Stoma Barrier Cutting Anxiety: Seeking Advice

Probably seems trivial to most of you but at 3 months post-op I still get some anxiety over whether my barrier is cut right as I have an odd-shaped stoma, not oval or circular. I worry, is it cut too large or too small. Most info is 1/8 inch of skin showing but that 1/8 inch of skin gets red and sore. Just recently I had a stoma nurse say she cuts it with no skin showing. If it is cut too small, can it hurt the stoma? I mean just slightly, not where it binds it. Or is 1/8 inch best? That really is about the only issue I have that causes me apprehension when changing my appliance. BTW, I have a colostomy. Thanks for all your input. All of you have been very helpful and encouraging to me with my previous post.

My colostomy sits even with my skin. So it doesn't stick out like others. But I also use an oval-shaped cut on my wafers. Just measure it if you can. And if nothing works, maybe see your doctor and see what they suggest for a cutting measurement.

Hello Teebull.

Your question is not at all trivial.
Having tried all sorts of different approaches to this problem, I am very interested in what other people do with regard to cutting and fitting wafers.
Some solutions (like Demacol stoma collars) are great for perfectly round stomas, but would not be so for odd shapes.
I could not get on with the various 'padding' compounds , but they would probably be a lot better at stopping soreness. 
Eventually I gave up on manufactured items and designed my own baseplates with a hole to fit my stoma precisely. I the simply stick the manufactured devices to those and cut the hole out with a craft blade. I've not had any problems since and the Bags/sleeves last months.
To get a template for the precise shape of the stoma can be difficult because we cannot see all the way around it . However, I resolved that problem by making a plaster cast of the area. This cast can then be used over and over as a template for whatever else I want to experiment with.

It is my contention that their should be a bespoke fitting and manufacturing service for people with stomas, who have difficulty adjusting to the manufacturer's gear. 

I hope you find a solution soon
Best wishes
Bill  

I cut it slightly smaller than my stoma, so the skin is covered. The cut edge can cut into the stoma, but just keep an eye out for any injury and adjust as necessary. It's no big deal to get a small nick on the stoma, but you obviously don't want to see a huge slice. I use a seal as well.

Axl

Mine always shows a little skin. Just depends on how I line it up on whether it's at the top or the bottom. I've had too tight bags on and would literally have a bruise color around my stoma when I'd change. You could always do the 1/8 and then use a barrier ring hanging over the edge just a tad so the barrier ring swells up and makes a tighter deal for ya. Mine does that quite often.

I can relate. I had difficulty, at first, with making a perfect cut. I was told 1/8th inch. This resulted in always having irritated skin around my stoma. Because my stoma is rather oblong, I'd use an ink pen and draw on the bag before cutting. Now, knowing my size ring on the bag, I just cut a perfect circle on the 32 line. I have found, in order to eliminate irritated skin around the stoma, I actually almost stuff my stoma area within the bag - so no skin is exposed. Sometimes I will miss my mark and have a bit of skin showing beneath my stoma - this always results in red irritated skin. When this happens, I use a dab of Remedy Calazime Skin Protectant and it clears up overnight. Jb

Hi Teebull, I have a colostomy and my stoma is kind of oval but at a slant. Lol. I use a 2-piece Coloplast pouching system. I just keep the plastic piece that I peel off the wafer to use as a template for the next wafer. After removing the old wafer and cleaning all real good, I try the new wafer on (with the plastic still on it) my stoma to make sure there is at least 1/8-1/4" all the way around. Make adjustments if needed before peeling off the plastic and putting it on. I do use the Coloplast Brava paste... I put it around the hole in my wafer before putting it on my body.

I hope this all sounds ok. I'm just having my first cup of coffee for the day. LOL

PS Even though I leave more room around my stoma than others, I have never had an issue with irritated skin. Maybe the paste is what is saving me. I change my wafer once a week.

I don't know if a urostomy wafer fitting is different, but I try not to have as little skin as possible showing. My stoma is oval, and at 7 weeks it seems to have shrunk all it's going to shrink. I cut the same oval every time now, but also check it before applying to make sure it fits. My wafer swells like crazy around my stoma, they call it turtle necking. (That was a new term for me)

My surgeon, when I told him what ostomy nurses say, 1/8 inch, he about lost his mind... Snug, he says... No skin showing but not cutting into the stoma. When I first got my stoma, I cut it that way. Then I got a stoma nurse, and she did the 1/8 of an inch and jacked up my skin so royally bad... Then my surgeon, now like I said, was not happy hearing that, lol, and he said I don't leave any gaps/skin showing.

Hi Teebull, I've had an ostomy for 30 some years and have always cut the wafer hole as close to the size of my stoma. Occasionally, the edge of the wafer causes bleeding on the bottom of my stoma, but I just hold some TP on it for a while and it stops.

I cut to the exact size of my stoma, no skin showing. If I'm off even a little bit, I'll get irritated skin in that spot. I too have an ileo and it's an odd shape, sort of misshapen oval. Sometimes there is a little bit of what looks like bruising right at the base of the stoma, but it doesn't seem to be an issue.

Terry

Well, as usual.......it depends. You really want the barrier to hug the stoma as tightly as possible, but the barrier material (hard plastic) is a bit inflexible and can irritate the side of your stoma if too tight. The best solution is to use an ostomy ring under the barrier. Choose a ring that's close in inside diameter, but it doesn't need to be exact. Cut the ring in one place to make it more like a curved piece of rope instead of a ring....and drape it over your stoma with the cut side on top. Then pull up, making sure the ring is tight against the bottom of your stoma. Then continue to pull up each side of the ring, wrapping it tightly around the sides of your stoma. Continue to the top, and if you have excess, just snip it off and connect the two ends of the ring back onto itself. If you come up a little short just pull gently on each side until you have enough. The top of your stoma sees the least amount of output, unless you're a vampire and sleep hanging from a tree, but tuck that area of the ring in good too. Your stoma is now sealed. With the ring tightly up against your stoma it really doesn't matter if you leave a gap around your stoma with the hole you cut in your barrier. Just make sure that after you apply the barrier you come back and press the barrier hole tightly to the ring underneath it........and you're golden. The ring is much easier on your stoma and won't cause any bleeding, and you can pull it tightly against the stoma to seal out the bad stuff......something you really can't do with the barrier alone. Not sure how long you leave your barrier on before changing it, but the ring should be good for at least 4 days, probably longer. This way there's no more leaks, you don't abrade the stoma with the hard plastic of the barrier, and the size hole you cut in your barrier isn't critical. Rings.........go get ya some!!

;O)

I have a couple of suggestions. I use pre-cut barriers. Yes, there is a small gap and the barrier needs to be centered. One day, I was off-center and had skin irritation. I have found if I use a thin wafer around the edge of my stoma, I eliminated my problems. I cut it and place it fairly close to the stoma. I understand there are no problems with the wafers being too close. Then I place my barrier on top of the wafer. I do not have to be accurate with the barrier. Pre-cut barriers are wonderful! It saves time and solves the problem of being too big or too small. I use Hollister products. The gentleman about uses wafers too. Good luck!

Hi Teebull. I have an ileostomy, but the situation would be similar. There are appliance brands out there that have moldable rings in the wafer that you can shape with your fingers around your stoma to allow for adequate coverage without cutting into it. I am fortunate that my stoma is round and my brand sends me a pre-sized wafer. Check out Convatec brand.

Bob,

Thanks for the detailed info. Sadly, I have used a couple of different rings and used some as strips to fill in my dip below my stoma that is a highway for stool right to my belly button. I have tried so many different combinations and lack thereof but continue to get leaks due to the dip in my skin. So I know if the wafer is cut a bit big, the ring should stop leaks but to no avail here. I am trying a Sensura flip bag now without the rings to see if it works. It has been 2 whole days lasting fine. But hoping the closer I cut to my stoma it won't leak or irritate my skin. I guess it's just a trial and error. Thanks 30Bob everyone!

Just use the Adapt Stoma Paste out of a tube and squeeze it around the stoma instead of a seal, then put the bag on.

I would recommend stoma paste. After you put the wafer on, you can fill in the cracks with the paste. It then becomes mostly hard and will also cover any rough cut edges of the wafer.

I use an Adapt barrier ring. I mold it by pressing my fingers along the flat of the ring and forming it to fit flush against the stoma, which is no problem because the adhesive cannot stick against the mucus of the stoma. Then I place the wafer on top with a 1/8 inch gap and push it down so it seals. This creates a reliable seal and does not injure the stoma.

Thank you again, everyone!

Hi Tee,

Hey, before you go away... I'd like to better understand your issue... in case I ever have to deal with something like that. So if you are using a ring with your barrier and still getting leaks... where exactly is the leak occurring? Is your output getting in between the ring and your stoma and then getting under the ring... or is it leaking through where your barrier and ring meet?

Because technically, if your stoma is sealed with the ring, and the ring is sealed to your barrier... you don't really need any adhesive under your barrier, as long as it sticks to the ring. For example, when I got my revision a couple weeks ago now, they didn't have to move my stoma, just remove all the morphed mess of skin I had around it. Where everyone else has a 'rosebud', I didn't. The skin around my stoma melded with the stoma so there was no division between my stoma and my skin... it just looked like my skin had a small hole in it. Yeah weird, I know. Doc says it happens to about 60% of ostomates... but who knows. Anyway, when the Doc cut away all that troubled skin around my stoma there was now a big gap around my stoma where all that ugly skin used to be. So he sliced and diced and pulled the skin in that area tight up to my stoma and stitched it. Think face lift on your abs. But now I got an incision about 4 or 5 inches long that runs from the bottom of my stoma down. And that means my ring and my barrier cover part of that incision. Not a big deal, except my incision got infected and made a real mess. Now I need to let the incision drain, but I also need to cover the top part of it with my ring and barrier, or my output would flow right into my incision... which would not make Bob a happy camper. The infection caused my skin on both sides of the incision to swell and lift, so I popped most of the stitches the good Doc put in, and the whole thing is one uneven mess.

So because I need access to the incision to wick out the pus and garbage the infection generates... but also have to seal my stoma to keep my crap out of my incision... I cut off the bottom of the barrier, leaving just enough material to cover the ring on the bottom. So the bandage part of the barrier, with the adhesive on it is now gone on the bottom part of the barrier. The only thing holding it all to me is the barrier ring's adhesion to both my skin and the barrier. And I've not had one leak yet and I've worn it as long as 4 days. Could have kept going, but wanted to give my skin a break and really clean the top of the incision. So if I can get my barrier to seal on the really uneven skin of my incision... I'm thinking you could too. Lately I've been squirting a dab of Adapt paste right at the intersection of the stoma and my incision, but that's just for peace of mind at this point. I don't even wear a belt!

I'd post a pic of my incision and how I do all this... but I think people would lose their lunch if they looked, as it's not pretty. But it works. So unless you have some really huge changes in the topography of your skin... I'm not understanding why it won't work for you. But it depends where you actually get your leak... which is why I'm curious.

;O)

Like you, I used to cut my wafer a tiny bit bigger than the base of my stoma. When I cut it to the base of the stoma, if I was working bending and stretching in the garden, I often got pinching of the base of the stoma. I would use Safe N Simple peristomal wipes, and they did help soothe irritated skin though.

But hallelujah, Convatec came out with their Natura Durahesive MOLDABLE barriers, and I use them exclusively now. No cutting at all. Before placing over your stoma, just stretch the waxy wafer part, place over your stoma, and that is it. The wafer gently acts like a turtleneck and rolls back part-way up the base of the stoma. Great skin now. I can get 5 - 7 days before changing everything again. It might be worth your requesting samples.

My stoma has a giant hernia around/under it. I can't get the right fit ever. Lying down, the stoma is almost half the size it is when I am standing. If I apply that size, then the edges won't stick because the stoma is oozing on it the minute I stand up. If I fit it to the stoma while standing, then I wind up with a lot of skin showing and it gets very irritated. Plus, either way I do it, it never sticks well at all. I am incredibly frustrated. All of the manufacturers have made suggestions that relate to their products, of course, but so far nothing really works.

Hello Patti O.

I do feel for you in your frustration. It is understandable that  the manufacturers' relate problems to their own products as they have a profit motive which underpins much of the existence.

Eventually, I gave up with trying to get solution via manufacturers and decided to make my own baseplates to suit my own body shape ( including hernias|). The manufacturer's devices still stick to my baseplates and last much longer than they might do if they were used as they were designed for. Nearly all the early problems I had were to do with how the wafers/baseplate would not fit and stick effectively to my skin/body. My 'common sense' tells me that when all else fails I have to 'do it myself'. 
Since I've been using (& tweaking) my own devices, I've had virtually no problems.
Every individual tends to be slightly different to every other, so there is no 'one-size-fits-all' solution to these problems. I have put a picture of what I have used for the past years on my profile to give you some idea of what is possible. However, I suspect that you will need to work out for yourself what you need to resolve you own difficulties.

I wish you luck in your experimentation and endeavours.

Best wishes

Bill