Caring for a Retracted Stoma with Leakage Issues

Replies
15
Views
182
neberi10
Jul 10, 2024 1:10 am

Hello everyone, I am caring for my Mom who has just received (6 weeks ago) an emergency colostomy. This was completely unexpected and a life change for both my Mom and me. Her stoma sits in a bit of a bowl and leakage is causing very irritated peristomal skin. We have a great and very supportive ostomy nurse but are rarely making it over 30 hours between changes. We are using a Coloplast convex ring and a 2-piece Coloplast convex system. For skin irritation, we've had success with Marathon when the skin breaks down, but I typically use powder and skin prep. Does anyone have ideas to get us past 30 hours?

AlexT
Jul 10, 2024 3:51 am

Get it redone so it stands out and solves the problem.

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Beachboy
Jul 10, 2024 4:18 am

Hello,

AlexT is correct. As soon as possible, consult with her surgeon about stomal revision surgery. If the surgeon is not a colorectal surgeon, she should find/insist on one. Installing a stoma so low to skin level is not proper. I had emergency exploratory surgery resulting in a colostomy. My surgeon has mine sticking out from one to two inches. It is a little too long... but better too much, than too little. Stomas expand, shrink, change shape, due to peristalsis activity. Your mom's surgeon should have been aware of this when creating her stoma.

Revision surgery will be able to lengthen her stoma. I'm at 18 months post-op with my permanent colostomy stoma. Never had a leak, peristomal skin looks great. I change the wafer every 7 days. I have gone 10 days just to see what would happen. 10 days looked as good as 7 days. It's good to know how long you can go.

Good luck and post what happens.

Axl
Jul 10, 2024 8:24 am

Hello

You don't say if you have tried a barrier spray or wipes like below.

Login to see image

 

Kas
Jul 10, 2024 10:17 am

I had the same problem; my colostomy stoma retracted and became a partial "innie" about 5 months after surgery due to adhesions. I had a revision and adhesion removal, and it's been great for the past 5 months!

 
Living with Your Ostomy | Hollister
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Justbreathe
Jul 10, 2024 11:36 am

Interesting responses - Surgery is a scary thing and, in my humble opinion, to be avoided if possible. Explore all avenues first. I have had a stoma for almost 4 years and have recently noticed my stoma has a tendency to curl up to skin level, mostly when I lie down. I wear a one-piece pouch and use a barrier wipe before placement. My skin is completely clear of any issues. I also change my pouch every other day—a personal preference and no desire to extend wearing time. I am currently looking into a convex barrier ring (I refer to it as a gasket). My suggestion would be to consider the myriad of choices and try several prior to further surgery. I am an 80-year-old who fears surgery and prefers to never see the interior walls of a surgery room or surgeon again…just saying…jb

ron in mich
Jul 10, 2024 12:25 pm

Hi Neberi, welcome to the site. It's kind of soon after surgery, but have you looked into irrigation of the colostomy?

Beth22
Jul 10, 2024 1:02 pm

Hi there,

Yes, like Alex and beachboy said, it needs to be revised. And I hate to say it will probably end up retracting even more. I hate the fact that your mom has to go through this. I know how bad the skin burns and stings; I myself have been in this spot more than once. And I have had to have revisions. She will have to wait a little bit before she can get it revised (the doctor pulls it out more). In the meantime, I would try a regular barrier ring instead of a convex barrier ring. The convex barrier ring could be adding too much thickness around the stoma. And there is another skin protection like Marathon, but it's called 3M Skin Protectant, and that worked better for me than Marathon. Medical Monks carries it, and you are able to buy it in singles or in a pack.

May I ask what type of doctor did the surgery?

Mysterious Mose
Jul 10, 2024 6:57 pm

Is the age in your profile yours or your mother's? I assume the former, and your mother is at least in her late 70s. If that is the case, I am with jb. Surgeries are more and more concerning the older we get.

Are you making sure to warm the wafer before application? A hair dryer set on low will do the trick. Have you tried barrier rings or paste? I use a Hollister convex wafer with a 1/34" flange. My stoma is stable, so I use 1" pre-cuts. I also use the Hollister 8815 slim barrier ring to help with the seal. Unlike most people, I apply the barrier ring to the wafer and make size adjustments there instead of putting it over the stoma first. Works for me. I assume you are making sure to press the wafer all around to help it seal.

The problem is the old saw. We are all different, and what works for one person never works for another. She is only six weeks into this. Things tend to get better as we adapt to our new configuration. Hopefully, that will be the case for your mother, and she can avoid additional surgery. But, I never quite understand how a surgeon can leave a person with an innie stoma. That just isn't right.

Daniel

aTraveler
Jul 10, 2024 7:28 pm

I had a similar problem. Don't use convex rings—use the flat rings. Continue using a convex barrier. Try using a moldable convex barrier. Coloplast and ConvaTec have moldable barriers. The moldable barrier will hug the stoma and there is no need to cut the opening. As I gained weight back, the valley around my stoma began to fill in. You can contact Coloplast and ConvaTec to get free samples of their moldable barriers and flat barrier rings. Also, consider getting an ostomy belt to hold the barrier closer to the skin. I almost forgot, get samples of barrier extenders, in the event the barrier is not adhering well. This should definitely give you multiple days—I get 4 days before the molding begins to break down.

neberi10
Jul 11, 2024 3:15 am
Reply to Justbreathe

Thank you for your response. My mom is 80 as well and surgery is not an option due to the reason for the colostomy. She has colon cancer and the stoma length was due to the lack of blood flow.

When you say you use a barrier wipe before placement, what do you mean?

neberi10
Jul 11, 2024 3:19 am
Reply to ron in mich

I have not, but I just read about it and that sounds next level. Perhaps that could be a future thing to tackle. I'm just so new to all of this.

neberi10
Jul 11, 2024 3:21 am
Reply to Kas

That's wonderful!

Justbreathe
Jul 11, 2024 11:01 am
Reply to neberi10

Barrier wipes come in little packages (just like adhesive remover wipes). I use ConvaTec Esenta Skin Barrier Wipe Sting Free but have also used Brava Skin Barrier Wipe from Coloplast.
I use a barrier wipe every time I do a change, even though my skin is clear - I do believe this protects my skin. Once applied, I give it a bit of time to dry. Again, I do change every other day - a personal preference, and although I am not fond of this task, I believe it is another reason I don't have any rashes or skin issues. I also shower every other day totally naked (I think I hear my stoma say “ahhhh - thank you”!). This may be a difficult task for you as well, and I totally understand after caring for my mom who had a stroke - showers are difficult.
Just a side note: When I was in the hospital, the nurses used Medline Remedy Phytoplex Cleanser No-Rinse Foam as a bathing method. It has a wonderful aroma and is the next best thing to a shower.
Medicare covers barrier wipes in my monthly supplies, but they can also be purchased on Amazon - $20.99 per pack of 25. jb

Justbreathe
Jul 11, 2024 11:32 am

I have posted a pic of these products under my photos …jb

Hisbiscus
Jul 14, 2024 8:03 pm

I have a flat stoma after hernia surgery. My only solution is to wear a hard convex bag by convatec with a ring and to change daily. 

Thus far this is the only thing that has been working. I really need to go talk to them about revising this stoma as it gets irritating to have to deal with this.