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Space between stoma & wafer

Posted by iMacG5, on Fri Mar 01, 2013 4:28 pm
Hey fellow ostomates, there’s so much knowledge here and I would love to put one issue to rest.  I think there should be no space between the stoma and the wafer.  If there is any gap (any bare skin showing) it should be protected with a barrier film then filled with paste or a seal similar to an Eaken Seal.  Maybe some rely on the barrier film alone to protect that space. If that works, great, but I’m not taking any chances.  What’s the verdict?
Reply by gee07, on Fri Mar 01, 2013 7:27 pm
iMacG5, (Mike)
Yes, when fitting a flange or wafer you should cut the hole so it is close as poss., to the stoma outside edge but to take care you don't cut it too tight as it will be sitting on the stoma, perhaps. That's not a good thing for the stoma. Yes some of us use a filling in paste(I do) while others use washers. It just depends on what works for each person.
Hope this helps.
Reply by gutenberg, on Fri Mar 01, 2013 9:53 pm
Great post Mike, I don't know where this space thing came from but with an Ileostomy where you have air and liquid involved and if you have more than a third of the pouch filled and if you bend over you can get what I would call an hydraulic effect and any opening is exactly where the force will be applied, and it only takes a small opening to force the contents under the wafer and then you're only hours away from a blowout, if you're lucky that is. maybe with a colostomy one could get away with a tiny bit of space, I don't know, I only have an Ileo. Thanks for posting that. Ed
Reply by Penguins7, on Sat Mar 02, 2013 12:56 am
Mike,  You bring up a very valid point and i totally agree that the wafer should be cut as close as possible to the stoma.  Is the paste easy to remove or does it take some work when changing the wafer?  Penguin
Reply by gutenberg, on Sat Mar 02, 2013 5:29 pm
Hi Rod, I know your question was directed to Mike but I'll just jump in here and Mike can answer when he has time. When I first arrived home with my new Ileo I remember oh so well cutting and trying to fit an oval stoma and using paste to fill in the blank spots and having nothing but a mess on my hands and had to change so frequently. It took me quite a while to figure out you could get the wafers cut to size and also that there was such a thing as Adapt rings, that's a Hollister brand name and I also found out from the company not to use skin prep as it did something to the adhesive on their products. But here I should add, people are all different, for instance, some could not use Hollister products at all. I have tried many different types of products and found the two piece exactly what worked for me and with the two piece the flange is on first and you can see what is filled and what isn't before putting on the pouch. And with the ring put on first you dont have to be so accurate when putting on the flange, just try to keep it approximately centered and you're good to go. Hope this helps and good luck, Ed
Reply by iMacG5, on Sat Mar 02, 2013 8:26 pm
Thanks for jumping in Ed.  Though I have a colostomy I agree with everything you wrote.  Paste is messy and it's difficult to clean off.  My preference, so far, is the Eaken Seals. I roll about a half of one between my hands until its about an eighth inch in diameter.  Then I flatten it using thumbs and index fingers so it's about a quarter inch wide and long enough to go completely around the stoma.  I position it right against the stoma and  just break off the extra and save it for next time.  Then I cover it with the wafer which also goes against the stoma without squeezing it.  I've had no leakage or skin problems under the wafer so far.  I am having some allergic reaction to the adhesive surrounding the wafer but we're working on it.  
Good luck to all and let's always share.
Sincerely,  Mike
Reply by Cecille, on Sun Mar 03, 2013 12:33 pm
This is one of the most importants posts I have read on this site.  It needs more people from the UK to make comments as we seem to have different products here than you people in the States, etc
Reply by iMacG5, on Sun Mar 03, 2013 1:20 pm
Hi Cecille.  I tried to send  a bunch of email addresses to you but I'm not able to. Next best thing is to advise you to look up the web site.  It shows a picture of what I tried to explain.
Then you might try the site, the, the,, and site.
What I remember from my last geography class is the UK is a pretty big island.  Just kidding, but my point is, there must be many services similar to ours.  Hope this helps.
Good luck and thanks for joining us.
Sincerely, Mike.
Reply by TB Cat, on Sun Mar 03, 2013 1:27 pm
Everyone is different. What works for me is to cut the wafer opening about 1/8 inch larger than the stoma and use a Hollister Adapt ring. I mold the ring to just fit the stoma diameter and try to get it fitted just right. I then install the wafer and press on it so the ring is tight around the stoma for a good seal.
Also, during installation, I use a hair dryer on low heat setting to soften up the adhesive on the wafer as well as the Adapt ring. A few hours after installation I check for the "mushroom" effect of the ring which tells me I'm in good shape.
I use Cymed Micro Skin one piece pouches and change every 6 days with no problems. The Cymed pouches are awesome in my opinion. They allow me to shower in between changes and also have a secondary seal should a leak occur. This can give you a few hours to get to a place to change if you have to.
Reply by Cecille, on Sun Mar 03, 2013 1:56 pm
All the best, Cecille
Reply by Snookis Mum, on Sun Mar 03, 2013 3:59 pm
I have an ileostomy, and use a Coloplast one-piece, with a Nu-Hope barrier ring. I put quite a lot of Stomahesive directly around the stoma, which seems to protect it even more. I usually get a full week out of my bag - probably could get more, but don't. I seldom have skin issues, so this seems to work.
Reply by Snookis Mum, on Sun Mar 03, 2013 4:02 pm
TBCat - what is the "mushroom effect"? I have never heard of it.
Reply by vikinga, on Sun Mar 03, 2013 5:09 pm
I also remember the 1/8th inch space between stoma and ring being the rule but I have now found that a close fit works for me.
I use a convex precut with a bit of paste around the lower half. I do usually use the skin barrier prep to help protect the skin. My skin is uneven around the stoma, hence the convex, but that has been changing so my bags tend to only last 3-4 days. Also, the paste tends to have solidified more and come off easier if the bag has been on for at least 2 days.
Does anyone here have the stoma in the middle between where the belly button used to be and pubes? It tends to present some different issues.
Reply by TheresaM1, on Sun Mar 03, 2013 6:13 pm
Sorry so late here...  Anyway, yes, an eighth of an inch is recommended.  The reasoning behind this is that the stoma swells and shrinks during peristalsis.  As the stoma has no nerve endings, it wouldn't be possible for you to tell if the stoma is "choking."  I guess if you fit your opening when you know your stoma is at the max, you could get away with this....
Reply by gutenberg, on Sun Mar 03, 2013 7:14 pm
Well now, its good to have a couple of different opinions on how much space one should have, but in the end, what is right is what works for you and when you have a system that gives you the protection and confidence you desire, I'd say best to stick with it. Where I have an Ileo and if I left an 1/8 inch gap that works out to 1/4 inch, 1/8 on each side, top and bottom and I know that is a sure way to guarantee a breakdown in a hurry. Now when I remove my flange I always check the back of it to make sure I'm not letting anything get by. So to each his own and may we all stay dry, Ed
Reply by Penguins7, on Sun Mar 03, 2013 9:14 pm
Ed,  What ever works and if it isnt broken dont try and fix it.  I thought the comment about the stoma expanding and contracting was interesting.  Sounds like another part of the anatomy.  What would cause the stoma to exppand and contract i guess is my question?  Penguin
Reply by Cattypex, on Sun Mar 03, 2013 10:08 pm
You know, I have an ileo and my first stoma lay right along an older surgery scar. The wafers never laid right and I had "fill in" with paste - but that never worked great for me. Convex flanges helped, but it wasn't until 2002 when I had to get my ileo revised and the stoma moved to the other side that the products (Hollister) worked really well for me.

I don't use paste anymore - it seems to compromise the seal, and is a gigantic pain to get off the skin when I change my stuff every 5 - 7 days. One thing that really helped was to make sure and get the smallest appliance possible for my stoma, and cut the hole almost the same size (after this long, I can eyeball it and get it right every time).

Another thing that helps me: when I change flanges, I peel off the old one, wipe everything down till it's clean skin with a warm, wet paper towel, swab it off one more time with a wet paper towel, then dry the skin thoroughly with more paper towels. NO SOAP!!!!  Paper towels (or paper napkins in a pinch, snitched from a hotel restaurant, ha ha) work MUCH better than any fabric I've used.

I can do the whole operation, from cutting the flange hole to clipping up the bottom of the bag, inside of 10 minutes now, as long as my guts are not putting out a bunch of stuff during the process. I rarely have skin issues anymore, unless I get lazy and leave it a day or two too long (you will know, your skin will itch and burn).

Good luck! Everyone has their own issues, and their own solutions. Hopefully some of mine are helpful!
Reply by iMacG5, on Mon Mar 04, 2013 5:14 pm
Thanks to all of you for your input.  Most, if not all, of us are still learning and the best educators seem to be our fellow ostomates.  The movement of the stoma during peristalsis should not require the wafer to be oversized and allow bare skin.  The paste, Eaken or other seals have some flexibility.  I don't think the wafer is that rigid that it will cut into the stoma during peristalsis which really takes place behind the stoma.  Having written that, it seems there are people who do exactly that (cut it larger) and don't have problems.  Though I can't imagine it, I'm still learning and anxious to learn more.  Thanks again to all.
Reply by hockey, on Mon Mar 04, 2013 6:28 pm
HI!!! Cecille; Ihave recommened a product that i have been using around the edges of my wafer (COLOSTOMY)--- It is called NEX-CARE - tape  I have been using it four about --3-- years it helps to keep the wafer secure to the skin it is 100% waterproof i use it scuba diving, swimming in the ocean  jumping rope dancing and any other activity that will make the skin perspire  --It also gives you confidence that you won't have leaks or blowouts-----
Reply by tim1948, on Mon Mar 04, 2013 10:01 pm
Great topic and information.  Q.  The skin around my stoma has some spots (10:00 O'Clock and 4:00 O'Clock) Where the skin is like GONE.  A small hole is there, and underneath I can see pink stoma or bowel.  It hasen't gotten any worse in the 4 yrs I've had my stoma,  but does anyone out there have this same problem?  It wasn't like that immediatly after my surgury but apeared about a year later.
Reply by iMacG5, on Mon Mar 04, 2013 10:42 pm
Hey tim,  I think a WOCN (Wound, Ostomy, and Continence Nurse) would be the expert to take a look and properly advise you.  Based on what's been written here I'm certain there are others with similar skin conditions and, hopefully, they'll respond.  Call the local WOCN office and set up an appointment.  My experiences with them were great.  Good luck and thanks for being involved.
Reply by iMacG5, on Tue Mar 12, 2013 11:28 am
vikinga, my first was a transverse loop colostomy, dead center ABOVE the naval.  I had to fill the naval with stomahesive and smooth it out using a wet finger.  Then letting the "patch" dry I applied the wafer and all was good.  It's now an end colostomy and the stoma is about 1 1/2 in. left of the naval. It's better.
Good luck,
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