Help Needed: Correct Order for Applying Stoma Products

My stoma nurse gave me Brava Protective Sheets, as I tend to be allergic to a lot of things, and she thought that they could help my 'allergic' skin reaction to the summer heat. But she never had time to give me proper instructions on how to use them. I have been experimenting, but I am still experiencing some output leakage directly around my stoma - it does cause my bag to come off, and usually, if my skin becomes very itchy around my stoma, I will take my bag off and reapply another one; or I change my bag every four days. (I have been able to keep my bag on for almost 7 days, but my stoma nurse explained that the bags are only at their maximum adhesive stickiness for approximately 3 days, and then the adhesive begins to deteriorate).

However, because of all my weight loss and my abdomen becoming softer and looser, I also use Adapt oval CeraRings, which I attach to the bottom of my base plate. But I am also supposed to use either a Brava moldable ring or a Welland HyperSeal with Manuka Honey in it.

I have watched a couple of videos I managed to find on YouTube that show how to apply the protective sheets, but none of the videos go into any detail about using it with a moldable ring.

So far, I have tried cleaning my skin thoroughly, putting about three light layers of stoma powder around my stoma, putting Cavilon no sting barrier spray over each layer, after which I spray my Cavilon barrier spray all over the area where my base plate and my flange extenders go, after which I add Eakin Cohesive paste around my stoma. I have been applying my protective sheet over that, and then I have been putting my moldable ring around my stoma, after which I stick my base plate over the lot.
I am still learning how to click on my large output pouch; sometimes it goes on easily, and other times I struggle a bit as I have lost a lot of sensation in my left hand due to nerve damage.

However, I am wondering if I should be putting my moldable ring under the protective sheet?

Is there anyone who could explain how I should be doing this? As I have had a lot of products changed over the last year, and although I had an effective way of putting my old bags on, because my old wafers had a precut hole which over time became too large for my stoma, and I had at least 4mm of skin that was eaten away for many years because my previous stoma nurse could not be bothered trying to find me a better product.

Now that I have been using the SenSura Mio extra deep convex base plates over the last 6 months, my skin has healed completely, and my stoma is a lot smaller than I originally thought it was because I didn't realize that the skin that had been eaten away was supposed to be skin. Over the past few months, I have had to change my stencil a number of times until the skin around my stoma healed completely.

I am just not 100% sure that I am doing things in the correct order. And as I have had my ileostomy for 28 years, most people assume that I know what I am doing - and that is not exactly always the case.

And as my stoma nurse is on leave again and there is no other stoma nurse available to help me, as my hospital only employs two stoma nurses. And I do not often ask people for help - which is something I am trying to work on, I thought I'd ask you guys!!

Gracie

Based on the instructions I received from my ostomy nurse, the protective sheet should go on the skin. I would put your products, like the barrier ring, on top.

But I ended up not using the samples I got, so someone else may know more.

Hi there, the sheet goes on the skin, and the ring and wafer after. But that is a lot of thickness. How much does your stoma protrude after using both the sheet and the ring and wafer? If the stoma doesn't protrude enough, it will cause leaks. Also, when cutting the wafer, you don't want to have skin exposed. Cut to the size and shape of your stoma. And yes, ostomy bags have a maximum of 4 days. Even if you can go longer, it's not recommended because of your skin breaking down, getting irritated, and infection. You could call any ostomy company, and they will tell you the same thing.

When I have put it all on, my stoma comes out almost entirely. However, I am finding that the Brava ring tends to absorb a lot of liquid, and I have to monitor it quite closely so that it doesn't block off my stoma.
I don't like to use the Hyperseal directly on my skin, as the honey in it causes candida.
I used to have quite a lot of bleeding; my stoma nurse says it's because I am on blood thinners. The leaking isn't greatly significant, and it's reduced a lot.
But I just wanted to make sure that I was doing everything in the correct order.

I have noticed that my stoma contracts back and forth occasionally. But altogether, my skin is in such a better condition than it looked 6 months ago. And I have only a slight discoloration where new skin has grown, but I have been assured that is normal.
I used to get a lot of overgranulation, but since I have been using the new bags, it's getting less and less.... I did think for some time that I'd never get rid of my proud flesh....

When I first got my ileostomy 28 years ago, I weighed a lot more than I do now. And my stomach was a lot tighter back then; now it is like my stoma is in a deep hollow - which is why I need the extra convex stuff. And this has improved things quite a bit.

A lot of products have been taken off the market, and I have been given a lot of products to try, so occasionally I feel a little out of my depth.

G-Day Gracie,

After reading your notes, it looks to me that you are using way too many products.

After you remove your appliance, try cleaning the area with just warm water, then dry the area 100%. Now spray your barrier spray and dry 100%, followed by your seal and then your base, and last the bag.

Regards, IGGIE

My Ostomy Journey: Bruce | Hollister

Hi Iggie

I trust my stoma nurse. She has had many years of experience. She knows me extremely well. And you may think that she has me on too many products; however, since she took over from my old stoma nurse, my entire life regarding my ileostomy has changed for the better.
I have lost a little over 30 kg over the years, where once my stomach was tight, my stoma sits now in what looks like a volcano crater - so I need all those products to make sure that I don't go backwards.
And as I don't have to pay for any of it, I don't really mind.
If you could see how my peristomal skin looks now, compared to six months ago, it is something I never expected to see. Where my peristomal skin used to look extremely excoriated and red, a little infected from time to time, it now has almost zero blemishes. I am really happy with my new stoma nurse, and I wish that I'd been her patient since she became a stoma nurse - I have known her for a very long time, as she has seen me go from hell to back multiple times. And the most important thing is that I trust her.
I am by no means a newbie when it comes to my ileostomy; after all, I have had to live with it for 28 years.

The one thing I never expected was that I would get to live as long as I have. Strictly speaking, I should not be alive. But since I am I am not complaining. Especially since I am almost 20 years past my supposed expiry date.


It would have been so easy to have given up when we were told that I would not live to see my 35th birthday, and here I am, almost 20 years past that.

You have a lot going on. The sheet definitely goes on your skin before the barrier/flange/wafer. For now, go ahead and place the barrier that you have attached a CeraRing to on top of the sheet. Since you have stated your stoma protrudes above the barrier, apply the moldable ring around the stoma on top of the barrier; that is, fit it around the stoma inside the part of the barrier that attaches to the pouch. Skip applying the paste to see if it is really needed.

Hi there! I am glad your stoma protrudes still with all that on; that's a good thing. And that you have less leaking... yeah, my stoma moved very, very... I like to say uniquely, lol. Mine goes completely backwards, so the eye of the stoma is staring straight back at me. Then she goes back even further, like my stoma was made backwards to give you a visual. My stoma moves by my sides, moving in and out and back and forward, and she moves in a helicopter around in circles. Then I prolapse, and 10 minutes later, she retracts. Then she goes normal. 😆 She is my acrobat performer. But I'm thankful for her as long as she stays out. This is my 6th stoma in a year.

Was that a typo, Beth — 6th stoma in a year!😮

Hi Gracie Bella,

I have only had my ileostomy since May 2024, so I do not know as much about the process as many others in the group.

My ET (Enterostomal Therapy) nurses have been wonderful. I had a rough recovery from my emergency surgery. When I was released the first time from the hospital, I had my ET nurse tell me to call anytime if I had any questions and to make an appointment if I was having any issues. Because I had an open wound due to an infection, I had home care nurses coming daily to repack my wound, and they would also change my appliance twice a week. I ended up with an issue with the skin around my stoma as the individuals that were changing my appliance were not sizing my flange correctly.

I made an appointment with my ET nurses, and they helped my husband and me ensure the sizing of the opening in the flange was correct and provided us with detailed written instructions on the process of changing the appliance.

I call the ET team when I have issues, and they will get back to me within the day. My last call was about my upcoming colonoscopy and what to expect.

As my ET nurses remind me, all our body shapes are different, and our skin reacts to products differently. In my case, I am allergic to various adhesives, so we had to try different types of flanges until we found one that would not irritate my skin as much as the others.

Anyway, back to your issue.

If I were you, I would call your nurse and see if she/he can meet with you and walk you through the process by helping you change your appliance and provide written instructions on the steps you need to take in your situation. Have her go as far as how to clean your skin after removing the appliance, to which order and how much product you should use.

I wish you luck,

Tammy

Hi Gracie, I am the caregiver for my wife's ileostomy, and we have had allergy-related issues and nightmare leakage trial and error as well. What has worked the best so far is powder-spray-powder-spray-spray, ceramide-infused barrier ring, and Hollister's ceramide-infused base plate, or flange. No other layer or barrier over or under the ceramide ring. Coloplast extenders, one Y-shaped toward the outside of her body, and a C-shaped one toward the belly button. We use the same spray you do, and the powder is likely the same as well. Be sure to warm the barrier ring so you can stretch it to fit closely to the stoma; no two are exactly alike. Make sure you are as dry as you can possibly be for the change. We skip overnight feeding (feeding tube) and work on it the next morning so we do not have to fight output and can get the peristomal area dry and clean. We also got a pressure ring to hold down the whole works for at least a couple of minutes at the change, to help the ring seat firmly and evenly. For the life of me, I can't find what ours is called, but it's the second one I've bought; the first was crappy. This one has a smaller circle on one end and a larger one on the other, so you can either press down on the bag seal ring or get inside it and put pressure on the ceramide barrier ring after the bag is on. GOOD LUCK!!

Thanks.... I am really glad that I have been doing it correctly.

Mmmmm.... now that my skin is looking so good, I guess it would not hurt to try what happens if I don't use my paste. Especially since I found the cohesive paste so frustratingly difficult to work with, especially since my stoma is at times completely uncooperative. I will have everything ready to go, and 'Mount Vesuvius' suddenly will erupt, and at times if I don't keep my eye on it, the output can jump really high, and then frustratingly I will have to clean everything from my skin again, and now and then my stoma won't stop working, so I need to grab a nappy, hold it over my stoma - sometimes for an hour. And as there's nothing I can do until 'Mount Vesuvius' decides to quit erupting, I just go and read a book for a while.
My stoma nurse recommended that a half hour before I intend to change my bag, I eat 4 marshmallows, and while this works fairly well, I have to admit that I cannot stand marshmallows. So I do not often follow that advice....
My skin has improved so much that every time I change my bag these days, I am still surprised with how good it looks. And now that I am also no longer dealing with a lot of blood around my stoma, partly because I am on blood thinners, that is making a significant improvement as well.

I was at first a little bit skeptical about the protective sheet. However, I have to admit that it has definitely reduced my reaction to the heat during summer.

A traveler, nope, no typo. I had two revisions and four relocations. Two of them were open.

Beth, it would be easy for you to pity yourself, and many would understand. I am glad you continue to fight on; we only have one body, and we are challenged to get the best possible use out of it. My ostomy has forced me to understand and appreciate the intricacies of human anatomy and physiology. It is one thing to deal with the physical challenges, but there is an even larger mental toll to overcome. To take on your many physical challenges requires tremendous mental stamina. I continue to gain strength from the grit you and others on this site show. I never asked for a stoma, but to share a space with you and others, I am proud to have a stoma of my own. I pray for your continued blessings.

I have had quite a few stomas which sunk so far back that they needed to go back in. I even had my ileostomy on my left side for a few years, and boy did that confuse a lot of doctors! It's been back on my right side since 2008, when I had to have 2 open surgeries, 3 days apart. Both operations lasted between 20 and over 24 hours. After the second surgery, I awoke in the ICU having been placed in an induced coma for a few weeks.
In total, I have had over 33 open bowel surgeries, and in total, I have had a bit over 50 operations in the past 32 years. I have had way too many blood clots. One ended up in my aorta, and my hospital doctors completely freaked out. I don't know why I am alive, but I am glad that I still am!
The only issue I have now, which is the most problematic, is that having so many central venous lines, quite a few femoral IV lines (which caused a lot of internal scarring), 5 portacaths, and 2 arteriovenous (AV) fistulas - normally AV fistulas are given to people who require dialysis; I had mine because my veins had packed up.
My carotid veins got blocked up, as well as my subclavian veins (the big veins which run underneath your collarbones - which lead to your arms), which in turn caused my brachial veins to thrombose - this means that I can no longer have central venous lines anymore.
And finding any veins is becoming a bit of a nightmare, as now I need an anesthetist to try to find a vein using a portable ultrasound machine. Sometimes it has taken 6 hours to find a vein.
The hospital has decided that any more surgeries where they need reliable IV access are too dangerous now. So... should I get another bowel obstruction, there is only a 2% chance I would live.
This is scary. And it is a huge pain in the neck when it comes to having blood tests! As now they need to take blood like they do to newborn babies - they prick my fingers (my hands usually are put in warm/hot water to make the blood come out easier) and then they milk my fingers to drop the blood drops into small microtubes.
I need to go to the laboratory to have it done, and often it takes a very long time, and every finger usually gets a small cut picked into them, just so that they have enough blood to test...
Blood which is put into microtubes can very easily clot, even with my being on blood thinners, so the quicker that my blood tests can be processed, the better.

Life has sure dealt me some hard times. But I try to keep focusing on the positive. I hate feeling sorry for myself, as I know there are people out in the world who're even worse off than me.

Joining this group has changed my life for the better. It is good being able to talk to people who also live with a bag, that's for sure!

Atraveler, thank you for your kind words. And I am not a quitter; I will continue to fight. What I went through has only made me stronger and stronger in Christ. I would not have been able to make it through without His strength. I am proud not just to have an ostomy, as I truly find it a blessing, but I am also proud of the scars. They tell a story—my story—a hard fight on a long road that wasn't traveled alone, but with my Savior Jesus by my side every step of the way. Thank you, Atraveler, for your prayers. I will keep you in my prayers as well. I believe I have said this to you before, but I will say it again: you are such a very kind and supportive person. A true example of what the ostomy community should be. Thank you again for reaching out and for all your kindness and kind words.

Thanks, Tammy.

I remember what it was like for me 28 years ago when I was finally allowed to come home after getting my ileostomy. The district nurses were a lifeline back then, as my bag would come off about 5 times a day, and I'd end up so upset! But every time I was out of my depth, they came.

The hospital where I go to (well, I try to stay away from the hospital these days, since there is not much anyone can do for me anymore, besides treat my pain) is one of the biggest hospitals in the country. And yet they only employ two ostomy nurses. And at this time of the year here in New Zealand, a lot of people go on holiday, from just before Christmas until schools begin again in February.
And at the moment, my stoma nurse is still on leave, and she only checks her emails about once a week.
So I could not ask her. However, on the bright side, I was doing things correctly.

What you said about making a stencil of your stoma resonates with me, as I have had my ileostomy for 28 years, but until about 6 months ago, I had only used precut hole wafers.
It took me quite a bit of time to figure out how to even make my stencil - but the stoma guides helped. My stoma is oval and not circular anymore, and I needed to take the guides, find the ones that fitted on all four sides, and mark the area where my stoma dipped, so that I could trace those bits and then combine them until I had the perfect shape.
I think my stoma nurse thought that since I'd had my stoma for so long, I'd be able to figure it out easily, and while I did eventually, after about 6 weeks, figure it out, it would have been nice if I'd received some help. But as I didn't ask - mostly because these days I know much more about ostomies than the district nurses, and my General Practitioner is fairly hopeless. I am his only patient with a bag, and I get annoyed that every time he refers to it as a colostomy, and although I correct him every time, he still does not seem to get it. But as his practice nurse knows a lot more, I can at least ask her for advice on some areas when I need it.

Still - I cannot wait until my stoma nurse is back to work full time! But as she's collected up so many holiday hours, the hospital is insisting that she uses them up.

All the best, Tammy,

Gracie

I'm grateful for this space. Each of you is so inspiring. We have bad days, and it helps to know others have similar problems. Other than this, I don't know anyone personally who has an ileostomy like me. For me, I had a bowel obstruction in November. My stoma then decided to change shape and didn't want to stand up. Now I use just the deep convex wafer and C straps, torque down that belt, and the pouch. It's freaky just to have basically that piece of plastic between my skin and poop!

Definitely agree that the mental strength is as difficult as the physical challenge. Anxiety, anyone?

It's nice to see another husband (like my own) who is as invested in their wives' stomas. I remember when I had my ileostomy surgery 28 years ago that when I awoke, John was very interested in looking at it - while I did not. As I'd originally gone in for exploratory surgery, they found that my entire large bowel had toxic megacolon and they had to remove it, or I would not have survived....
I also remember that my nurse kept showing me how to twist the bottom of the pouch and secure it - only I didn't realize she was doing it wrong. At that time, the hospital still had carpet!! And when they first got me out of bed, to stand up, my pouch unrolled and everything in it went down my legs and all over the carpet. I was completely and totally mortified while John just stood there laughing, and when I glanced at him, he just said "OOPS".....
After 28 years though, having an ileostomy has become my normal, which seems to surprise a lot of people.... But no one ever told me that if you have not had to wipe your bottom for so long, I'd get to a point where I can no longer easily reach. And because I have a rectal stump which needs to empty itself - in explosive diarrhea, even though the rectal stump is only about 4 cm in length, I have to do a lot of contorting to be able to reach... 😂

And yes, warming everything up - I stick my things under my leg or under my bra; it does help to make things stick better. I used to use Adapt medical adhesive - but they stopped making that, which was very frustrating at first as I'd begun to rely on it a lot. However, new wafers seem to be a lot stickier compared to my old appliance.

It sometimes can be extremely annoying to be allergic to so many things. So I understand your wife's struggles. But taking antihistamines every day has made an enormous difference for me. Although I still cannot spend much time in the sun, nor sit directly on grass - as I will break into a huge itchy rash all over my face and my arms. I can only use Nivea products or Sebamed products on my skin - any other products I will react to.
And this allergic issue seems to be genetic as my nieces also struggle with the same allergies.

All the best to you and your wife,

Gracie.

I think that we, who have faith in Christ, even when we go through quite a lot of trauma, unlike unbelievers, find strength through Him.
I have a lot of scars as well. I am not in the habit of showing them to anyone but my husband. And like you, they are a source of pride for me also. Even if my husband likes to tease me that the doctors should have just installed a zip!
Three times I had to be resuscitated. And I had 3 near-death experiences, which only gave me more hope. Dying does not scare me, for I know where I will be going.
But having to fight with every ounce of my strength, not willing to give up, even though my doctors didn't expect me to live, I decided that was not up to the doctors but up to my Lord and Saviour.
Also, the fact that God miraculously saved my life so many times did not go unnoticed by the people who cared for me in the hospital. I have always been open to others about my faith, and sharing my faith with others brings me joy.

I think that God led me to this site. And it humbles me by how many kind and understanding people there are in this community. Because I didn't know a single person who also had a bag, and being home/bed bound for the majority of my days, I was starting to feel a little alone. My husband is my full-time caregiver, and while he does everything within his power and refuses to put me in respite care, even for just a week - as he believes he can take better care of me than anyone else - joining this group has changed my life in ways I didn't expect.

Yours in Christ,

Gracie.

PS You're in my prayers also!!

Anxiety - yes, definitely when I am trying to put another bag on, but my ileostomy will not quit working. In the beginning, it was a pretty standard thing for me to wake up at 3 a.m., discover my bag had come off in the middle of the night, and I'd get terribly upset. My husband would tell me not to cry over spilled milk; he'd tell me to go and have a shower, and when I'd come back to bed, he would have changed all the sheets and blanket, duvet on our bed, and I'd be able to calmly put another bag on and go back to sleep.

My worst experience, which is something I now have to laugh about because it was utterly ridiculous, was about 6 months after my surgery. My husband convinced me to go for a walk in the bush behind our home, which involved hopping over the fence into the pine forest next to our land, over a small bridge that goes over the stream which surrounds 3/4 of our property.
Partway through the walk, I could feel a warm sensation going down my right leg and into my gumboot.
Immediately, I told John that my bag had come off and that we needed to get home ASAP!
John convinced me that he knew a 'short cut' - I have learned over the years that when my hubby comes up with a 'short cut,' it's not always the short cut I am looking for..... So I followed him, only ending up on the other side of the stream, where there was a tree lying across the stream.
I was horrified! But John convinced me that it would be easy if I let him help me.... (It was the middle of winter, and we'd moved into our home despite it not being finished 100%, and we had a shower outside, with a hot water cylinder outside which we needed to turn on at least an hour before we showered). Typically, clumsy as I can be, John did his best to help me cross the stream, but halfway I slipped and fell into the icy cold stream!!
Not only was I covered in shit, but also in mud, completely soaked through.

I did not wait an hour for the water to heat up - instead, I asked John to bring me a bucket and towels, and I put my soiled clothing into the bucket and quickly had a cold shower - after which I changed my bag and sat by our wood stove drinking hot chocolate to warm up again....

These days, I have to laugh at the predicament I ended up in. Compared to everything I have gone through, it was insignificant, and I now find the entire thing hilarious!!

But yes, having the mental strength to deal with whatever comes our way does help. And I keep reminding myself that nobody ever said life would be easy!