Am I Being Too Fussy About My Stoma Care?

I am 8 weeks out from an emergency colostomy, from a leak from bowel resection.

My stoma is located high on my stomach, above my belly button, front and center. I don't know the reason it was chosen; I haven't thought to ask. I'm learning so much from the group. I have a feeling it had to do with where the resection was done two weeks before and adhesions that had already formed.

My stoma is not round; it has a bump at the 10 o'clock position and the 6 o'clock position. So while my measurement is 35mm, I have to cut two shapes out to accommodate the bumps. Also, since the wafer goes so close to and over my belly button, I have had issues with the inside part (the part you cut) of the wafer not sticking down and gaping open. So I have been using half a barrier ring at the lower portion of my stoma and paste along the rest, and at times, I have to fill that gap with paste once I have the wafer on because it will lift up in that spot. Plus, I do put some paste in my belly button.

I guess my question is, when cutting the wafer, how close is TOO close? I am always second-guessing myself, thinking that there isn't enough room or that it is going to rub my stoma and hurt it.

Thanks for all the suggestions you can send.

Hi Mimipark,

Welcome to this place. You will find much support here. My stoma is also positioned high up above my belly button on my waistline. I like it because the waistband of any workout leggings gives it extra good support. My original stoma was moved from a lower one to my waist—which I personally like so much better.
Have you seen a stoma nurse? I strongly encourage you to go back. Sometimes they can get a better visual than we can, including more ideas on how to manage it.

Hello M

Is there a reason you don't use the entire moldable ring? When you cut the hole too small, it will cut the stoma and it will bleed a little. This is not a big deal as the stoma will heal very, very quickly. At the next change, keep the backing that you pull off the wafer and use it for a stencil at the next change; this will help you fine-tune your cutting process. After you cut the hole in the wafer, run a finger around the cut to smooth any rough edges. Some people cut the wafer slightly larger than the stoma, some slightly smaller, but you will work out what is best for you. Are you sure your skin is bone dry below the stoma before you apply the appliance? How far exactly is your stoma from your navel?

I've found that extender strips are useful where you have folds or gaps at the edge of your wafer. They hold the edge down and extend the area of adhesion.

Gosh, I hope that made sense!

I agree with the suggestion to see an ostomy nurse.

Hi Mimi, when I use the ring or washer, I cut through one side and then dry one more time around my stoma with TP. Then, I wrap the ring around the stoma, starting at the bottom and forming it snug all the way around. That way, if I cut my wafer too big, sometimes the ring will swell up and the gap is filled in.

My Ostomy Journey: Ryan | Hollister

I always cut my wafer bigger than the stoma but only a little bit bigger. But the seal/ring should be a nice snug fit. How far above your belly button is the stoma?

Regards, IGGIE

Over 30 years and I'm still very fussy lol and still learning......1 mm gap with wafer around stoma is the standard advice and seal ring can touch your stoma as the seal won't harm the stoma.

I use a full ring just to ensure a good tight seal. I cut my wafer pretty close to my stoma, but the extra space that there is is filled in by the ring. I am currently cutting my wafers on the 25mm line as my stoma has shrunk. However, I recently had surgery to fix incisional and parastomal hernias, and that has made my stoma a little bit bigger, so I have to cut my wafer a little bit bigger. I use the ring to fill in the gaps. Using a full ring will give you better protection as it will move to fit around your stoma. How close to your belly button is your stoma? I know having your belly button in the way is going to lead to a gap in your wafer. That is not ideal. Maybe consult with your doctor or stoma nurse about strategies to deal with this situation.

I only use half the ring because if I use the whole ring, it makes the top puff out more. I guess to say, the top of my belly is already taller than the lower part, so it is not really needed on the top. The bottom of my stoma is about an inch to an inch and a half from my navel.

Yes, I am sure the skin is dry. Silly the things we do, but I usually wave a piece of paper over my skin to help dry it. I also put the wafer under my arm to warm it up while I'm prepping the area. I have found this works better than just trying to warm it once it is on my body, but I also do that as well.

Thank you for reminding me to keep the template. Thank you for your help.

Thank you for your suggestion. The problem I'm having isn't with the edge of the wafer and gaps; it's the area that I cut to place around my wafer. I don't know if there is a proper name for that portion, but it's that actual area you cut that I have a problem with the gap.

While I have had home health nurses with stoma experience, no one has suggested that I see an actual stoma nurse. I will have to check into that.

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Yes, I am always sure that things are good and dry. That ring sure does swell up, doesn't it?

Thank you for your reply.

My belly button is about an inch to an inch and a half from the bottom of my stoma. Plus, add to that the incision site from where I recently had resection surgery, so there is a divot beyond my belly button as well.

So, if I cut my wafer a little bit bigger all the way around, using the ring is acceptable to help, hopefully, prevent having a leak?

Thank you for your reply. I have learned, thanks to the group, that it is okay for the ring and the paste to touch my stoma with no ill effects. There is so much to learn, and I really feel I could have received better training for all this in the hospital, but the WOCN nurse came on my last day there to show my husband and me how to change everything, and that was pretty much it. Except for the suggestion of "look it up on TikTok."

Thank you for your reply. Everyone here has been so wonderful.

My belly button is about an inch to an inch and a half from the bottom of my stoma. So it is within that area of the wafer that I am cutting. (I don't know if that area has an actual term.) I have tried the full ring, and I find that because of the shape of my upper belly, it causes the bottom to gap even further. That is why I only do the bottom and use some paste around the rest of the stoma.

I do not have a stoma nurse. I have had home health nurses who have stoma experience, but as far as I can tell, they are not WOCN.

I'm not sure if this will help with your specific situation, but because my stoma has such a weird shape (and I hate trying to cut out the template), I started using a moldable wafer that you stretch out, and then it gradually conforms to the exact shape of your stoma. I use this on top of my moldable barrier ring. Between the two, I am always comfortable, never feel that my stoma is being strangled, and have minimized leaks considerably.

As far as adhering everything to your skin, you've received some great suggestions from the crew - including getting the opinion of a qualified WOCN. But if you can't, at least the home health nurses who have stoma experience may be able to offer their suggestions. I have a parastomal hernia that makes adhering my wafer challenging, but still quite doable.

I am sure that with tweaks and fine-tuning, your journey can be improved and more enjoyable. We're all here to help! :)

M
xo

Hi M

I used to put the bag under my arm too. These days, I just hit it with a hair dryer also around the stoma to make sure the skin is dry; it can be hard to check underneath. Your stoma is close to your navel. I have seen people cut a semi-circle out of the wafer where it would pass over a navel so it gets a good seal against the skin and doesn't get caught on clothing, etc. This may also allow you to use a flange extender on the bottom, as it will help to get a good purchase on the skin above your navel.

That sounds really difficult that your stoma is only an inch and a half away from your belly button. Does the paste help? I am sorry a full ring is not possible for you due to the shape of your stomach. That must be very frustrating. Maybe someone on here will have a better idea for you. It is hard when you don't have the right kind of nurse to help you out. Hopefully, the home health nurse you do have can help you troubleshoot the problem. My own stoma is on the right-hand side of my body but is near my belly button; fortunately, it does not interfere with my pouching. I consider myself lucky.

Thank you for suggesting the moldable wafer. I will have to check that out.

I have received some wonderful suggestions from the group. I am sure I will get the hang of exactly what works for me in time.

I make a little Chef's hat out of 2 pieces of toilet paper folded to make a 'strip' to wrap around the stoma. I dry it and make it easy to hold and lift to dry the underneath with a hairdryer. I then give the new bag a 20-second blast also to warm it, then slip the toilet paper off and the bag on. (I apply the ring to the bag in advance and slightly turtleneck the inner edge outwards so it slips into the dip snugly around the stoma).

I am also fussy and went through hell my first 6 months as the surgeon did a terrible job giving me a colostomy. I couldn't get a bag to fit and was changing 4 to 6 times a day. I fired that surgeon and got a new one and was scheduled to have a reversal surgery. I had a sepsis ovarian cyst that exploded and landed me in ICU for 3 weeks and in a nursing facility for 2 and a half months while waiting for the reversal surgery. Needless to say, he was unable to do the reversal as he was saving my life but gave me a double loop ostomy, and now I have an ileostomy that works beautifully; however, it required learning how to get a good fit as I also am herniated at the stoma site.

I use a moldable ring, but I only use it for the right and left side. I use the moldable strips that I use to fill in the gaps (I have a bigger tummy with rolls) and the tube paste on the bag attachment itself. I also am using a convex bag. I do cut my bag just to fit over the stoma with little to no gap, and it seems to work beautifully.

Keep in mind that it does change in size and shape in the beginning and changes less over time, but it still will change here and there, so you will need to adjust the bag cut to fit comfortably and correctly. It's an ongoing process. Just a bit of advice: if you're running thick output, use a little baby oil in your bag, and it will help with movement and not busting open your seal due to pancaking. I do not recommend Johnson and Johnson baby oil but Walmart's Equate brand as it's not as greasy as Johnson and Johnson.

I also sit on my bag to heat it up as well as holding it in place tightly for an additional 5 minutes. Whatever you choose to do, it is almost impossible to hurt your stoma as it heals rapidly and has no feelings. It's the skin around the stoma that you need to be careful of. Also, I use barrier wipes to protect the skin around the stoma.

I hope this helps a bit, and I wish you the best in your journey.

I use these when I am going out, but I do have to slice a bit off; otherwise, it goes over my belly button.

The blow dryer, my new best friend.

If your stoma shrinks, make sure you are using the smallest size wafer that you can.

Hi there why you using the paste? Why not just holister drainable 2 piece with ring and barrier strip for better protection with it staying on and no leaks and remember what you eat can cause leakage and holister seems to be the best for me!!

drainable 

flange 

ring 

barrier strips all the way around so I use 3 each change 

any break outs it’s a fungal powder and you have to put it on it and remember it’s hard to still so use small amounts and it’s call Nystatin powder I use very little and wipe off some and just leave on the sore spot! Hope you understand what I mean because this site I get confused how to go on and use so I don’t come on often 

good luck 

I 🍀 been over 3

Victoria