin, it's going to cause issues with the wafer sticking. Get all the buildup of adhesive off of the area around my stoma and where the wafer was with one or two more adhesive remover wipes. Clean the area really well with soap and water on a paper towel, making sure to get all that adhesive remover off. Grab a new paper towel and soap up again if needed, and then rinse with a few more paper towels with water only on them. Repeat a few times with a new paper towel rinsing. Dry the area very, very well before applying new wafers.

Also, are your wafers cut to fit? Or do you cut them yourself? A new stoma will change size, so if the hole is too big or too small, it can cause leaks.

I hope some of this helps, and also, there are lots of YouTube videos on ostomy to help us.

It looks like you're getting a rash a bit from the leaking. Don't let that go on too much longer.

Best if you can get in with a stoma nurse.

Good points by Hibiscus.

Wash hands well with soap that has no fragrance, lotions, or dyes. These chemicals will interfere with wafer adhesion. I use Cetaphil bar soap.

With clean hands, now carefully scrub the peristomal skin around your stoma using the same soap. Be extra careful around stitches. Rinse and pat dry with paper towels. Now use an adhesive remover wipe to carefully remove any residual adhesive remaining around the stoma. Be careful around those stitches. Use a finger, and lightly press the skin down around your stoma. As you pull your finger up, if it feels sticky anywhere, use another remover wipe. Check again.

I use a Hollister 2-piece like you. But I have a colostomy, so much less of a leak problem. Ileostomy is harder to leak-proof.

You might try a moldable barrier ring instead of paste. I use Coloplast Brava moldable ring, 2-inch diameter. You might have to wait until your stitches are removed. You don't want to pull anything out.

The advantage of the ring is you can cut a larger wafer hole. The ring seals against the stoma, and the wafer seals to the ring. You can also add a ring to the top of the wafer, sealing the stoma. This way you have a double seal: a ring under the wafer, and one on top.

Are you using a support belt? Hollister makes a thin elastic belt that clips onto the bag, holding it secure. I wear one every day.

There are also wider support belts. Nu-Hope Corporation makes a variety of belts. Many ostomates put on a belt for an hour or so after a wafer change.

Also, hold the wafer against your stomach on the side opposite your stoma for a minute to warm it up, then remove the plastic backing and fit it onto your stoma.

You can order support belts from your ostomy product supplier.

Instead of paste, try a barrier ring. All the major manufacturers (Coloplast, ConvaTec, Hollister) have barrier rings:

Coloplast: Brava Protective Seals

ConvaTec: Eakin Cohesive Seals

Hollister: Adapt Barrier Rings

If using rings doesn't work, you may need to try a convex barrier or moldable barrier. I recommend getting free samples of each for your experimentation after your stitches are healed.

Hi Tubster,

You have an ileostomy and only change your bags out 2-3 times per day? Not sure why you can't roll up a bag bottom, but we'll save that for another day. How full are your bags when you empty them? I mean, they must be about to burst if you're only changing them 2 or 3 times per day, unless you don't eat. You can't let your output sit around your stoma, like if you sleep on your back, or if your bag is so full that when you grab it to empty it, it pushes the output up and around your stoma. So there's that. And obviously, if you have any gas in the bag and you squeeze it, the gas will be forced between your barrier and your skin, so be mindful of that as well.

Your stoma looks plenty long in the pics... but does it retract at night or when you haven't eaten in some time? You don't want it retracting below the height of the ring and barrier, or output will get between those and your skin. Next, like everyone suggested, try a barrier ring instead of the paste. The paste is junk, as it breaks down very quickly when in contact with liquid output and even the "sweat" from your stoma. When you apply the ring, put it on your skin (not on the back of the barrier) and make sure it fits snug up against your stoma (don't cut the hole in the ring the same size as your stoma, make sure it's a little smaller, so it hugs your stoma well). Even if you decide to stick with using paste, put the paste on your skin around your stoma and then put the barrier over the paste. This is the only way you can be sure the paste seals well to your stoma.

If none of these tips work, then you need to start taking your barrier off BEFORE it starts leaking and see if it gives you any clues why it's leaking and where the leak starts from. Also, as mentioned before, wearing a belt is highly recommended, and keep the belt snug, but not so tight it distorts the barrier. You have what looks like a perfectly normal stoma and surrounding skin, so you shouldn't be experiencing any leaks. Don't let your skin irritation get much worse, or you'll have a lot more problems to deal with. If the leaks don't stop very soon, get in contact with an ostomy nurse, either locally or at Hollister, and let them walk you through what they think the problem is.

Hope this helps,

Bob

;O)

Bob,

Great info, thanks.

The barrier ring, I think, is the next step to try. I cannot roll a bag up because I have a spinal cord injury and my fingers don't have enough "pinch" to roll it up and seal it. I've been changing my bag at 1/3 full to 1/2. I eat three square meals and snacks. I am taking Imodium to keep it from being too watery.

As someone who uses a wheelchair, I have watched myself, and I do think I have a couple of things I do when I go to reach for things that might be pressing my stoma against my thigh. I'm going to keep an extra eye on that too.

You did give me some good info, thanks.

Randy

Thank you, yes I do think the ring might be my next try at something new.

Thanks for your comments.

I think a ring is definitely next.

Hi Randy, welcome to the site. You've got a lot of info to digest, but it's all good. I've found with the barrier rings/seals, the Eakins are easier on the skin, but the Brava seals are more durable but harder to remove when changing the wafer.

Hi!

It looks like you have a good fit around your stoma, and your stoma sticks out far enough, so it's got to be backwash of stool from the bag, up and around the stoma, and getting underneath it.

I used to use paste for years and finally switched to Brava rings…so much better! I also don't use soap of any kind, ever…just warm water…and use skin prep wipes, dry, then I dab on Torbots Skin Tac. Just don't apply it to the area immediately around the stoma on the sutures till they're gone.

So, clean with water only, dry…skin prep, dry…Skin Tac, dry, thin Brava ring, then flange.

Both skin prep and Skin Tac dry quickly.

Oh, and when taking a bag off, make sure you try and secure the base flange down while pulling up on the bag to take it off, so the wafer doesn't come loose with each bag change.