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Newbie needs help.....Leaking under wafer....any solutions?

Posted by stayn2busy, on Sat May 02, 2009 12:22 pm
Four weeks ago, my husband suffered a ruptured diverticulitis and ended up with a sigmoid colostomy. He is thin build (after 10 days of ice chips only)...really thin, and his stoma is basically almost flush with his skin. Every appliance we have tried since surgery, has leaked. If the whole wafer doesn't come off unexpectedly, or when we change it, there is a patty of stool under the wafer on his skin that has caused skin break down to the point of bleeding. We have tried Convatec, but he has an allergy to that tape; Hollister sent a convex ring to try and that bag just came off the next day, with a collection of stool under the wafer; yesterday we tried the eakin ring which was very moldable  and I was hopeful the solution, but it too pulled off last night on our way home from dinner. Right now we have a Coloplast shallow convex wafer on and I'm keeping my fingers crossed.  He is using the closed end, disposable bags with filters. Surely someone out there has had this problem and found the solution. We are lubricating the bags on the inside to make sure the stool slides to the bottom and doesn't collect around the stoma, but still every bag / wafer has the same problem. Our ostomy nurse at the hospital told us we'd have it figured out about the time he's coming back to have his reversal.....I want to figure this out before August. Please help!
Past Member
Reply by Past Member, on Sat May 02, 2009 4:15 pm
First off, don't hesitate to call the stoma nurses or doctors for help! They are there to help and will do so.

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.


Paul
Reply by stayn2busy, on Sat May 02, 2009 8:29 pm
I appreciate your tips. His skin around the stoma is mostly flat. On his raw bleeding skin I've been applying stomahesive powder, brushing off the excess, spraying convatec skin barrier on & letting it dry before putting on the wafer....that's what the ostomy nurse told me to do. I'm guessing you don't have any trouble with the appliance sticking when you use the maalox?? I will give it a try....it's unreal how fast the skin around the stoma breaks down. If I can't stop the stool from leaking under the wafer, I'll definitely try the coloplast wafer that you described...maybe that would protect his skin. Thanks again for your help! Karen
Past Member
Reply by Past Member, on Sat May 02, 2009 9:02 pm
The Coloplast barrier will protect his skin, but it has to be healed first. I have tried all the powders and such too, but the only thing that worked to heal the skin was Maalox. It is a vicious cycle. You need to heal the skin to get the appliance to work properly, but the appliance is preventing the skin from healing.....

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?
Reply by stayn2busy, on Sat May 02, 2009 10:16 pm
His stoma is oval, so I've been using the cut to fit and have been getting it pretty snug around the stoma.....then I thought maybe I was getting it TOO snug, so I would leave less than 1/8inch around...and still the leaking stool under the wafer. I've tried the stoma paste (what a mess) and still the leakage. The coloplast shallow convex wafer that I put on last night is still holding --- I'm keeping my fingers crossed! Of course won't know if it's leaking until it falls off or we change it and find the stool underneath   I will be getting some Maalox tomorrow. Thanks!
Reply by eddie, on Sat May 02, 2009 10:47 pm
Hey, I had this problem with my ileostomy and used the hollister convex ring and the convex barrier device, please don't be insulted but are you sure you are using the convex ring correctly, it has been my experience as a nurse that most people think it goes on with the flat sise down, anyway hope this helps
eddie
Reply by stayn2busy, on Sat May 02, 2009 11:23 pm
Thank you for your input, but yes I did have it on correctly. I'm not sure why it didn't stick, but when I used it, the whole wafer came off within a few hours. His skin is very broken down & bleeding so that may  have attributed to it not sticking. They sent me two of them, so I might try it again once I get the skin healed up. I also tried the Eakin ring and really like it too, but it too allowed leakage underneath. I've ordered some hollister convex barrier samples too. This is just so frustrating, not only adjusting to life with an ostomy, but having to deal with the bag not staying on and the skin breakdown. This forum has been great....lots of good ideas. Thanks!
Reply by eddie, on Sun May 03, 2009 12:50 am
if the skin is broke down that is a problem, what i did was dry my skin with a hair dryer set on low, them apply a layer of skin powder any brand will do be sure to blow off excess or brush off then apply the ring & barrier. Then I would hold it firmly down for a few mintes, I have also used tape around my barrier to help it stay firmly on. Another idea is too use a belt to help keep it in place, believe me I do know how frustrating this is if you can get the barrier to seal the skin will heal up fairly quickly , it is fairly painful too. Good luck please let me know if you find an idea that works, this worked for me but i did have to go to a convex ring as well as barrier too
eddie
Reply by sierragoldie, on Sun May 03, 2009 10:45 am
I have had problems with lifting wafers and here is what I do which helps...most of the time.  When I begin to change my appliance, I take the barrier ring, and the wafer, and put them under my hip to get them warmed up to body temperature.  I clean the skin, let it dry, (and especially if the skin is raw and irritated I don't hurry this process, letting the skin stay open to the air for as long as possible.)  Then I apply the powder and use the gel protectant to moisten it.  Then I put on the barrier ring positioning it as close to edge of the stoma as possible.  On top of that I put a ring of stoma paste, and the then apply the convex wafer, pressing down on the interior of the ring to insure it is a firm contact.  Then I apply latex free tape to the sides of the wafer.  Then I apply the bag, and pull up my underwear and my bedcovers and place the palm of my hand over the area and PRAY! for about five minutes.  Then, and this is important, I get up and walk around.  I think if you stay in bed and roll over to the side it puts a crimp in the wafer that will be more prown to leak.  (I call it having a blowout)  God be with you all.
Nurse
Reply by Whoa, on Sun May 03, 2009 1:16 pm
Staynbusy

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
Reply by nncc, on Sun May 03, 2009 7:44 pm
you mentioned that your husbands stoma is oval...I use the moldable wafer from convatec.  its a 2 part system and the moldable area eliminates really measuring the stoma, which i found a bit painful when my skin was flaring.  You just roll open the hole to fit the stoma and peel off the backing and stick it...it molds itself to the size and shape of your stoma....I love it becasue i really hated measuring and cutting....
Reply by stayn2busy, on Sun May 03, 2009 9:10 pm
Thanks everyone for the wonderful tips!!! That makes good sense about the skin folds when sitting and causing creases. Most recently used a coloplast convex barrier....very stiff, all pectin without tape, which he said was uncomfortable; along the edges it didn't stick, started curling up. I've ordered some convex barriers from Hollister...hopefully they'll arrive within a few days. I SO APPRECIATE EVERYONE'S INPUT & TIPS. Thanks so much!! karen
Reply by stayn2busy, on Sun May 03, 2009 9:16 pm
NNCC,
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
Reply by andyangiet, on Mon May 04, 2009 1:42 am
It took me a while to find the right bag and wafer for me. I use a two piece coloplast. It is convexity. My stoma only pokes out a 1/2 an inch maybe. I also use a belt, it really seemed to help. When my skin get really bad I use the skin barrier and powder also. I put the powder on and dab the powder with the skin prep. Let it sit for a bit and use a eakin seal that I put on the wafer part first and then put the whole thing with bag already attached on and hold it there. Sometimes it will sting but I just hold it there and get a good hold. Then I put a belt on for extra support and try not to eat or drink anything for a while so you won't have the stool coming out right away. It is tough, I went almost two years wearing the wrong bag for me. I don't have any ostomy nurses around me and the doctors would tell me to do this and that but with them not knowing much about it, they would tell me to do things that would not make the bag stick to my skin. I have to drive an hour and a half to see an ostomy nurse. If you are don't use any type of soap or body wash around the area. Even the stuff they give you from the hospital. I had one of the reps from Coloplast tell me that. It leaves a residue on the skin and for some people make it hard for the bag to stick. I feel your pain and frustration. I would cry sometimes cuz my skin was so raw and it hurts so bad all the time, another thing that work depending on what kinda of skin problems is the powder you use for you athletes feet in a yellow bottle. That helped me out clear stuff up fast, when it was raw and bleeding. I hope you find out a good solution. It is hard to function when your bag won't stay on.
Reply by funnygurl, on Mon May 04, 2009 1:52 am
Leaks are a problem for everyone I know,  and especially at the beginning.  I warm up the moldable convatec flanges and use extra stoma paste where the leaks usually happen.  Maalox does work as strange as it sounds.  Also the 4 inch skin barrier under the flange has worked for a friend who had similar skin probs in the beginning.   For some of us this is life with a permanent ostomy.  I taught high school for 2 years with an ostomy before retiring.  You have to find what works through trial and error.  Everyone's skin and stoma are different.  You are very lucky his can be reversed.
Past Member
Reply by Past Member, on Mon May 04, 2009 7:00 am
                                 
funnygurl wrote:
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.
Reply by Butterfly, on Mon May 04, 2009 8:28 am
Hello there. so sorry you are having so many problems. I'm glad you are such a support to your husband. I live in the U.K so not sure where you are, or what you can obtain.

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
Reply by chess124, on Mon May 04, 2009 9:47 am
hi you say that your husbands skin reacts badly to the convatec mouldable barriers..i would suggest that you carry on using them as they are really good at sealing around the stoma and as mentioned before..you do not have to mess about with cutting /measuring etc.. before you apply the mouldable barrier use salts peri prep wipes on the skin first ( this will create an extra barrier which hopefully your skin will not react against) let it dry for 30 seconds and then apply the mouldable barrier exactly as instucted on label(v important) hold everythind down with a warm hand for 30 seconds and you might have more luck... hope this helps you both in your endevours to get a flange that does not allow leaking... i have found the convactec mouldable flange to be one of the best ever beakthroughs in stoma care....good luck
Nurse
Reply by KBear, on Mon May 04, 2009 9:49 am
I am a stoma nurse.
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
Reply by cancerfree, on Mon May 04, 2009 9:59 am
I have the same problem, mine is flat on one side and about 1/4 " on the other and a "moat" around the stoma because it is the second one in the same place.  The only thing I can suggest is trying convex flanges if you haven't tried them yet.  A two piece would be more economical.  If the bag is only hours or a day old it can be slapped back on a new flange if you don't have insurance coverage.

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.   

Sandi
Reply by Quietdreamer28, on Mon May 04, 2009 6:13 pm
Yeah I would def suggest using an eakin. I don't use the paste because it irritates my skin but the eakin gives the needed support of the bag and sticks the wafer onto my skin pretty snug. Def use the skin barrier powder and wipes though that helps a lot with irritation.
Reply by joolz , on Tue May 05, 2009 3:58 pm
I have had this problem for many years, and every now and again i still do. The best solution for me was STOMAHESIVE PASTE, you aply that around the site as close as posible
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.
Reply by jcheg, on Tue May 05, 2009 4:10 pm
i found that eating a diet high in fruit and drinking plenty of water keeps the output very loose so it runs straight into the pouch and does not cling around the stomer. after years of constipation a loose output is a pleasure..................
Reply by keysgirl, on Thu May 07, 2009 6:37 pm
Wow...I don't have the problem or suggestions....I have a colostomy.  But I just wanted to say that all of your suggestions were so giving and loving.  I thank God for all of you and ask him to bless you for your loving, giving hearts.  Peace & Love in the Universe...Sadiqah
Reply by stayn2busy, on Thu May 07, 2009 10:42 pm
I want to THANK EVERYONE for all the wonderful advice. It has been great to find a forum where others are willing to take the time to reach out to strangers and offer support. I wish God's richest blessing on you all!! Thank you again! Karen
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