Barrier Spray for Ostomy Care: Pros and Cons?

I'm getting conflicting info regarding barrier sprays. I had my first couple of colostomy bag leaks this past week. The first was after an appointment where the ostomy nurse decided to try a different/convex product because of the inflammation around my ostomy. The nurse used stoma powder on the edge where there was still some separation from the surgery, then barrier spray, beneath a convex barrier ring and a flat plastic flange. The next day I had my first leak beneath the seal and under the edge. It was disturbing and inconvenient, though luckily I was home and had all my gear in the bathroom when I found it was leaking.

I changed the whole set-up but discovered the skin was now irritated and raw. I called Hollister to ask why it might have leaked and was told not to use barrier spray with the Cera-ring, which I had never been told by the ostomy team. I started to have painful stinging with even regular activity, as if the bag was pulling on my skin. When I changed the set-up three days later, I had more redness around the ostomy, so I contacted an ostomy nurse who said to try an antifungal powder with barrier spray next time I changed the flange.

There were now ulcerations on the skin around the stoma, very painful stinging and stabbing sensations, so I tried the stoma powder and antifungal powder with barrier spray, but two days later experienced another edge leak that was both painful and inconvenient. So I went back to the Cera-ring, stoma powder without barrier spray.

I finally am going in for my appointment with the ostomy care department this morning to see what it looks like after all this, and I'm super frustrated with my ostomy nurse and wish I could see someone else, but they keep scheduling me with her.

What is your experience with barrier spray vs. no barrier spray regarding leaks? What about ulcerated tissue? I'm tired of being in pain and also would like to move confidently in my life without having leaks.

G-Day Andrine,

I use Hollister and have no problems, but that's me. You need to get all the companies to send you samples and try all of them to find the right one for you. Trial and error.

Regards, IGGIE

That doesn't answer my questions regarding barrier spray.

Let's see if I can clear up some confusion because I think the situation is complicated and you are getting a full explanation.

If you use any powder at all, stoma powder or fungal powder, you must use barrier spray or wipes to seal the powder. If you do not do this, the adhesive will not stick well and you will have leaks, which will damage your skin.

I did not know that one should not use barrier spray with a cera-ring, but I will not presume to argue with Hollister about that. However, there are other kinds of barrier rings, and you should certainly use some sort of barrier ring. Without a barrier ring, you are likely to get leaks, which will worsen your skin condition. The Hollister nurse should have told you that.

Now that your skin is irritated, it will be very difficult to get a good seal with your appliance. You are going to have a bit of a rough time until you can get your skin healed. You must use stoma powder and barrier spray or a protective barrier of some sort to heal your skin.

I think your stoma nurse will have the most insight. If I were advising, I'd suggest going back to the non-convex appliance or switching brands altogether. I'd also switch your barrier ring.

Ultimately, after your skin heals and you no longer need stoma powder, you can omit the barrier spray if you want. There are people here who do not use it routinely.

Personally, I like barrier spray/wipes and use it most of the time. I've never liked the cera-rings. I use a different kind of barrier ring.

Edit to add: I may be confused about what rings I use because I went to get pictures; it wasn't what I thought. I use the Hollister Adapt rings and have never had a problem using barrier wipes. The rings I don't like, which I thought were cera-rings, are actually Eakin seals. Those are always disintegrating on me. I have not tried a wide variety of rings, so someone else may correct me. Suffice to say, it seems ridiculous that you can't use barrier spray with any of the rings, and your ostomy nurse is probably more reliable than whoever you spoke to at Hollister.

Thanks, Susan. The initial leak occurred when I tried a different company/product.

I didn't have a leak when I used stoma powder (brushing off the excess) without the barrier spray. I guess I'm not clear as to why the flange adhesive doesn't stick well to the barrier spray. I thought that was the point of it.

How to Manage Emotions with LeeAnne Hayden | Hollister

That is the point of the barrier spray. You are spot on. I think you had a problem with the different appliance, and it had nothing whatsoever to do with the barrier spray.

There, I said it. I was trying to be so politic, but that simply doesn't work.

Hello andrine23.
Thanks for sharing your experiences and inviting us to participate. 
The problem is that many people react differently to different products, which is why IGGIE suggests trying many products from different manufacturers until you find one (or more) that suits you. I have tried most makes of barrier spray and have had no problems with any of them. However, the wafers on devices are a different matter and I have had all sorts of problems with them. This was such a problem at first that I decided to make my own baseplates and secure them with prosthetic glue. This worked for me and I have remained with that method until the last month when I was invited to take part in a trial of 'new' bags.
Being someone that I will 'try anything once', I agreed to take part in the trial. The outcome for me was a mixed bag of for's and against's. The main drawback was that several of the bags did not stick on the lower circumference of the wafer, which seems to me to be the most important part.
Because I irrigate and have little or no output during the day, this did not pose me a problem. However, I did report back that I thought this would be a major problem involving 'leaks' for many ostomates.
I do hope you will experiment until you find something that is functional for you. 
Best wishes

Bill 

I've never used barrier spray or wipes and have very healthy skin. Sometimes less is best. I believe in using things if you need them. My own view is to just use things when there's a problem. Once it's healed, stop using the product until, if needed, again in the future.

I use a Hollister bag and flange with a Salts ring with aloe and a barrier wipe. I often get 10+ days before changing it out.

Hubz had leaks when trying convex wafers, recommended because his stoma is flush with the skin. Every configuration leaked, some with barrier rings, some not.

Success eventually came with stoma powder only on red areas, Cavilon barrier spray over that (thanks to a recommendation from this group), Hollister barrier ring built up on the low side closest to the bellybutton, and cut to fit 2-piece flat Hollister drainable, changing out twice a week at the recommendation of the Ostomy Nurse.

The skin has been happy and healthy for weeks now (knock on wood), so it's not likely we'll be changing anything anytime soon!

I hope you find what works for you soon. This group seems to have seen it all and is always willing to help!

I use Hollister 7805 rings - I tried the Cera rings and found they fell apart. After I wash my skin, I apply Brava barrier cream (my skin gets dry, so cream is good). After it soaks in, I put antifungal powder or stoma powder depending on how my skin is doing. Then I use Cavilon skin protector, which I dab on - I tried barrier spray but didn't like it. After I finish putting my appliance on, I hold it against my skin for a minute or so to make sure everything is holding well. It's all trial and error to find what works for you. If my skin is irritated, I apply cortisone cream, antifungal cream, and lay down for 20 minutes to let it absorb into my skin, then wash off with Cetaphil cleanser. I only do the cortisone if my skin is bad - it's not good to use it too much as it can thin your skin. I cut my appliance as close to my stoma as I can - about the thickness of a dime - if I have too much room, my skin gets damaged.

I'll get backlash for this, especially from one member, but here it goes. I contacted Hollister when I first got my ostomy about barrier spray/wipes. They replied with…don't use barrier spray/wipe unless you have irritated skin. So, I contacted my ostomy nurse and asked her since she never really mentioned anything about it. Her reply was that they used to recommend using it because the sticky part of your setup was very tough on your skin because of what it was made out of. But nowadays, with improved ingredients, she doesn't recommend it unless your skin is irritated. Now, some on here swear by it and use it every time they change their stuff. Do they really need it? Who knows. Having confidence in whatever you use for your ostomy setup is huge, so getting someone to change their opinion is difficult. Personally, I used it when I first got my ostomy, but after those replies, I haven't used any barrier spray/wipes in years and haven't had any skin issues. I think the product is a personal choice unless needed. Not a direct answer, just my experience and opinion.

For what it's worth, my routine is

1. Cavilon barrier spray

2. Salts Aloe ring

3. B. Braun convex bag

No problems.

Alex's reply is the closest to what all the major companies are now recommending. I've been a WOC for 20 years, and many companies said to put skin prep/barrier spray on everything every time, and then it changed to just when using powder.

Education tip: every brand wafer is a version of a hydrocolloid (replicate/deuoderm/second skin bandages). The hydro in them is meant to hydrate your skin and absorb moisture from your skin to protect it—that's why it turns white and swells when you see the back after a few days. All stoma powder is… is wafer ground up into a powder. It's a hydrocolloid powder. So I say all the time—there is no magic in this powder that a good wafer alone won't heal, but a wafer won't stick to moist/raw/weeping skin—that's the only time powder is needed. If I'm using a super thin layer, I may or may not dab skin prep on it—depends on how thick I need it or how weepy the skin is. Hollister cera is different because of the lotions built in, so they say not to use skin prep.

Most ostomy brand skin prep is now silicone-based, so not as thick. The other brands are sometimes so thick they leave a plastic polymer layer on your skin, and now the hydrocolloid that's meant to grab dead skin cells to get a seal is sitting on a slick layer of plastic film—I rarely recommend them unless there are really raw areas we are sealing, and only for a short time (like Cavilon or Marathon). Sounds like you need

1. To find the right fit

2. Heal your skin—I would tell you to help get your acidity back to your skin to strengthen it—Vashe soak on a paper towel for 1-2 minutes (Amazon or Walgreens) or, if really weepy, Domboro soak (OTC) to stop the weep.

Then dome OTC Flonase/basic pet is water-based and works as a low-dose steroid to calm angry skin. (Stop using once healed—just for occasional use.) Let it dry, and if still weepy, then stoma powder and wipe away excess or cool hairdryer to dry, and if it looks dry, then no skin prep. If it's weeping back up, then use the skin prep to crust.

If you can get a seal, then skin should heal after a couple of changes—try adding a belt to really hold the wafer on while the skin is healing and plan to change more often to treat the skin until healed, then figure your routine.

There are other ostomy nurses with different experiences and now companies that will do virtual visits on Zoom—yes, it can be done and be very helpful and effective for helping get a different perspective and in your home—just Google it.

Good luck… I'm so sorry you're going through this, but I'm glad you're seeking help.

Your advice is excellent whenever I see it. You give people a choice. As for backlash, I ended up blocking someone because it got creepy. It's okay to disagree, but we all get to pick what's best for each of us. I like that you don't feel the need to be right all the time, which means you have wisdom.

I do not have experience with the spray, but I do have experience with rashes, which I think are not uncommon considering a background of colitis, which is an autoimmune disease.

I have managed to control the rashes by giving the stoma area time to air out when I am changing equipment. I usually find some reading or some chores to do in the bathroom and can leave the stoma naked during a quiet period. And when rashes do develop, I try to use a small amount of hydrocortisone cream, which seems to be very helpful.

I use skin barrier spray at every change of the appliance. In this routine

1. Remove old appliance and use adhesive remover spray or wipes to loosen glue

2. Wash the whole area well with Hygenia wet wipes (hospital recommended), being sure that all extraneous material from the stoma is cleaned off

3. Spray skin barrier film around the wafer area and WAIT until it is completely dry (about 11 seconds).

4. Apply the wafer/appliance; I usually use a bit of M9 deodorant in the bag.

Hi, this is Jennifer. I'm so sorry to hear that you are having problems. Firstly, I want to say that I am only giving information from experience, not medical. BARRIER WIPES VERSUS SPRAYS: I have never used the spray, only wipes, but there is a trick to it. After cleaning the area, I ONLY ever use water. Let the area dry, starting at the top of the stoma, extending slightly into the stoma. Wipe in a continuous movement, either clockwise or anti (it doesn't matter which) around the whole stoma, then without removing the wipe, continue out to where the flange finishes. Don't change direction, as it can remove what you lay down.

PART TWO

Hi, this is Jennifer. I hit the submit button before I finished. After the barrier wipe dries, put on the ring, then the bag. Try to make sure that you warm the ring and bag before applying; pop it down your bra before you start the whole process. Regarding the "ulcers," check with your stoma nurse that they aren't granulomas. The acid in your output could be causing this, and they are a pain. They can add to leakages as they are raised, and output leaks out between them. Stoma powder can increase these, according to my stoma nurse.

IT'S A GOOD IDEA TO TAKE A PHOTO OF YOUR STOMA BEFORE YOU GO TO THE NURSE OR DOCTOR; it may get you out of having to take your bag off.

BEST OF LUCK

I experimented with many devices, and my peristomal area was raw, sore, and bleeding. My ostomy nurse put me on an antibiotic stoma powder called Nyamyc. It cleaned it up. Barrier spray oversprayed and made a poor seal. I found that the pads from the big three don't have enough liquid to properly dissolve the powder. My RN put me on Cavilon wipes. Lots of juice in it. Not covered by med. insurance, bummer.

I hope you are using an adhesive release spray or wipe as you take off the appliance. Pulling an appliance off without this help is going to abrade the skin and hurt.

I use a skin barrier every time I put on a new appliance. Let it dry completely.

Thanks, everyone, for the detailed information. Yes, I always use the adhesive removal wipes when I remove the appliance. I usually shower with the wafer off and let it air out as much as I can, but I don't get to control my output, so that's sometimes a messy challenge. My ostomy nurse looked quite concerned when we changed it in their office last Wednesday due to the increased ulcers and blood; they applied stoma powder, barrier spray, AquaGel Ag antimicrobial, and DuoDerm to "bandage" the wounds. I was offered a (thin) belt for the first time (8 weeks out) and have been wearing it some, though I usually use an ostomy bandeau to hold things flush with my belly. I had another leak on Saturday with that setup, right where the "bandage" was applied. I'm guessing because the flange didn't stick well to the barrier spray and DuoDerm.

It is so exhausting to do a huge unplanned cleanup and change mid-day because I'm also recovering from shoulder surgery (which is why I have an ostomy - due to opioid-induced bowel rupture 10 days after shoulder surgery), and my arm is still very sore. I applied the same AquaGel Ag and DuoDerm "bandage" to try and heal the tears in my skin. I ended up in the ER with severe abdominal pain on Sunday, and though there were no hernias or obstructions, they discovered a UTI (E. coli) infection and put me on antibiotics and bed rest until the skin heals. I've been moving at sloth speed since to avoid ripping open the skin ulcers and changing everything every 2 days instead of 3 or 4. It looked better yesterday - I didn't use the "bandage," just stoma powder, barrier spray, and a barrier ring under a convex flange - and I have an appointment tomorrow, so we'll see how it looks then.

I'm so tired of being unable to do anything but lie around and move super slow so I don't tear myself open :( Only 3 months ago, I was hiking in the Olympic Mountains with my 5-year-old grandkiddo; now I can't get out of bed without pain. I hope this is all a temporary setback and I will be able to get out in the world again.

Hello Andrine

If you are prepared to experiment, there have been people here who have applied 3M micropore tape to their skin first, then applied the appliance as normal after that to give the skin an opportunity to heal, and it worked for them. Some have also used flange extenders for the same thing, just to get some relief and let the skin begin to heal until you get a handle on your setup.

Hi Andrine,

As long as your skin is in such bad condition, you are going to have trouble with the appliance sticking. This is a temporary thing. It will get better.

If the narrow belt they gave you is one that attaches to the flange, it will help keep the flange attached to the skin. You should wear this at least until your skin heals. It will let you move a little more freely. If I'm right about what you mean by bandeau, I think that could be worn on top if you like.

It is tough going from being very active to sick. I promise you will get better. Be patient and kind to yourself while this gets resolved. Take things slowly and you'll be hiking again.