Hi, need help… my wife is having leaks (3 last night) and we have to change the system. Her stoma is new and in an inverted oval shape. Are we doing something wrong?
She is using Hollister, 11703, 18133 bag and 7805 ring.
Please help with ideas or products; she is so sad. I am just trying to help.
casey
Hey there,
How new is her stoma? And how inverted is her stoma? Is it flush with the skin, or is the stoma below the skin level? If it's flush with the skin, a convex wafer is recommended, and see if that works. If it has retracted below the skin surface, she needs to have it redone and needs to go see a doctor.
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I totally agree with Beth, a convex wafer and a sealing washer if it is flush, but if below, get to see your surgeon. Regards, IGGIE
You mentioned you are using a 2-piece system with a convex wafer and a barrier ring. Was she using this setup successfully in the hospital? Do you know if she has a colostomy or ileostomy? Since you are using a cut-to-fit wafer for an oval stoma, my initial guess would be that the cutting of the opening is too large.
My recommendation would be to use a moldable barrier that would conform to your stoma. Convatec sells moldable barriers, and based on the size of the system you are using, my guess is you could use the following:
You can confirm with ConvaTec that this is the correct size system. Hollister sells the FormaFlex skin barrier, but I am not sure if they have a convex version.
You can continue using the same barrier ring.
Beth's advice is spot on. Be sure you warm the ring while you are prepping the change, so you can stretch it to fit as closely as possible to the shape of the stoma. This seems minor, but when I first started doing my wife's ileostomy, I just put the ring on cold, and we had much more leakage than currently. Hollister makes a thinner barrier ring as well, 8805; this might help with the inversion. I wish you well!
I use a Hollister 11905 Soft Convex flange/wafer and an 8805 ring. That solved my leakage issues. I would also suggest that you review the process you use to change the appliance. Ensure that the skin around the stoma, where the wafer is placed, is very dry. Again, I use powder and a skin barrier spray/wipe (a couple of layers). I put my ring on the wafer before applying it to my skin. Just before, I use my hair dryer and warm it up quite thoroughly. After I am done, I use a Magic Bag (a bag filled with white beans) that I have put in the microwave for a couple of minutes and hold it over the wafer. This seems to promote adhesion. I am sorry to hear that your wife is so very sad. Things will get better. Been there and felt that way.
Make sure the area is very clean and dry. Be sure all adhesive remover is thoroughly washed off.
Clean only with water for now (you can add soap later, but keeping it simple will help you troubleshoot).
Barrier wipe only (this protects the skin and helps with adhesion); unless her skin is broken, don't use anything else (keep it simple). Note, I was given a free sample of a barrier cream, and it caused me endless trouble. I suggest you avoid creams and stick to wipes or spray.
Definitely use a ring and consider a Traveler's suggestion, but that may take time to acquire.
Dry the skin very well.
Warm the ring and flange so they stick better.
Add barrier extenders to give you more time to catch a leak before it makes a mess.
Does she have any scars or skin folds that interfere with the wafer? That's the advanced course.
Hi Casey,
I had a similar problem; my stoma would retract if I was sitting and leaning forward, and when I was lying down, it would go flat to the skin. The retracting was found by my ET nurses when I went back a month and a half after my emergency surgery for a diverticulitis perforation.
They switched me to the Coloplast Convex appliance. The order numbers are:
Barrier Ring: 12035 box of 10
Flanges: 16886 box of 5, need to order two boxes.
Pouches: 12243 box of 10
I would make an appointment with your ET nurse (stoma nurse) to have a new fitting done. Have them check how it looks when your wife is lying down as well as sitting up and sitting up leaning forward.
My hubby helps me with my appliance changes as I wear trifocals and am too uncoordinated with my actions when I look in the mirror. He basically spots me when I am putting the barrier ring and flange on, as I cannot see below my stoma to make sure I have the ring and flange placed correctly. Now the only time that I have issues with leaking is if PIA (the name my hubby gave my stoma) decides she is going to burp up some food or liquid, and it gets underneath the barrier ring.
Our routine now is:
Just remember your ET nurses are there for you to talk with for as long as your wife has her stoma.
I wish you and your wife all the best.
It is below the skin. She just had it done 4 weeks ago. She sees the surgeon next week, but I doubt they will fix it now. She is in cancer treatment and will fix it after treatment. Or can they fix it before?
She was using it in the hospital successfully, and it's a temporary ileostomy. It looks like the ring is getting wet and swelling up. We just got a call from the stoma nurse and she thinks we should stop using the ring.
Hi Casey
Before replying, I thought I would first do some homework; as it has happened to me a number of times, but it is so long ago, and I had so many operations that it is hard to recall them all, or even in what order things happened. My retracted stomas were all surgically redone after nothing else worked - still, my memory is rather dim as I have had over 50 operations. And I have had my ileostomy for 28 years now.
First of all, you have been given a lot of good advice.
I hope that these sites will give you a bit more information.
https://www.acpgbi.org.uk/about/news/49/the_problem_stoma_a_retracted_stoma/
https://www.colostomyuk.org/wp-content/uploads/2016/09/Prolapse-and-retracted-stoma.pdf
All the best for your wife and yourself.
Gracie
G-Day Casey,
They should be able to fix it right away, and it should not be a very big operation. If it goes OK, all the surgeon has to do is pull the stoma out and fix it to a better length. Talk to the surgeon right away. Regards, IGGIE
She's a little heavier, but her biggest issue seems to be that the ring 7805 Hollister is swelling up. We had to change it again today, as it almost closed the hole completely.
I don't know how you survive without the ring. If the ring is swelling up, it's because output is getting to it. Without the ring, the output will now get on the skin — definitely not good with an ileostomy. The ring swells because it is absorbing output. Has her stoma shrunk, and is the template you were using in the hospital too large — is there much space between the stoma and the wafer opening?
The ring is designed to swell and absorb the output to prevent it from getting to the skin.
You are using a 2-piece system. If you fear the ring is about to block the opening, remove the bag and clear the area, then reattach the bag.
I agree with aTraveler; check the size of the stoma. I was told to do this every bag change for 6 weeks or until the size was stable, whichever was longer.
Yes, while the ring is designed to swell, the problem is that's the only thing that sounds like her output is hitting. It's creating a wall; there's too much height for how low the stoma is, and it is more than likely causing the output to pool inside instead of going in the bag.
Does she still have staples? Also, the stoma is new and will fluctuate in diameter and height, as well as becoming inverted. It can be hysterical at the beginning because of these changes and fluctuations. She's likely thinking this is how it's going to be and it will be unlivable. New stomas have temper tantrums. If she has staples, there will be an issue until the staples are out. If they are out, it's likely the stoma is just going through its terrible twos.
I swear by Coloplast products. Every other product is flimsy and does not adhere well. I had leaks until my staples were removed.
I'd like to know exactly start to finish what you use, in what order. I can help.
If that is the case, and it certainly seems you are right, then she probably needs more convexity. Instead of no barrier ring, I would try a convex barrier ring. Hollister sells the CeraRing™ Convex Barrier Rings:
Her stoma is deeply retracted, yes, output is getting to the ring, it gets between the wafer and skin and reaches the ring, thus the swelling. I set the ring back a little further when I attached it to the wafer last night. It's been 13 hours and it has held, but I can see the ring swelling; it just hasn't blocked the output yet. To your point, I also worry that it is touching her skin. The nurse will be in to see it in an hour, but she screwed it up last time. Any other thoughts? A flatter ring maybe? Do I put the ring on the skin first or wafer? The nurses put it on the skin first, but I put it on the wafer first. Thoughts?
Yes, thanks for your thoughts. Yes, staples are still in, and we have a surgeon next week to remove them. I set the ring back a bit further from the cutout last night, and I think it has held for about 13 hours. Should I put the ring in skin first or wafer? I feel like nobody has helped us learn about this. High anxiety, and yes, it feels like there will also be leaks.
Do I punch the ring a bit so it's flatter and set it back a bit?
Hey Casey, I would use a ring at all. I had one of mine invert. The ring is too thick and will add too much height, and it creates a wall like I was saying. Convex wafer to try, and you can use strip paste from Coloplast. It's a solid paste that you can flatten super thin or mold however you want as an option. The biggest key right now is to protect the skin. Once that skin gets super raw and red, nothing is going to stick to it. I used it, and it helped me the Calvi.
On 3M advanced skin protectant, or Marathon. It's going to put a protective layer over her skin, and the bag will stick to it. It's different than the skin barrier wipes.
Ring needs to be between the wafer and her skin.
My urostomy is retracted but not as deeply as your wife's based on your description. For my urostomy, I mold the ring to the bottom of my deep convexity wafer before applying. For my colostomy, I mold it around the stoma then apply the wafer. So both methods work. This is how I was taught by my ostomy nurse. She didn't explain, but I am guessing that molding the ring to the wafer like I do for the urostomy is better for convex wafers.
The rings come in different thicknesses, so maybe a thinner ring would work better. Also, try different brands; the rings vary, and you may be able to find one that doesn't swell as much.
I'd definitely try the Coloplast deep convexity wafer. It has the most convexity I've seen, much more than the Hollister, which is similar to the Coloplast light convexity wafer. It was a game changer for me with my urostomy.
Beth, they are already using a convex wafer; the convexity is just not deep enough. They can try a deeper convex wafer, as Susan suggests, or use a convex barrier ring. The 3M is a good suggestion to protect the skin.
So this ring is not flat? Looks like it has ridges. Hmm. Is it adjustable?
I received a sample of Coloplast sensors Mio deep convex. Is that the one you suggested?