Best Convex Baseplate for Flush Stoma? Need Help to Avoid 3rd Surgery

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rachelle1412
May 18, 2023 10:51 pm

I am looking for opinions on the best convex baseplate for a flush stoma (it also really retracts way below skin level when active)? Or techniques to help the seal? My first surgery was in 2020 and second in 2021 and I've never been able to get a good seal. Output always ends up under the barrier ring on my skin, regardless of ring brand. It leads to leaks past the ring reasonably often. I am quite thin but I don't know if that's a factor. I have predominantly used Coloplast SenSura Mio and have tried other brands, currently trying Hollister New Image. Any tips or suggestions for dealing with a flush stoma? I'm at a loss and about to make an appointment with my surgeon to talk about a third surgery in 4 years.

w30bob
May 18, 2023 11:13 pm

Hi Rach,

To be honest.........if your output is directly impacting where your barrier contacts your skin you'll always have problems with output getting under the barrier. I dealt with the same thing, and while there are a number of things you can try.....I never found one that held up for more than 2 days reliably. Since having my stoma revised a couple months ago I only wish I'd done it sooner. Having a stoma that sticks out eliminates so many problems that I can't recommend it highly enough. I know another operation sucks, but if they can simply cut it loose and pull it out a couple centimeters they won't even have to open you up and you'll be home in 2 days. On the bad side........if they do have to open you up........you already know what that's all about. But you can choose to bite the bullet and have it done or you can worry about leaks and embarrassing moments wherever you go........until you do have it fixed. I'd go with the former, as you can't put a price on the piece of mind having a nice normal stoma brings.

;O)

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Celia1552
May 19, 2023 1:43 am

Hi Rachelle, I use Hollister Convex 85711 one-piece bags with Hollister Adapt thin ring... Warm the ring slightly before you apply it. I take it out of the little box and tuck it under my waistband or in my bra with the thin plastic covers on it. Then take the covers off the warmed ring right before you use it... The slight warming helps it adhere. I also use stoma powder around the stoma circumference and blow excess off with an empty squeeze bottle air puffs before applying the warmed ring. My stoma is pretty level with my skin... This has helped me tremendously. The surgeon did not pull out my intestines very far, I think because he thought he would be able to do a reversal in 7 weeks... It took me over two years to heal so I have had to deal with a low rider since the beginning... Had lots of leaks and irritation until I went to Hollister bag #above. Hope this will help, Hollister is real good about sending you samples to try... Best Wishes!

Beth22
May 19, 2023 1:43 am

Hi there,

I am sorry you have to go through this. It is one of the hardest things as an ostomates. I myself have been where you are at. I had my original ileostomy creation in Jan of 2022 and I just had my 5th revision in a year and had to have it relocated twice. I have very stretchy skin from hypermobility disorder which caused my retractions and the original site was in a poor placement site. If you have tried everything and you are still having the same problem, then I would say unfortunately surgery will be your way to go. Question: when you have had revisions, have they been relocated at all or just a revision in the same hole and pulling it out more? I ask because a bad placement site on your abdomen can cause retractions and leaking.

Hisbiscus
May 19, 2023 1:49 am

I have a flush stoma. My stoma used to stick out nicely until I had a mesh surgery for my parastomal hernias. I came out of surgery with a flat one and sometimes it will stick out randomly but lopsided sideways. I had to go on the hunt for new pouches. The Convatec Active Life Durahesive Hard Deep Convex might work for you. It did for me but I had problems with the adhesive. What I found is working for me now is the Sensura Mio one-piece deep convex. No filter. Coloplast 16778. What I also found is cutting the hole too big or too small was causing leakage issues or stoma sinking issues. If I cut the hole too small the output would get up under the base plate and if I cut it too big of course leaking around the stoma area.
What I also found is less is more. I stopped using the barrier rings because with a flat stoma it was making things worse. It was like putting a wall up around the stoma not really pushing anything in and keeping the stoma dunk down even more as well as causing more leaks. I also stopped using barrier film wipes. I realized I only need them if I'm having an irritation problem and that they can build up on the skin causing adhesion issues.
What is working for me is to use Smith and Nephew Remove Adhesive Remover Wipes to get off excess adhesive and remove the pouch. Sometimes I use a few of those wipes and may even go over with alcohol at times. Then go over that with a paper towel that has warm or hot water. Rinsing over and over with a new paper towel each time. Then to wash the area with Dial Gold Antibacterial Soap using another paper towel and rinse well. Make sure everything is dry and then place my pouch down. I push my finger around the stoma to push that adhesive down around the stoma. Then put on the Sensura Mio Ostomy Belt on the bag tight but not too tight. Leave the belt on for 10 minutes and this leaves my stoma sticking out in the bag and a nice good tight seal.
Believe me, I've tried everything and with experimenting for months I've found this to be perfection for my flat stoma.
If all else fails, you may have to think about that surgery.

 
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IGGIE
May 19, 2023 3:15 am

Hi Rachelle,

I am in Melbourne and the Hollister system is the best. My stoma lately has been going from 1.5 cm back to flush and I have found what works for me. Hollister Convex wafer 13506 with Bag 18183 and a sealing washer Welland XMHWA310 these are cut to size to fit my 30m/m stoma. If your stoma is a different size, talk to your stoma nurse and she will put you onto the right size. I also, before fitting the sealing washer, I spray the area around the stoma with 3M product Cavilon sting-free part No:- 3544M. This helps the seal to stick extra strong. I hope this works for you, let us know how you go. Regards IGGIE

heathroxie67
May 19, 2023 6:18 am
Reply to w30bob

I'm dealing with the same thing. I'm inverted after my revision. I'm up for a 3rd surgery but I can't find a good surgeon that will do it. In the meantime, I use a product called Torbot. It's a brush-on adhesive for medical purposes. I also get your baseplates pre-cut. That gives you more support around the stoma. I also lay all my adhesive products on a heating pad. I use Torbot, a 4x4, the baseplate, and 3 curve extenders around the baseplate. I can get it to stay on for a week, sometimes longer. I change out the bag. I hope this helps. By the way, I'll go anywhere if someone knows of a surgeon.

Axl
May 19, 2023 9:23 am

Hi Rachelle

My first stoma was virtually flush, I went to a Braun 42720P Flexima midi convex bag, Salts mouldable seal and the Cavilon spray, and I use the belt with the bag. This worked well for me and I still use the same eight years later except for the spray as I don't need it anymore. I'm in Vic and this bag is readily available as another option for you to try. I am also slim and that is not an issue at all, the best appliance will be the one that works for you.

Axl

w30bob
May 19, 2023 5:47 pm
Reply to heathroxie67

Hi H,

I can give you the name of mine here in MD, but you really should be able to find a good one closer to home. You can also search for 'Gastroenterology Centers of Excellence' that are close and get in contact with them for recommendations. The other thing you can do is call the ostomy nurses at the biggest hospitals in an area that's a comfortable drive and talk to them. It may take a few conversations before they'll open up and tell you which surgeon is really the best, but it's worth the effort... and they know because they have to deal with each surgeon's screw-ups!

;O)

w30bob
May 19, 2023 5:55 pm
Reply to Axl

Hi Axl,

I don't think we can get BBraun ostomy supplies here in the States. I looked for them a bit back and came up empty. Maybe that's changed, but I just did a quick search and came up empty again.

;O)

Axl
May 19, 2023 10:19 pm
Reply to w30bob

Hi Bob, I do seem to recall something like that. In Oz, we have an excellent ostomy network for supplies and stoma nurses and an abundance of supplies to try and use, although it did get a little skinny for a period there at the height of Covid. No idea how many Rachelle has sampled yet, but the range is huge.

Cat6
May 21, 2023 8:36 pm

Hi, I have a flush stoma too and I've tried lots of samples. I found Hollister 88725 to work best. It's a smaller, one-piece drainable pouch with a filter and a Velcro lock and roll end. The round plate that sticks on your skin is so pliable. I warm it up with a blow dryer but can rub it in between hands for a couple of minutes if no dryer is available. It makes it stick better. Also, you get 20 in a box so they are good for a day and a half of wear. Best wishes.

Superme
May 22, 2023 4:01 am

Hollister is probably the most popular and usually has good results. I think people like it because it is a bit less expensive. I use Convatec and never have problems. Others may say Coloplast. You would really have to try them all to see what works best. An Ostomy Nurse could help with selection and perhaps give some samples. Mike

sunburst
May 22, 2023 4:00 pm

I use Hollister Convex Wafer (part of 2 piece) - 11703 and regular barrier ring - 8805. They do have convex barrier rings also.
My stoma stays up mostly and sometimes retracts to close to level. I have 2 vertical folds on either side of stoma. That combo has eliminated my leakage issues from the folds and the convex wafer definitely keeps my buddy above level.
Hollister will send samples as will other companies.
Good luck

Pinkie pooh
May 22, 2023 10:57 pm

Hi all, I had a loop colostomy. It was reversed to an end colostomy. It too was very, very flush. I went through so many different products. In 3 months, I had it revised. It's better than it was but still slightly flush but manageable. I use Coloplast Assura 1-piece closed with filter and protective skin barrier spray. I spray the area, then use my blow dryer on low heat to heat my belly as well as my pouch before putting it on. 95% of the time it doesn't leak. I tried using the rings but they made it leak, could not get it to adhere so I decided no ring, just the spray and pouch. Also, do you irrigate? That makes a whole lot of difference. My ostomy goes in while administering the water but that's not a problem. Hope you find a solution that fits.

kadhd
May 24, 2023 12:26 pm

I had four surgeries before everything "clicked," so I know your concerns! My last surgery was in 2006 at Mayo Clinic, and they did a terrific job of correcting three prior surgeries. Their ostomy team put me into a Hollister wafer (mine is 14904, but you may need a different size), and I also use Adapt Barrier rings to add a rope of what the nurses called "caulk" around the wafer opening. I find that cutting the barrier rings into quarters provides me with enough material to roll a rope of "caulk" to run around the pre-cut opening. While I will occasionally spring a leak due to loose stools, I've been satisfied with this method for 17 years now!

Good luck!

rachelle1412
May 28, 2023 10:21 pm

Thank you all for all your suggestions. I've tried heaps, most recently Hollister, which was good except the adhesive was just too strong for my annoying fragile skin when you need to change it every couple of days. I am going to give the Coloplast SenSura Mio Deep Convex another go as I have lots of bags to go with it stocked up. I am pretty sure I am headed for another surgery. I just want to try to make it last another 6-ish months as I might need a urostomy soon. I've already had a Mitrofanoff for a few years, and this week I am having a neuromodulator put on my spine as a last-ditch effort to keep my bladder. I have a feeding tube too, and space on my small body is at a premium, so if we are potentially going to have to move things around, at least both my surgeons plan it together and maybe even do it as a double op, but I will keep trying things until things work themselves out with the bladder. You never know, but a revision is looking likely. I can't even remember how many products I've tried, but I have definitely made use of companies handing out samples. There's literally not much else to try.

saida
Jul 10, 2023 12:49 pm

It does help for me to keep air in the bag, so the output is by gravity going down. Sorry if you already tried that. Also, when you don't drink enough water, the output will have a different texture and will be more sticky, being prone to go under the baseplate.
I hope you the best, Dear.