Is This a Good Enough Seal?

Login to see image

I'm about a month out from my colostomy surgery, and I guess I'm still trying to figure out what my goal should be for creating a seal on my appliance. I have consistently found output around my stoma and under the wafer with every change. My understanding was that any output under the wafer is a compromised seal and that when I take off the appliance, the back of the wafer can be puffy and white around the hole, but there should be no output on it. 

This is what my 2-piece Hollister wafer looked like with my last change. I had had it on for 2 days. The only other product I used between my skin and the wafer was some Skin-Tac. Does this look like a good enough seal, or should I be doing something differently?

Hello,

I use a 2-piece Hollister too. I have a colostomy, 16 months post-op.

I used to use just a wafer. I had to cut the wafer hole to precisely fit my oblong stoma. Too much hassle and time wasted. Plus, the wafer by itself was uncomfortable.

Then I learned about moldable barrier rings. Game changer for me. Now I cut the wafer hole with a lot of clearance all around my stoma. Takes 2 minutes. After test fitting the wafer over my stoma, I set the wafer aside. I grab a barrier ring, put on gloves, cut through one side of the ring, then gently squeeze and pull the ring until it is long enough to fit completely around my stoma.

Standing in front of a full-length mirror, I gently attach the ring. Starting at the middle of the ring, at the bottom center of my stoma, I lightly press the ring onto my skin. The inner edge of the ring is right against the base of the stoma where it exits the skin. I work the ring up both sides of the stoma. At the top of the stoma, both ring ends come together. It does not matter if they overlap or there's a small gap.

Then I install the wafer over the ring. The ring seals to the stoma and skin, and the wafer seals to the ring and skin. I've never had a leak. And I've had some very full bags. It used to take me an hour to remove a wafer, clean around my stoma, and remove residual adhesive. Then cut a new wafer to precisely fit my oblong stoma, then slap it on. Now I get it all done in 15 minutes.

I change the ring/wafer every 7 days. My peristomal skin remains perfect.

I use 2-inch diameter rings, 1/16 thick. I prefer Coloplast Brava rings.

Hi Year,

I really can't see the details in your pic to determine if it's working or not, but as you said the goal is no output under your wafer. Period. From what I can see it looks like your stoma is oblong. Does that mean it shoots to the side or straight out? How far does it stick out from your skin? The biggest driver for seal degradation is the consistency of your output. Liquid is harder to seal than semi-solid, and breaks down the ring material faster. How often you change your barrier varies from person to person, but the point is to always change it BEFORE it fails to seal, whether that's every second, third, or fourth day or longer. Like Beach, I always put the ring around my stoma and then put the barrier over that, and never put the ring on the barrier and then the whole shebang over my stoma. The ring has to seal properly and can be sized best if you put it around your stoma first. You didn't mention whether you wear a belt or not. If you don't, you should. This way, even if the ring loses adhesion to your skin, the belt will keep it pressed against your skin. Also, how do you sleep? You don't want output staying in contact with your stoma and the ring material for long periods of time, or the ring material will degrade rather quickly. It'll do this if you sleep on your back or even your side.

;O)

I would suggest first trying the moldable ring that Dan and Bob suggest. If you still get seepage, I would try a convex wafer with the additional ring. If you're a little flabby around the stoma, like a lot of us, the convex wafer may work better. Unlike Dan and Bob, I put the barrier ring on my convex wafer beforehand. Works fine that way. I have an ileostomy and I normally get 7-8 days between changes.

Are you warming your wafer before you apply it? Many of us, me included, use a hair dryer on low to warm things up. I do it after taking the tape from the flange and putting the ring in place. When I have issues, it is usually because I failed to do this step.

Daniel

I would be one happier camper if mine looked like that! I see no reason to be worried.

You mentioned you use Skin-Tac. When using Skin-Tac, it's best to put the barrier ring around your stoma before you apply the Skin-Tac. Make sure the moldable barrier ring is hugging your stoma — there should be no gap between the ring and your stoma. Once you have the barrier around your stoma, then apply the Skin-Tac outward from the edge of the ring towards where the tape boundary will land. Give it time to dry in order to increase the stickiness. Before applying the wafer, I remove the paper from the tape boundary. I then apply the wafer over the stoma and ring, smoothing out the tape boundary once the wafer is in place. It may take a couple of times before you get your technique down. Since you have Skin-Tac under the tape boundary, if you get too big of a crease/wrinkle in your tape boundary, you can lift up that area, straighten it out, and tape it back down. The picture you provided doesn't show much output under the wafer.