Help Needed: Daily Changes for Convex Ileostomy Pain

Hello! I'm about 2 months out from my 2nd surgery where they set up a loop ileostomy, and my skin is getting completely torn up. I would love some help!

My first stoma protruded a good 1/2" and I could go 7 days between changes, but the new one is inset and almost flat. Within a day, liquid output gets under my barrier ring and corrodes my peristomal skin; it is so, so painful.

Currently, my process is:

1) Adhesive wipes to remove everything + wet washcloth to clean up the area

2) Shower with mild soap, let air dry for ~15 min

3) Use Coloplast barrier wipes, then paste to fill in some convexity

4) Apply Coloplast convex ring, blast with a hair dryer, apply 2-piece convex soft bag

Everything seems super secure and feels great after the change. Then, 6 hours later, I can feel that tickle and the pain starts. I'm at my wit's end here!

-R

G-Day lambdacdm,

You say you use a paste; are you using paste only or also a sealing washer? If you are only using paste, try to use a washer that fits snugly up to the stoma and the bag just a little bit bigger so as to not rub on the stoma. The washer should give a good enough seal to stop it from leaking onto your skin.

In between each step, make sure it is all 100% dry. Try other products as well; you can get free samples from all the companies.

Good luck, let us know how you go.

Regards, IGGIE

I do use a washer, but I will also try out some different product samples!

Hubz has a loop colostomy that's inset, almost level to the skin and oval. Convex samples of several brands were suggested and tried, but his challenge was pancaking, with heavy output building up behind the convex wafers and irritating the skin, even leaking.

We went back to a 2-piece flat Hollister wafer, 70mm to accommodate the width of the stoma, and used a 2" barrier ring to fill the gap around the stoma where it dips below the wafer. On the side of the belly button, his WOC showed me how to break the end of the barrier ring and overlap the ends to thicken that side (see photos). The ring is then gently pulled to fit the shape of the stoma and the opening in the self-cut wafer.

She also demonstrated a technique called 'crusting' using stoma powder on irritated skin, smoothing it down lightly with a finger, then topping it with a skin protectant wipe and letting it dry. If really irritated or still shiny, I'll repeat another layer until well crusted, then apply the barrier ring and wafer.

It's amazing how fast his skin heals using this technique. There are YouTube videos, or your WOC can show their technique.

As much as we tried, the convex shape of any brand didn't really seem to work for him, but we're pretty new to all this, so this is a very limited opinion. It's just what we've found to work so far, and I really hope you find a way to help your skin stay happy.

Good luck!!
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Hi Lam, welcome to the site. I don't get why surgeons don't realize that a flush stoma can be a pain and cause pain. When you remove the barrier/wafer, look at the back of it to see if there is one spot that is prone to leakage. Then maybe fill that spot with paste or cut up a ring and build that area up. Good luck.

My Ostomy Journey: Keyla | Hollister

If I interpret you correctly, you are using a convex ring in addition to a convex bag/wafer. I tried that, and it didn't work well for me. I consistently had stool pushing under the wafer between the ring and the wafer. It was weird and problematic.

My urostomy is an innie, and my colostomy is near skin level or a bit above (it varies), and I get mostly very liquid output. I find the convexity very helpful for liquid output. But if my output thickens, the convexity is a problem because it tends to stick in the "bowl" of the convex wafer and pancake. So for thicker output, I think a flat wafer may be better.

I would try a different ring because it seems like the ring makes a huge difference. I would also consider getting a sample of the Coloplast Sensura Mio deep convex wafers. These provide more convexity than the other brands and may help.

Thank you all for the advice; I appreciate it! I put in an order for Eakin ring samples, and I'm going to try out powder crusting! If this doesn't work, then I can also try switching out my wafer or try ring cutting.

Hubz reminded me this morning how the WOC mentioned the paste wasn't a good idea to fill in his low spot as it can tend to break down while rings are better at staying together. Not sure if that applies, but we did end up with a major leak (luckily at home) when we experimented with the paste.

Also, the most recent order of Hollister was changed to all CeraPlus, which has an ingredient that helps the skin. It might be coincidence, but the CeraPlus setup has been noticeably more comfortable for him, and he didn't know I changed to that version! He just said everything felt really good, like he's started to forget he has it on.

Again, this is all very recent, so there are folks with tons more experience than we have in this forum!

Have you tried using Marathon on your sore skin? It crusts and protects the skin. Maybe that would allow your skin to heal, and then things would stick better. If your skin is broken down and painful, things will have trouble adhering to it. So, if you address the sore skin first, then you might have better luck with some of the other suggestions given here.

If your wafer is thin, I'm wondering if the hair dryer blast is putting too much heat on it and adversely affecting the adhesion, thus causing the leakage.

I just rub my wafer between my hands 3-4 times before removing the protective cover.

Try using the Hollister #8815 thin ring before applying the pouch. You can make the ring to size to fit around your stomach. Try the Convatec convex pouch. You can get some sample rings from Hollister or, even if you are

in a hurry, get them from Amazon. I have had an ileostomy for 50 years and have tried everything.

Also, check to see where the nearest ostomy monthly meetings are held and attend. They have ostomy

nurses and representatives from major suppliers there. It's really worth your time to visit, and you can

join. Trial and error is not the best course. If you do, your skin will get really raw and damaged.

Good luck.

I've had very similar issues recently with my end ileostomy. I had been in a Hollister convexity two-piece and switched to Coloplast Sensura Mio two-piece. The convexity was great, but the pancaking with the Mio was way worse than the Hollister.

I switched back to Hollister but decided to use the Coloplast paste and go back to crusting. I use the stoma powder and then spray it with Cavilon skin barrier and use barrier wipes on the skin surrounding the crusting (2 layers), let it air dry well (the wafer is tucked in my bra the whole time to warm it, but you could place it under your arm), then use the paste to create a thick ring around my stoma and fill in the dip by my navel. Let it air dry a bit and place the Hollister wafer and spend about 30 seconds rubbing the wafer to make sure it's seated well. I place the bag on and then lay the pre-heated heating pad across my stomach for about 10 minutes. This has made a world of difference. If I don't double-crust (using the spray; wipes don't work on the powder for me), I have leakage and eroded skin.

Also, I find adding a barrier ring works against the convex wafer, making it too thick for the stoma to pop out. Also, try different paste. Hollister's stung and broke down, but Coloplast is gentle (no alcohol or pectin) and did the trick.

Good luck! A nearly flat stoma is so tricky!

I've had very similar issues recently with my end ileostomy. I had been in a Hollister convexity two-piece and switched to Coloplast Sensura Mio two-piece. The convexity was great, but the pancaking with the Mio was way worse than the Hollister.

I switched back to Hollister but decided to use the Coloplast paste and go back to crusting. I use the stoma powder and then spray it with Cavilon skin barrier and use barrier wipes on the skin surrounding the crusting (2 layers), let it air dry well (the wafer is tucked in my bra the whole time to warm it, but you could place it under your arm), then use the paste to create a thick ring around my stoma and fill in the dip by my navel. Let it air dry a bit and place the Hollister wafer and spend about 30 seconds rubbing the wafer to make sure it's seated well. I place the bag on and then lay the pre-heated heating pad across my stomach for about 10 minutes. This has made a world of difference. If I don't double-crust (using the spray; wipes don't work on the powder for me), I have leakage and eroded skin.

Also, I find adding a barrier ring works against the convex wafer, making it too thick for the stoma to pop out. Also, try different paste. Hollister's stung and broke down, but Coloplast is gentle (no alcohol or pectin) and did the trick.

Good luck! A nearly flat stoma is so tricky!