Choosing Between One-Piece and Two-Piece Stoma Appliances

I had my peristomal hernia repaired nearly 4 weeks ago. Now my stoma is an innie and is giving me all sorts of problems. They gave me a one-piece appliance after surgery. It was soft and comfortable, but difficult to rinse out. I reverted to the 2-piece pouching I was using before, and because I have an innie, I am having all sorts of problems—leakage, pancaking, cannot get anything to stick because my skin is ulcerated. I am not having success with convex wafers, as they push on me too much. Should I go back to the one-piece? Has anyone else experienced this?

A stoma protruding to skin level, or below, will be nothing but trouble. Research "revision surgery" to pull out the stoma at least 3/4 of an inch above the skin line.

There might be a physical reason your surgeon fashioned your stoma so close to skin level. At a minimum, you should consult with them about this.

Hi Blaze

I agree completely with BB. I have had an ileostomy for 28 years. A couple of times my stoma sunk down, and there was absolutely nothing I could do to make my bags stick, and living with a stoma where the bag comes off a few times a day, ending up with raw skin and bleeding constantly was not much fun.
Sometimes it just happens. And I'd have my stoma remade.
If you've tried everything and you are getting nowhere, go and speak to your surgeon, or even get a second opinion about whether or not it would be better for your quality of life if you had your stoma repaired.
The stoma I have now has fortunately stayed happily where it is for 17 years; and although weight loss is creating some challenges, I'm happy with how it is now.
Even if I have an awful lot of scarring.

Are you using a convex pouching system? I use a Coloplast light convex 2-piece click. I have a half innie loop ostomy, and it's annoying to say the least. My ostomy nurse finally tried a convex 2-piece pouch and barrier. It was the first time I had kept one from leaking for more than a day in weeks. I hope this helps.

Hi Blazer,

As others have said.........the only real solution is to get your stoma revised. I know......you don't want to go through another operation and all that........but if your stoma isn't protruding past your skin, you're going to be chasing this demon your whole life and are never going to win. You might get times when things work, but they won't last long. And you'll never have confidence or peace of mind. I struggled with my flush stoma for 7 years or so before finally biting the bullet and having it fixed. It was a very simple procedure and could have been outpatient if the doc didn't want to make sure everything was fine, but I was released from the hospital the very next day and couldn't be happier. I don't even think about leaks anymore and it went a LONG way to getting my life back to normal in so many ways.

Of course, there could be complications, and your surgeon will discuss that with you. If they find your stoma can't be simply snipped free, pulled out, and resewn back to your skin, then they may have to open you up.........and that's a 3-5 day stay in the hospital. But if they repaired your hernia just 4 weeks ago, I'm sure they looked around to make sure there were no adhesions or issues.

Go have the conversation with a surgeon who specializes in stoma placement. Don't use the person who repaired your hernia, but rather find someone who has a good track record with stoma placement. Find out how many they've done and what percentage didn't work out so well. Placing the stoma is a bit of a crap shoot, but those who've done enough of them know what they're doing.

So far in my journey as an ostomate.........having my stoma revised has been the best thing I've ever done. You won't regret it even if they do have to open you up. A week of incision pain will get you a lifetime of easy ostomy care. You'll find it's a whole new world with a correct stoma and it'll be well worth it. And I'd say the same thing to anyone with a flush or recessed stoma. Your life can be soooo much better if you just have a proper stoma. Replacing your barrier/bag will be just like changing a Band-Aid on a big cut. My barrier changing time went from an hour plus to 10 minutes from when I grab my supplies to when I'm done cleaning up the area. It's an amazing change. Go get you some!

;O)

My Ostomy Journey: Keyla | Hollister

I really like the convex two-piece. I can even unseal it a little to let the air escape, so I don't have to empty it as often.

Hi, my name is Kerry. I have two ileostomies, one on the right and one on the left. My mucus one is what I thought was my poop, based on the look, but it's not. My other one is so tiny I didn't think it was that one. I think mine is like this because of how much small and large bowel had to be taken out. I have no problem with my bags leaking, and mine is probably just under my skin level. I use a two-piece bag and a seal, but I didn't know you could get it sorted if possible. Like you said, it may not be enough to do it. My daughter is a nurse, and she said it's because of how poorly I was and how bad the perforated bowels were. Thank you, nice to learn something new.

Wow, I just went through all that. March of last year is when I got my emergency surgery, so it was below the skin. Then, come August and September, it started burning so bad on my skin. And when I did get in to see my doctor, I couldn't get it raised until December. You need to get it raised as soon as you can, in my opinion.

If a one piece was more comfortable and easier to use, i.e., fewer problems with leaks, etc., I don't see why you wouldn't go back to it. Do you really need to rinse your bag? Can you live without doing that? Use a lubricating deodorant and just skip the rinsing. Change your bag every 3 or 4 days if you can, and it shouldn't matter too much if you can't rinse it out.