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I Really Need Help with Ileostomy.

Posts:15
 

Hoping someone out there can give me some words of wisdom. I had an ileostomy done 2 1/2 years ago due to Crohn's and my colon exploding in seventeen different biopsied pieces. I had a very good outlook after a colonoscopy, mainly because I was no longer in awful pain 24/7. However, my great mood has slowly turned into a very depressed (even though I fight it) and angry mood. I have continuously had leaking problems. I have talked to my doctor, and he sends me to the ostomy nurse at the hospital, and even though I like her, I feel she must be on Hollister's payroll. I have tried every Hollister item that they have, but I still have major leaks. Every night, and if I'm lucky enough to wake in the morning with a dry bed, I hold my breath for the day leak. Anyway, now I feel that no flange will stay on because I have so much scar tissue from the leaks eating my "very sensitive skin" (even though I've used the wipes, the paste, the powder, the glue, tape.....nothing helps to keep them on). I've come to the conclusion that stapling them on wouldn't even work. Yep, I've even tried the "paper" flange, and that thing ate my skin worse than the others. Because I have too many sores every time I have to change my seal, I sit on the potty (backwards) (ain't that a visual) for an hour or two just pouring hot water over the area to get it clean and to stop the bleeding of the new tears. If I used alcohol to clean it, I would probably beat a hole in the wall. Does anyone know of ANY product out there that I could use? I'm even game for a rubber tubing and strapping a bottle on my leg. I really need something that will not eat my skin up like this. Thanks for listening, Sandi.

 
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Hi sandib: I have been going though the same episode with my skin and stoma.My ET nurse has instructed me to use calamine lotion on the skin that is irritated. Just make sure that the lotion is dry before butting on the flange.(perhaps these are ulcers), also make sure the sore area is dry or as dry as it can be before you put the lotion on . And this takes some time . also make sure that the opening in the flange is the right size , very important. As for the stoma she has used a silver stick to kill off the ulcers on my stoma. I to had started to doubt my faith, its stressful. I even have cut the adhesive around the flange off before putting it on . In 04 when I was having problems they sent me to a dermatologist,he said I might have a reaction to one of the paste.also stop using the wipes just water to clean the area. do you use a belt . (I mean for your stoma not a belt of whiskey,although not a bad idea. Just some idea's , and good luck keep us posted. bostomy
Posts:18
 
Hello sandi

So sorry you have these problems. I've had the same experience with leakages. I was told the ulcers on my tummy where the flange sits was Ulcerative colitis on the outside. I didn't know that could happen and thought when I got my Ileostomy that was the end of U.C. I was back on the steroids till it went.. I still get very sore skin sometimes from leaking.

Impending leakages when you are out or when at home with guests (even close friends) is constant and very real.

Yes, you feel down about it ... I do, some days you wonder what it's all about. You say you have a good husband, so do I... but at the end of the day... it helps to talk to someone who is going through the same situation. I had my first Ileostomy operation three months before I got married. I remember laying in the hospital thinking 'he won't want to marry me now (especially as I have other health problems) but he did! Bless!
Three years of my stoma nurse trying different makes of appliances, I eventually phoned the ConvaTec helpline and the girl at the other end of the line was fantastic. ( I'm in England but guess they have the same thing near you.) She sent me samples of two piece appliances and this last year, although I still have problems it's not nearly as bad. From 3or4 changes a day I can now go 24hours without changing. I also find the skin protect spray helps put a film between my skin and the flange.
Do hope you manage to find the best for you. As bostomy says...keep us posted.
Whoa
Nurse
Posts:139
 
Sandib
Yikes, you are really having a time with it all!

I'm guessing you are fairly savvy about your stoma and skin care since you have had your ileostomy a while.  Not sure if leakage is something suddenly new.  

I'm not looking at you or your stoma, don't know your insurance issues, but you need containment...and fast.  Check your skin:  If it is raw only in the leak areas, then it is probably a matter of filling in the gaps in your skin to get a seal.  If this is the case, I would recommend:

Appliance:  Call Convatec 1-800-422-8811 , order their convex wafer (or ask for samples) in your stoma size with corresponding pouch, Eakins seal and belt.  Hopefully you have some Stomahesive or Karaya powder and either No Sting Skin Prep (Smith and Nephew) or 3M Cavilon.  (I would advise the one piece Active Life convex drainable pouch IF it has belt loops, you can check with Convatec, but think it doesn't have the belt loops.  the skin barrier portion is even larger on the one piece and a bit deeper convexity.)

Clean you skin with warm water and pat or blow dry on cool.  Stretch an Eakins seal over the back of the sticky side wafer.  Use another Eakins and pull off 2 pieces about 3/4" long, place  one strip on top of the Eakins already on the wafer at 3 o'clock position and 9 o'clock position .  
Apply a small amount of Karaya or stomahesive powder on any raw, moist skin, dust off all excess powder.  Dab either Cavilon or No Sting
Skin Prep over the areas where powder stuck to skin to seal it in.  Let dry, then apply your wafer/pouch/belt.  Belt should be somewhat tight enough to pull the appliance towards you.  Lay reclining with your hand over skin barrier portion of appliance at least 15 minutes.

You may have to change in 24 hours if your skin is so weepy nothing can adhere for long.  then work up to 2 days, then 3 days.  Don't wait for it to leak, just go ahead and change it more often until your skin clears.

You could try all the above but use a convex Hollister if you have it and their Adapt Rings instead of Eakins.  The convexity on the Convatecs are a bit deeper and more rigid though and sometimes work a bit better.

IF your skin around your stoma is red and weepy and in the perfect shape of either the skin barrier or tape portion....then you most likely have a contact dermatitis from your current appliance.  In that case, I would do the same as outlined above, but  NOT use the Hollister...you need to go into another brand.

I'm not looking at you, so can only make guesses.  Also check your skin and stoma in sitting position when your appliance is off.  If you have dimples at 3 and 9 o'clock, they need to be filled .  Does the stoma get lost in skin folds?  This is where convexity/filllers like Eakins and paste helps as well as a belt.

I would hold off on the paste to prevent burning until your skin simmers down...

Not sure if your stoma is a bud, flush or retracted (an "inny")?  The above should help.  I'd also make sure there if no skin fistula given your history of Crohns...

It would not hurt to see another ostomy RN.  I have been stumped in the past and will ask my peers to see for second opinion....

Please let us know how things go!

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing

 


here is an idea to help get the initial seal simular to whoa`s suggestion.
get one of the wide stretchy belts they sell in the athletic dept at most chain stores ie:walmart
now get a sharp pointy pr of scissors and cut you a hole in the middle of the belt, make it just slightly larger than the ring on the flange that the pouch snaps onto.
when you change your flange put the belt on and work the pouch gently thru the hole, now you can pull the belt tight and fasten the velcro. this will support and hold the flange tightly to your body while leaving the pouch free. i hope this helps some, dont despair.. you will overcome it.
Posts:15
 
Thanks so much to all of you....there are some really great suggestions.  I'll try all of them!!!!  
Only thing with getting a precut flange is that I'm always having to cut it at different sizes.  For some reason the stoma is somethimes real swollen and I have to cut it bigger then usual.  I think this may be some of the leaking problems.  I was told that the stoma swells due to blockages I get quite often.
Wow!!!!!  How simple could it be to suggest a belt!!   No one has ever even brought that up.  What does the belt do, hold the flange tighter on the skin?
Whoa....you mentioned not using the paste.  Are you refering to the stoma paste?  If your referring to glue, I do not use it very often because it is so hard to get off the skin after a few hrs, or even the next day.  But the stoma paste I use along with the Osto-Seal.  That helps the leaking somewhat but only for a 24 hr. period.

Do you know anything about the Nu Hope Non Adhesive Ostomy system? I was reading about it in my Edgepark cataloge.  Was wondering if that system would work better for me.  I guess it is something new because my Osto Nurse said she was not aware of it.

My bleeding isn't caused from ulcers.  The glue on the flange actually tears my skin off where the output has leaked even tho I use the glue remover pads to take the seal off.  Of course after a leak, most of the seal is off the skin anyway.

The calamine lotion sounds like a good idea Bostomy.  Do you know if it's hard to get off of the open skin area?  That seems to be the problem I have with everything I use now.  The flange isn't on long enough by the time I have to change it again, that even the stomahesive powder I use is hard to get off without using an alcohol pad, which usually is something that burns so bad I try not to have to use that.

I really do appreciate all of your suggestions.  I does help to get other ideas from you all.  Thanks so much,,,Sandi

 
You may also want to try and cut your stomal opening always from a sitting or standing position.  The stoma actually has different dimensions than when lying down.  when you cut the opening do what we call the 'starburst' cut severl slits into the wafer about 1/2 inch.  do this at the 3,6, 9 and 12 oclock positions.  What this does is allows the wafer to give a little as the stool is coming out so that you don't push the wafer off as the stoma expands.  Try it.

_________________
RN
Posts:15
 
LRau,,,thanks for that suggestion.  Should I still do that if I have no "stool" as I refer to it.  I only have liquid all the time.  I would even be glad to have the "mush" substance" some people call it.  I'm just wondering if cutting the star burst would help stop the leakage I have if it's just a liquid and not stool.
Posts:733
 
Hi sandib, hope you have been having some luck with fixing the leaking problem.I can totally understand.When this,ileostomy with crohns happened to me in 2004,along with a huge weight loss.....anything and everything I ate and drank came through so fast and all liquid.The poor stoma nurse was at a loss as how to keep a wafer/bag on me for more than a few hrs.And with the output hitting directly on the open wound/skin,"OH MY GOD!!!" Just like I imagine acid would feel like.While in hospital still,they done 16 wafer/bag changes in less than 24hrs...and by the last change.....I was crying before I rang for the nurse,as I knew what was coming.So I begged to be drugged to the eye balls, and only for the look in my eyes did I get it.(you know the look...gimme before I kill you)..My skin was slippery as well as sticky...but oh soooo painfull and the redness.What I am trying to get to here is,what fixed me.Anything with codiene in it...for me, straight codiene, taken for the side-affects of constipation.(check with your doc first).Almost imediately(24hrs) I could see the difference...I now can have what would be classed at a normal stool.AND, I have gained my weight back.AND NO MORE LEAKING!..Not saying it is for everyone, but till you got a fix on the main problem you have now.Stopping the ulceration.........Also, not sure what it is called there,but here its callled 'FRIARS BALSAM'....as they say in the trade,it sticks sh*t to sh*t...Pardon the pun,but it works like a charm...just apply to dry skin in the shape of your wafer and left till sticky/dry to touch,then add wafer, wrap hands around for a sec for the heat to seal the deal...Ok well hope any of whats here can help and wish you all the luck...take it easy ..Tarababy

 
i would try it.  sometimes you can see the stoma getting bigger and then smaller even as the liquids are just coming out.  It is the normal parastaltic movement of the intestines.  I can't be sure, since I cannot see you to assess it, but you could give it a try.  
As far as some of the other advice you got, I agree with the belt.  I always put my ileosotmy patients in convex wafers with a belt and always use either paste or the paste strips by Coloplast.  the Coloplast paste strips do not contain alcohol so that is more comfortable.  They come in a stick for that I pull a hunk off of and then roll it between my hands into a rope or snake.  Just like we did with playdough in elementary school.  If you also have any crevices when you sit you can fill in the crevices with that tool.  Sometimes I have even used a combination of the strip paste then put the tube paste over that.  I cannot tell you why these things work for some and not for others, but it is a matter of trial and error.  

The belt is a must though.  I also like the coloplast belt better than any other, it is easier to hook and is softer than convatec or Hollister belts.  No, I don't work for coloplast....I just like their stuff.  
Call them 1 800 788 0293 and ask for samples.  They too have ostomy nurses that can help and customer service reps that are knowledgeable.  Get all the samples out of them  you can.  Remember, they want your business so they will send you anything.

If you decide on a belt, get with a new one with your monthly order.  It can be thrown in the washer, but always dry flat so it won't stretch out.  You'll have  several of them before you know it.  Always good to have extras.  Wear it all the time, even to bed.

Hope this helps.  Let us know.

_________________
RN
Posts:15
 
tarababy You are so Funny.  Gotta tell ya girl, I read some of your responses in this forman and it's the best medicine for me right now.  You just make me laugh.  Thanks for the info....codein would be good, but that's one drug I can't take among many.  The chrones pain is in remission right now, so I don't have to put up with that right now, Thank you God....and the pain from my sores isn't so awful bad that I need a pain killer.  I find that putting ice in a prophy-manly thing - non ribbed--I can just sit and watch TV with one on each side of my seal and in deadens the pain.  Don't think it's so great for the seal, but sure helps my sores quit burning.

LRau Thank you so much for coloplast phone #.  I did call them and they were VERY NICE., so I don't care if you work for them LOL.  They are going to send me quite a few different items, plus a belt..for free, for me to see which one's work best for me.  I didn't know before talking to her today even what a convex seal was, but now I do.  I probably should have been using that type from the beginning too.  Anyway, I'm hoping that one of the products she sends will help.

I aso called nuhope and they are going to send me a box of the no seal system they have for illeostomy folks.  I had to have my et nurse call her to request them.  The gal at nuhope said that I would pobably still have to use a seal & bag at night tho since my output if so heavy.  I'm not sure that theirs will work during the day either but I'll try them. Sorta scared of that one....seems like it could be TOO much freedom.  
Thanks again you guys.....really appreciate all the suggestions.
Whoa
Nurse
Posts:139
 
Sandib

Yes I meant Paste as in Stomahesive paste, Adapt paste.  Sorry sometimes use the word "glue" interchangeably.

Lots of advice here!  Start with little and add what you need.  

The adhesiveless system:  There was one the market a system called   VPI, I am thinking that Nu Hope may have bought them.   I have used the VPI for a couple patients yearts ago with poor luck containing stool, part of that being they had flush stomas.  It has a better chance of working with a bud stoma.  The bags/parts you wash and re-use.  I'm sure it worked for some or wouldn't still be on the market.  The silicone ring and belt are the features to keep it all in place.  Maybe Nu Hope has made some improvements.  

If you have not used convexity in the past, that and  a filler/washer (coloplast strips, Eakins, Adapt rings, whatever brand) around the stoma and filling creases , adding a belt should help.   I don't advise convexity unless necessary as over long term I have had pt's get skin ulcerations from the pressure of the wafer convexity and belt.  However, containment takes first priority and think this may help you.

I think I picked up you have Crohn's and high output.  It's worth a talk with your MD re: slowing down your gut with medications.  The usual ones: Immodium and Lomotil.  Though usually contraindicated, some of our MDs have been adding a little Metamucil with good results.    Codiene is a good to slow things down but best to try the others first.

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
Posts:15
 
WhoaThanks for that advise.  The Nurse at coloplast did mention that and offered to send another one that I may want to rotate between the two.  I do bleed everytime I change the seal from the base of my stoma so she have some concern regarding that.
I'm not sure what "kind" of stoma I have.  It sticks out about 1/2 to 1". and the base is not flat to my stomach.  There is a crevas.  Man, you must think I'm a total dip do not knowing much about this after 2 1/2 yrs.
But, honestly, I even left the hospital with no information except who to contact to order my supplies. Course, after being in a coma for 3 months, they really didn't tell me much, but they did talk alot to my hubby.  He knew how to clean and change me and did that for 3months after I got home.  then I had the strength and "courage" to try it myself.  
I figured you meant paste instead of glue, but what I didn't know was that your not supposed to put the glue on your skin like a paint job and all over the seal until I read that.  Really feel like I'm getting some good education here.  Thanks alot, Sandi
And by the way.....we tried medimucil but that caused blockage, too much fiber for me.  So he now has me on Levsin which seems to help somewhat.  Still think my food and drink goes straight thru me tho.
Posts:4
 
Sandib,
I've been struggling with finding the perfect system myself.  I've been trying every combination of everything and have a few suggestions for your arsenal.
1) Make sure your clothing isn't too snug.  That's what usually cuases my daytime problems.  2) Taking an Immodium at night. 3) MUST TRY the ostomy fluid absorption products (Cymed's Ilesorb is currently backordered; Parthenon's Par-Sorb; Nu-Hope's Nu-Sorb; there may be others).  These products will take liquid and turn it into mush.  These are awesome.  4) If you don't need the convex, try Cymed's washer.  It isn't a hydrocolloid which tends to cause more issues for me than help but it does provide a thin extra barrier just around your stoma.  Hollister's Adapt rings aren't bad either.  Usually molding 1/2 of a ring works better for me than a whole one.
Posts:15
 
Thanks zosya for your suggestions.  My cloths aren't too tight so that's not a problem.  I'll try the immodium if this new medication doesn't keep working.   It seems to be helping some.  But I WILL check into that absortion stuff.  That's sounds interesting.  The belt I ordered and received seems to help alot but I think I may have it on to tight as the bag fasteners seem to be stressed somewhat and making the mount of the bag fold.  and if I loosen it, it doesn't feel right.  I guess it's just one of those things I have to get used to. Sandi
Posts:19
 
I just wanted to add a quick note to all of these wonderful suggestions and say that I was having similar issues and a local ET nurse suggested the convex flanges and the ostomy belt.....unbelievable, it has made a world of difference for me. I was having to change sometimes two-three times a day and my skin was a mess, now I'm back to changing at "normal" intervals (unless I have an unusual day or a bad seal). I use convex flanges, with tape, eakin seals and an ostomy belt, I only have minor skin irritations now compared to my extremely raw sensitive skin that I was dealing with before.
Good Luck!
Posts:9
 
Hi All,
I have also suffered with some terrible leaks and painful raw skin as a result.  I too have a very watery output most of the time, and get a really 'windy' bag at times.
I have tried several different types of one piece systems.  My stoma was made quite cental and low and the stoma nurse said it was more 'flush' to my body than most so to be prepared for leaks  
As expected, once home boy did they begin......2 years on and I have found the solution for me.  The convex flange bags didn't stay put on me and peeled off on the inner side next to my scar.  The best option for me is now a two-piece system, and the only reason behind this I believe is that the flanges are much more stickier.  I supposed they are designed to stay stuck on for 3 days?   I change the front part every day and I'm able to clearly see that it is still firmly stuck on me too, so I get the confidence I need to carry on with the day.  Forgot to say that I use Cavilon barrier wipes too, this has healed my raw skin quickly.  Hope this helps anyone else in a similar position         The two-piece system was recommended to me by gman on this site, I thank him greatly for suggesting it and would like to say the people I've met on here have made a big difference to me
Take care
Michelle x
Posts:2
 
I too have been struggling with raw irritated skin for many years.  I lead a very active life and have come to accept it as part and parcel of all the negative things associated with this situation.  I am by nature an optomistic individual and will continue to work through any crap this disease throws at me.  I will not submit.  However, I sure could use some help from time to time.  I'm not used to asking.  HELP!!
Posts:19
 
Mannishboy, you will find lots of great ideas and suggestions for dealing with your current problem in this thread. The knowledge of fellow ostomate's is invaluable and the advice from the ET nurses second to none. Hang in there you will find something that works for you, and when you really get frustrated just remember the alternative, the many years of pain and suffering you went through before having the surgery. I often have skin issues and leaky bags and ruined sheets and clothing, but I write all that off to minor inconvenience's when I look at how healthy I am now compared to seven years ago before my first surgery. The raw stingy skin and all of the other irritations that come with my dear friend baggy are only hiccups compared to the 10 years of suffering I did before I my "sidekick" was added. You will find something that works for you, it will take some time but there is always some type of solution.

 
Sandi, (and everyone else who get leaks)

I had a terrible time when I went from a temp. ileostomy to permanent. My skin is so sensitive that when I went to an allergist they used the term "dermographic", meaning I can drag my fingernails down my skin and will welt up. One weekend a few years ago I had so many leaks because my skin was weeping. I went through over a dozen appliances in less than twelve hours. Eeek!

I called my Doctor on a Saturday and this is the advice I got, which helped immensely:

Use Maalox dabbed onto cotton balls to coat the area that is irritated and let it dry. I used a hair dryer on low to dry it faster. Then use a skin barrier ( Coloplast item #3210) between your appliance and your skin.


I have tried all the powders, pastes, etc., and none of them would work on my skin. I use the Convatec Sur-fit Natura flange. However, if it touches my skin at all then I itch, then weep and all goes downhill. So I use the Coloplast barrier and never have any problems. I cruise a few ostomy type forums and am amazed at how many people get leaks. I have to say that I am very active and am a mechanic for a living and the thought of leaking never enters my mind.


I hope that you find relief. Get your skin healed up and try the Coloplast skin barrier to see if they help you.



*Note: I do not work for Coloplast in any way. These barriers just work so well for me that I have to spread the word
Posts:8
 
Sandie,
I am new here and I am going through the same exact thing. Im scared to sleep in my bed.... Hubby is coming home from the Army and I am terrified of sleeping in our bed. I see the ostomy nurse everyweek it seems like. So I dont have any advice on that, however I am alergic to some of the tapes and adhesives and my skin after being out of surgery 3 wks ago, the home health nurse brough out a product to me that might help you. Its to help your skin heal and its soothing.....Its called "Duo Derm" after wearing it for 4 days my skin is looking so much better. Best of luck to you & Godbless.
Posts:75
 
Hi I thought once the colon is removed th UC is gone? Did not know this can cause skin problems por other problems?
Whoa
Nurse
Posts:139
 
True, most often the skin manifestations that some folks get with ulcerative colitis usually vanish once the diseased colon is removed.  There are documented cases of pyoderma gangrenosum even with the colon gone.    I have had patients that had persistant skin ulcerations post surgery, not related to stool leaking. Occasionally Crohns and UC can be difficult to distinguish.  I think it is important to get follow up for any lesions or ulcers.

If there are ulcerations, I would recommend having an ostomy nurse check.  If he/she can't make sense of it, then I would recommend a good dermatologist , skin biopsy, and bring an extra appliance so you can take everything off for show and tell.  (You would be amazed that I have sent folks into the dermatologist for peristomal ulcers and the doctor never asked the person to remove the appliance !!)   It would also be a good idea to let the gastrointestinal specialist or surgeon know what is going on.

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing

 


Hi my nurse told me to eat a banana or creamy peanutbutter and saltine crackers to thicken up the output and it seems to work for me, have u tried that.  
Posts:110
 
Hey SandiB, gosh your getting good tips and advice from all corners here lass, so you have to forgive, but i'm going to have to throw another wee tip by you, soz lass. Armywifemom briefly touched upon a wee gem "Duoderm" or Tegaderm as we call it over here.

I can't remember if i answered a similar question on this forum or another one (goldfish brain lol), it was a question on how to treat peristomal ulcers/weeping skin effectively. I will copy it straight from my Info Diary if i may, it may be of use it may not, but hey...

"Regardless if peristomal ulcers are formed due to mechanical or chemical breakdown of the skin, they present a challenging situation for any ostomate. It is nessesary to dress the wound, manage the weepage that they produce and still enable the use of an effective pouching system.

Because weepage from the ulcer interferes with the effectiveness of the adhesive flange, you have to manage them in a way to still maintain security and extended pouch wear, to do this use a calcium agnite dressing, they are ideal for the management of constant weeping. Calcium agnite dressings can hold up to 20 times their weight in body fluids resulting in less frequent pouch changes than other gauzes.

A sacrel shaped(round) transparent adhesive dressing needs to be used to secure the agnite dressing in place. This also protects the ulcer from bacteria and environmental contaminants. The transparent dressing also provides a dry surface to enable your pouch to adhere effectively.

Depending on the amount of weepage produced this system can be used effectively for up to 3 days before replacing.

This system of dressing peristomal ulcers is highly effective and studies have shown by changing the dressings every 2-3 days you can reduce peristmal ulcers by up to 2/3rds of most cases 6 weeks whist still maintain security and effective pouch wear. Further use of the dressings will eventually heal it altogether.

Peristomal skin problems can be managed effectively if they are diagnosed and treated effectively, however there are many ostomates that either have allergies or are sensitised to certain products used for managing your stoma and peristomal skin, after doing a patch test you discover that you can't use any of the products mentioned, then for anything other than managing excessive weeping And fungal infections, temporarily using a gauze and some sacrel shaped(round) transparent adhesive dressing until symptoms have died down will aid the healing process until effective treatment is sought.

Sacrel shaped Tegaderm and Duoderm are suitable for such transparent dressings."

So a wee tip there for you to think about, take care Sandi.x
Posts:110
 
Actually now we are on the subject, i'll just go ahead and post all i have on taking extra care to prevent further trauma to the peristomal skin.  Here is a few tips on how to best achieve this, directly from a colorectal surgeon that specialises in pediatrics......Hope it is of use to all with peristomal skin problems.x

When an ostomy appliance needs to be replaced, care must be taken to avoid damaging the peristomal skin during pouch removal. A soft cloth dampened with warm water should be used to loosen the barrier adhesive. Soap, which contains surfactants, may be helpful to decrease the amount of friction required to remove a particularly adherent barrier from the skin without trauma. The soiled pouch should be removed by gently pushing down on the skin to separate it from the wafer while lifting up on the pouch.

Adhesive removers, often used to minimize traumatic pouch removal should not be used.
Skin reactions consistent with chemical breakdown occurring after exposure to petroleum distillates, an ingredient contained in adhesive removers.
Furthermore, adhesive removers contain alcohol, which is well documented as causing topical and systemic effects including skin blistering, burns and ulcers.

Use of adhesive remover should be limited to situations in which adhesives are so bonded to the skin that it cannot be removed without risking damage to the fragile epidermis.
After application, the skin should be thoroughly washed and rinsed to remove any chemical residue. Pectin remaining on the skin after pouch removal should not interfere with pouch adherence and unless you are allergic to Pectin, is not damaging to the skin, so it need not be vigorously removed.

Peristomal skin should be gently cleansed with water between pouch applications. The use of soap is discouraged because any residue left under the barrier could cause chemical dermatitis. If soap is used, it should be a pH neutral soap without antibacterial or deodorant additives and it should be thoroughly rinsed from the skin before pouch reapplication.
Alkaline soaps may disrupt the acid mantle of the skin for up to 7 days thereby crippling an important barrier to infection. Soaps containing moisturizers should be avoided because they will interfere with pouch adherence.

Commercial infant wipes are lanolin based and most contain alcohol, and thus they are not suitable for cleansing peristomal skin.
Skin barrier wipes or skin sealants are plasticizing agents applied to the skin to create a barrier. They can protect skin from the corrosive effect of stool and are used effectively.
Skin sealants are sometimes used by ostomates to protect peristomal skin from epidermal stripping, which may occur during pouch removal.

Currently, the only alcohol free skin sealant on the market is Cavilon No Sting Barrier Film sold by 3M. This product consists of hexamethyldisoloxane, acrylate copolymer, and polyphenylmethylsiloxane. (( i think whoa suggested another no-sting product also))

Cavilon as a protective barrier beneath transparent semipermeable adhesive dressings used to secure intravenous cannulations on newborns showed a significant decrease in epidermal stripping without adverse effect on skin integrity after removal of the dressing and barrier film

If a barrier wipe must be used only an alcohol free sealant should be used and it should be allowed to dry thoroughly to allow any chemical component to evaporate before pouch application. The addition of a supplimental barrier under the flange may improve wear time.
Several pectin based moldable barriers and caulking strips are available that are able to withstand exposure to corrosive effluent. They can be shaped and trimmed to fit around any stoma for added protection against tunneling of effluent under the pouch.

Karaya should never be used because it releases acetic acid when it comes in contact with moisture and may burn the skin.

Use of adhesive is discouraged if you have peristomal skin problems to prevent epidermal stripping with removal. Generally, the pectin will bond with the skin and maintain an adequate pouch seal. However, a pouch incorporating a gentle adhesive tape around the flange may prolong pouch life if the edges of the skin barrier loosen with continued exposure to moisture.

Pouching systems in which the hydrocolloid barrier is available separate from the pouch but does not include a plastic flange greatly reduce trauma due to fewer changes of the flange.

Hydrocolloid skin barriers are flexible and will melt and mold around the stoma without causing damage provided the opening is not smaller than the stoma. A finger should be run around the cut edge of the barrier to smooth the rough edges before pouch application.

Uneven skin surfaces caused by incisions, skin creases, and other obstacles should be leveled before pouch application. A peristomal surface that is flat will provide the most effective pouching surface.
Skin barrier pastes are used to protect peristomal skin from effluent and to create a level pouching surface, they should be avoided because of their alcohol content. They may also contain formaldehyde, although in quantities small enough to avoid being listed in the ingredients.

A noncommercial, alcohol free paste can be created by mixing skin barrier powder and glycerin.
The ingredients are mixed in proportions to achieve the consistency of toothpaste and then applied with a syringe. Without alcohol as a preservative, however, this mixture will quickly harden. Small amounts should be mixed for one time use only.
When other options fail and commercial paste is required to keep a pouch in place, a low-alcohol paste should be used. Paste should be applied to the barrier with a syringe to minimize the amount used, and it should be applied only in areas where adhesion is most problematic. The paste should be . allowed to air out at least 1 minute to maximize evaporation of the alcohol before pouch application.
Any skin barrier paste, however, including noncommercial paste, should be used with caution. The bond created between the skin and the pouch may be greater than the bond between the skin layers and may strip the epidermis when removed. Paste should be used only when other op- tions to increase pouch wear time have been ex- hausted.

Fungal infections, which can proliferate in the warm, moist environment beneath the barrier and erode the skin, can be treated with nystatin powder applied to the involved area, with excess being gently brushed away before pouching. Alternatively, the powder can be mixed with water, painted over the involved area, and allowed to dry before reapplying the pouch.

To ensure dryness of the peristomal skin before pouch application, a skin barrier powder can be applied to weepy areas prior to pouching to absorb moisture and protect the peristomal skin. Skin barrier powders are alcohol free and safe to use.

When applying skin barrier powder . Only the minimum amount of powder needed to seal the eroded area of skin should be used, and excess powder should be gently wiped away. If the use of antifungal or skin barrier powders limit pouch adhesion, they can be sealed by patting the powder with a damp finger and allowing the area to dry. Any areas continuing to weep should be retreated with barrier powder in like manner until the weepage is contained.

Pouch adhesion may be limited by liquid effluent pooling around the stoma and degrading the barrier. This situation is especially problematic with ileostomies.
Measures should be taken to wick the liquid stool away from the stoma. Gel crystals that absorb liquid several times their weight, similar to the product in disposable diapers, are commercially available and can be used in pouches. An easy, inexpensive, noncommercial method of wicking away liquid effluent is to place cotton balls within the pouch.

After leveling the pouching surface, ensuring that the peristomal skin is completely dry, and applying the pouch, the barrier should be warmed. This can be accomplished by placing a hand over the barrier for 1 or 2 minutes after pouch application.
The importance of this step should not be minimized. Warming the barrier allows it to mold to the contours of the abdomen and increases adhesion of the barrier to the skin, improving wear time. Heating the barrier under a hairdryer is discouraged because the amount of heat absorbed into the wafer is not controllable and an overheated barrier can easily burn fragile skin.

It is always preferable to pouch a stoma to protect the peristomal skin from injury, particularly with an ileostomy. Sometimes, though, despite the best pouching system, pouches will not adhere to the abdomen. The peristomal skin must be protected from effluent by an occlusive barrier ointment such as petrolatum or zinc oxide. If the skin is denuded and oozing, however, these products will not adhere.
A skin barrier powder can be applied to denuded areas, followed by liberal application of a protective ointment. Alternatively, the powder and ointment can be mixed together and applied to the excoriated skin. barrier ointments are available that will adhere to severely denuded skin and may be helpful to protect the skin from caustic effluent.

The ointment does not need to be removed from the skin, routine removal may traumatize the skin. Covering the ointment with a layer of petrolatum or petroleum impregnated gauze will allow easy cleaning of effluent from the skin without removing the protective barrier ointment.

Finally, fluffed gauze or a diaper can be placed around the stoma to absorb waste.
Every effort should be made to develop a pouching system that uses as few products as possible.
Gus
Posts:552
 
Can I just ask how its all going,,and have you soved the problem. I get leaks now and then but they usually come along when its really hot weather or I amdoing physical stuff. Other than that every 4 or 5 days I change the flange and bag and I use a gluem remover wiper to break the seal on the glue. Never had a tear in the last 3 years or with the first Ileosotomy. I truly hope everything is improving,, nothing would give me the sh*ts more than always having leaks. Well nothing other than an ileosotomy lol
Posts:8
 
Hi,
I tried the Dermacol collar and haven't looked back.
The collar flexes and expands with the stoma and prevents leakage for me, for several days.
I only recently had an ileostomy march 2009 and am so glad some one came up with the better technology.

cheers,
Morpheus
Posts:2
 
hi sandib,
   i have ieostomy too just 3 weeks ago. I am using the Mary's Twin from B/Braun. I think its french made and it works wonder for me. they also have this filler paste to put on small crevices where the leak usually start.
mine always leak near the belly button so we put paste near that area. Hope it helps.
Posts:48
 
Hey everyone,

After reading what you all deal, with I feel very fortunate and blessed to have a colostomy, so no leakage.

I have been leaving info all over this site about colo-majic flushable liners.  No, I don't work for them or own stock.  I am so happy to have found them...my life is so much easier.  When you use the liners no stool can leak under the flange, because it never comes into contact with the flange or your body.  It goes directly into the liner and when you are ready simply remove it and flush.  Even if you don't want to use them regularly (although I don't see why you wouldn't want to)  you could use them while your skin heals. I use the closed-end pouch which lasts me about 2 to 4 days, depending how well it holds up from the use.  It never gets soiled.  if you have to pay for your pouches you can save a lot of money using them.

Google colo-majic flushable liners and get samples from the distributers to see if they work for you.  I got mine from C&M Ostomy supplies because they cost $63 for 300, rather than $65 like the other distributers.  The price includes shipping.

I'd be interested to know how they work with ileostomies.

Live well everyone
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