Second, is the skin surrounding his stoma flat or recessed? If it is recessed, there are wafers that will fit into that area.
Third, is the appliance not holding onto the skin because the skin is irritated and weeping? If it is, he can soak in a tub with no appliance on and sooth the skin. Then dry it off with a soft towel and apply Maalox (yes, the stuff you drink for stomach upset) to the irritated skin with cotton balls and allow it to dry. You can help it dry with a hair dryer. Then you can apply the appliance.
I also use Convatec products, but my skin is so sensitive that the adhesive they use wreaks havoc on me. So in between the wafer and my skin I use skin barrier made by Coloplast. The Coloplast part number is 3210. This is a 4"x4" barrier and they have other sizes.
I have had weekends that were just a pure hell because my skin got so irritated. Once, I went through a dozen appliances in less than a day. eeeek. Call the hospital where his surgeon works. They usually have someone from each department on call during the weekends so someone will be able to help you with this. Plus they will also notify your doctor and the stoma nurses and keep them up to date.
Another question. Are you buying the wafers already cut to his stoma size or are you cutting the hole out yourself? Is it a tight fit around the stoma?
Great advice from everyone.
I would add: check what happens to the stoma when hubby is in a sitting position. If it is flush, often there are creases at 3 and 9 o'clock . If this is the case, prepare the skin as you did (powder, dust off, No Sting skin prep or Cavilon....or if using Maalox I would do it short term and stil prep it after).
At the 3 and 9 o'clock creases, place a small piece of Eakins (about 1/2"long) and push into place to make skin contact. Caulk where it meets the stoma at 3 and 6 o'clock. I'd cut the opening no more than a sliver larger than the stoma. Use your convex wafer and you can add an Eakins if you like. Whatever 2 piece pouch you use, add a belt, should be fairly firm which will help pull the edges down for a seal. Have your hubby lay down with hand over appliance a good 20 minutes before getting up.
Sometimes convexity works for flush stomas, sometimes you find a more flexible appliance does the trick with the fill ins. The problem with the flexible appliances (ie, Microskin or Coloplast has some very flexible ones also) is that they don't usually have belt loops.
I would continue working with his stoma nurse. My first couple of tries with educated guesses can fail too, and I try to add what I need.
Hopefully his skin is mostly just irritated around the stoma? Occ. people get contact dermatitis from the skin barrier itself and the skin basically falls apart and weeps...causing leaking. You would know if this is the issue by the pattern on the skin; skin will appear red or weepy/blistered in the exact pattern of the offending irritant. If this is the case, switching brands is suggsted. I have patch tested skin in the past, no reaction, but with entire appliance on over period of time, the skin has reacted. Just wanted to check if this was ruled out.
Fingers crossed you get this solved.
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
I just used my first moldable barrier sample ---and I must say it was very nice not having to trace & cut. If this one prevents the stool from leaking under the barrier, I think I would like to use them, definitely much quicker. The one I just put on is from Convatec, and unfortunately, his skin really reacts to their adhesive, but it was the only convex barrier I had. Thanks for your input, this site has been so helpful!!! karen
|Leaks are a problem for everyone I know|
Not for everyone! I had an issue after I went to a permanent ileo, but only for a weekend. Once I got it straightened out, I've never had a leak again and it's been several years. I also lead a VERY active lifestyle and have even slipped a few times when working on a car and scraped my belly down the lip of a car's trunk, right over my stoma, and still no leaks.
If you accept that there will be leaks, well, then there will. If you find a solution/routine that works for you and stick (pun intended!) to it, you will have an easier time of it.
Edit: In my experience, the powders and wipes and such are not for me. The less substances that I can put on, the better the adhesion and the easier it is to change. All I use is a Convatec two piece and the Coloplast barrier and it couldn't be easier, and my skin is good.
Lots of people are letting you know how they deal with this so I thought I would put some input into this with my situation.
I have leaked so badly I have virtually become a recluse at some times, only going out if I really had to. I was changing my appliance up to eight times a day.
I have just been away, staying in an hotel and had two leaks in that time. (I took my own bedding and protective under-sheet just to keep my mind at rest!)
Unfortunately my stoma nurse at the hospital, although a nice lady, did not help me and I ended up trawling the web and phoning round myself. I use convatec two piece....stoma nurse only tried one piece with me. I use a larger size bag at night. I change the flange bit every twenty four hours if I haven't had to renew it before that.
To remove an appliance I use Lift Plus Medical Adhesive Remover 5502. No need to rinse with water after as it does not affect anything new sticking so great when out and about.
Before applying new appliance I spray with Cavilon (I think you use that) and use one of those little hand held battery fans to quickly dry it off.
I cut my own flanges and press in a Combihesive Disposal Convex Insert S7627. This is a hard, white plastic ring that slightly changes the shape of the Flexible flange Convatec S7203...this has helped a lot. A tad difficult to put in the first few times, as it looks the wrong size... but you soon get the hang of it.
Someone else mentioned they use a belt which I find has helped 90%, especially since I lost weight and have a much flatter tummy. I use a standard Convatec one at night which clips onto the tabs at the sides of the appliance ring.
During the day...and this is what has made a huge huge difference ...I use a belt called a Sash Hernia Support belt. (I got this through the Covatec help line.) It's a wider belt fastened with Velcro as tight as needed and it has a type of plastic disc that sits over the flange bit and it helps the stoma protrude further out than it would (mine is completely flat if I don't use this.) I know it's a hernia belt but wow...what a difference it's made to my life.
I use Adept Lubricating Deodorant to make it slippy inside the bag and add a squre of Absorba gel to turn liquid to something more solid once it has left the body.
I'm maybe not very clear in explaining and if you have any more questions please let me know and I will try and help more. It's all been a case of trial and error over the last four years till I am happy with my regeme now.
I'm glad your husband may have a chance of a reversal in August but hope between everyone we can help make life easier long before then.
Good luck...let us know how you get on....regards Butterfly
In response to your leakage problem.
Rule of thumb-
If you have a soft flabby belly or jelly belly, then use a hard appliance
If you have a hard belly then use a soft appliance.
Examples of hard appliances are typically two pieces, some with convexity
Examples of soft is typically the one piece appliance.
For a retracted stoma, that tends to leak-you must have a convex appliance. I also recommend using an eakin Ring (convatec). Usually also put this person in a belt. Often use a hernia belt. Some folks will get an abdominal binder, and cut a hole in the binder for the pouch to come out of.
The eakin ring is a modable ring, it is easy to mold it to fit the size of your appliance.
You must put the ring on the appliance before putting it on your body. The ring will rest around the stoma and form an extra strong border. The correct process to apply the ring is to first press down the edges to the flange, pinching the edges to close them tight. Like you are squeezing the edges to-gether, so no stool can get inbetween the ring and the appliance.
I do not like to suggest using skin prep, unless there is skin breakdown.
These new products do not really require any skin prep.
If all else fails you can use stoma glue or stoma bond. This is a product I use often with Urostomies. Again, I do not like to use this on Ileostomy or Colostomy unless REALLY nothing else will work. It is hard on the skin.
Hope this helps some. Kbear
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Nurse practitioner
* Bachelor of Science in Nursing
Although I have had some luck with the coloplast barrier sheets for seals I think the eakin seals give better protection for leaks since they are thicker and they take longer for the stool to break them down. I don't know what your husband's diet is like but he should try and avoid acidy foods and caffeine as much as possible.
Also, if there are any crevices around the stoma they can be filled in with the coloplast barrier tape. Just rip off a piece to fit it. I have better luck by actually placing it on the flange instead of my skin. Just be careful that you place it properly when you attached the flange to your skin. You could try putting a strip of it around the ring of the flange, approximately 1/8" from the edge. Putting it too close to the edge will only cause it flow through the hole of the flange and will block the stoma's output causing it to pool even more.
I'm sure you do, but make sure that the area is clean and stool free before placing the flange on. I know this is difficult if you happen to spring a leak when the stoma is active. There have been times when I have had to stand there for 20 minutes and just keep wiping it while it is running so that I can eventualy get the flange on during a "quiet" time and once or twice I just put an huge thick towel on the bed and laid down with a roll of toilet paper and a plastic grocery bag till it stopped running enough.
Eating a marshmellow or two once or twice a day will help thicken his stool also. I was told of this trick by one of the ostomy reps. Also great when you want a change (without a leak or have a shower or bath without the flange). Eat them 15 to 20 minutes prior to taking the flange off.
There have been more than a few times when I have had to literally run out of places or back to my car because of leaks so I know what it's like to always have that fear in the back of your mind . Unfortunately you have to drastically limit your exercise, sit ups and anything that affects that area of your body are OUT!! Recently I've started just laying on my back and do leg lifts just to stretch my lower back and try and rebuild some of the muscles there. Walking is good but I've learned not to spend too much time out in the cold for at least 24 hours after applying a new flange; the cold seems to break the seal between the skin and flange if it wasn't cured enough.
In bed, it would be best to lie in a position that is half way between lying on your side and lying on your stomach . This will help the stool to sort of drop into the bag instead of pooling around the stoma . The ostomy belt does make a big difference as mentioned previously. Hopefully a reversal is in the future or perhaps the surgeon can do a reconstruction. You didn't mention if there was a medical reason for the flat stoma. Myself, have large adhesions that prevented my stoma from being pulled out any further.
You also might want to change to a brand that has the convexity built in, one less thing to deal with when speed is required. I use the convatec moldables and they are great. They also have the belt loops on the bags instead of the flange which provides more security also. Refusing to accept there will be leaks will not eliminate them. believe me. This is not a matter of mind over matter. It's a matter have a shitty stoma (no pun intended).
I saw the stoma nurse at Mount Sinai back in January and was told that I was already doing everything possible to prevent leaks without having a reconstruction done. Unfortunately, sometimes they become a way of life. Watch what you eat if you are leaving the house. The nights when I have service or class, I make sure I have pasta for dinner, the starch helps a great deal. I've had this one for almost 4.5 years. It does get better when you accept that this is part of you and part of your life. Feeling sorry for yourself only makes it harder to deal with.
I hope you find some relief from my reply.
and then put your appliance on, you will find that nothing will go through the seal of the paste. If the skin is red or weeping dry it and you can put the paste on to it, it may sting a little but not for long and the benefits and results should be good.I also found that the skin also starts getting better as the paste is keeping anything from going on there. I hope this is of some use to you as it helped me a great deal, and still does. JOOLZ.