Wafer fit around stoma - snug or loose?

Sorry all, I'm having a hard time leaving this post.  There's been so much excellent advice given and I think we're all on the same page but I'm not positive.  Larry, you've done so much great work and I'm sure lots of folks have benefitted.  When you refer to EXCORIATED SKIN and placing the wafer in a diamond or square orientation, we readers need to know this has to do with the adhesive at the perimeter of the appliance and has nothing to do with stoma output or how much space there should be between the stoma and the wafer.  At the risk of you all telling me to "shut the #%@& up", I must repeat, "Any unprotected skin will become damaged if contacted by discharge from the stoma".  Protection can include Cavilon spray and the like, paste, Eaken seals or similar stuff.  Larry, you are 100% correct in your assessment of the surrounding adhesive situation.

Thank you all for your patience.

Mike

I have had two surgeries on my ileostomy since August, the last being in December, so you can imagine it being raw plus extra wounds under the adhesive area of the bags. But I am noticing for the first time really red angry skin plus red blisters. So I have been cutting the wafer larger and none of the commercial pastes or wipes have helped, leading me to think of when my kids were young (late 70s!) and nappy rash. I bought a jar of zinc and castor oil cream my pharmacist made up for me, as apparently it isn't used anymore, but voila, it's working. Good clean dry skin and an application of cream on the red areas provide instant relief. Happy new year xx

Yup! That's what I used in the past when I had some problems with redness close to the stoma. I would plan ahead for my change and not eat or drink for a few hours before bed, so when I got up in the morning, I was basically "cleaned out". I would then remove the appliance, do my normal wash and clean routine, and then use the medicated baby ointment, massaging it into the skin. After that, I would sit back and relax, letting the skin breathe for a few minutes with a hand towel in case I got a gurgle. Then I would apply my new barrier. And when I would change the next time, the redness would be gone, good as new!

Sigh. If this posts twice, chalk it up to my challenges with a brand new computer (as in set up today). I liked what others have said about cleaning and putting ointment on skin with sores. Babies get diaper rash from poop. So do we, under similar conditions. I have had success with Neosporin, with Eakin seals, and with a $10 tube of Convatec's Sensicare Protective Barrier 3. Got it on Amazon. Maybe you can find it cheaper. One application seems to do the trick. But consistent skin and stoma care and cleaning is a must. If you see red spots, you deal with them before they become blisters or sores.

And while you're waiting for the skin and/or ointment to dry, let me help you with the second problem. Take a piece of paper--printer paper or any clean paper. Take your scissors, take a mirror, if need be, and position it so you have a good view of the stoma(s), and channel your paper doll skills. Start with a small cut in the paper and look at the stoma(s), cut and look, cut and look until you have a cut-out shape that resembles the shape of your stoma. When you can place the cut-out over the stoma WITHOUT ITS EDGES TOUCHING THE STOMA, you are golden. Take that cut-out, place it on a piece of cardboard, brush a pencil over it, cut out the cardboard, and compare your cut-outs. They must match. That becomes your pattern. You'll need to play paper dolls regularly to be sure you have the best fit as the shape(s) of your stomas change.

I've been plagued with edema and some prolapse since about the second month of my first colostomy. I've researched all over the web and not found a satisfactory answer WHY prolapse happens. But I have a theory. What has happened to me is this. I favored Convatec supplies. I also cut the fit too tight. The hard plastic-like material occasionally scratched the stoma. Normally when I get a scratch, it bleeds and clots right up, stopping the bleeding. (1) This is not possible with stomas, because they maintain a mucus-moist environment (2) The chemo can cause problems with bleeding and (3) It's easy to scratch the stoma and not even know it, because there are no nerve endings to let you know you've irritated or hurt the stoma. So you have to be observant. And you have to be very gentle cleaning and shaping flanges or anything else around the stoma. Because, if you irritate it blood just keeps coming to try to salve it over. My first prolapse was overnight, and about the size, shape and color of a lobe of my liver. No pain, just a LOT of hassle getting that fixed without surgery. The prolapse that caused my second surgery was completely different. I had what most guys would brag about, complete with a bluish head on the end. That was what caused the need for a surgical repair.

On the subject of cleaning, here is what I've learned in the last 9 months. I was using baby wipes. A home health nurse said that's a bad idea, because the chemicals can mess with the stoma's natural secretions. She suggested using (I kid you not) white Viva towels moistened with warm water to clean the stoma and the skin around it. She also said to wash your hands before touching the stoma or the skin, and wash after (naturally).

When I had so much trouble going through as many as four flanges and bags a day because diarrhea was flooding the flange and dissolving the adhesives, I had to resort to Imodium A-D. It firmed up the output and made cleaning the bags out and cleaning the flange area SO much easier. And I had less irritation to the skin. Again, I found really cheap generic Imodium on Amazon ($4 for 2 bottles of 200 tiny tablets). One of my nurses fussed at me for making the cut too big. Of course she happened to come after I had made the first attempt to cut the flange to fit the two ostomies. But the problem was not helped by the fact that my flange's wax-like collar had melted away from the hot output of the stoma, so I had a LOT of skin showing and some sores, of course.

Lastly, I'll give you a tip to help with the pain of pressing and pressing and pressing until the bag snaps to the flange. Convatec bags seem to adhere more securely, but boy can they hurt! When I left the hospital that second time, they gave me a few large floating flange two-piece units. The ring is attached so you can get under it to snap the bag to the ring, instead of pushing the bag until it snaps to the ring adhered to your abdomen (or hip or wherever). And the self-lock drain pouch is great. I fold and lock it, and never unlock it, but take the bag off at the top and drain it from there. The top opening is bigger and easier and faster to clean. This may seem common sense to you all, but it took me about 8 months to figure this stuff out. May it help somebodies! And may we all look to a fabulous 2014! Joyous New Year.

Thanks, I appreciate the effort you put into your reply. I am going to try to trace the stoma as you said. Also, I have found that salt bags suit me more because they have a skin-sensitive range, plus the elastic-shaped tape to put around the flange to help stop leaks. I have been a bit unlucky; I followed to the letter my stoma nurse's advice and went for pre-cut flanges and then slightly enlarged the hole to allow the various shapes, etc., the ileostomy stoma does as it evacuates, but the output terribly irritates my exposed stoma and surrounding skin. I am kicking myself; I never put two and two together and realized that it corresponds each time to directly after my chemo. DER! The chemo changes the acidity and it's corrosive, and me, an ex-nurse! But it isn't my area of expertise; I worked in the ER (well, that's my excuse and I'm sticking to it lol). So thanks to everyone for your help, and I hope you all have a happy, healthy new year.

After many trials, I found the best suited for me was the Convatec convex mouldable wafer. I do not need the convexity, but it seems to fit best. There is no need for paste strips, paste, or eakinseals. It has the longest duration than any other I've tried and have never had an accident with it. I also use the large output bag due to large amounts of fluid from the ileostomy where others just can't seem to hold the weight without bursting through the Velcro closures or leaking.

Having worked for a dermatologist for 15 years, I've gotta tell you.... Ivory, Dial, and Safeguard are some of the harshest soaps you can get. Dove is one of the gentlest.

I obtained a device from www.InnovationByYou.com which attaches to the belt loops.
It works pretty well but is only available in Europe.

Hi Anoniem18, could you possibly send me the link and the item details (name or code) so that I can look at it online and possibly purchase one as I have a cousin who is coming to Australia in the next few weeks so she could get it for me, thanks and much appreciated in advance. Lorraine.

You might be able to manufacture one out of reasonably thick hard plastic.
Ed

Just thought I ask, does your stoma nurse have a stoma? So whatever works for you ...

And you want to avoid at all cost having your stool come into contact with your skin. And how many stomas does your stoma nurse deal with.

I have found that I listen to people who make suggestions, do some research, and then do what I think is best for me. It has worked surprisingly well for me.

BTW, there are 6 million people in the Toronto area and 95 people with a stoma on this site, do the math. I have dealt with more stoma issues since April 2012 than any stoma nurse in the area. I think they do tremendous work and I was glad to have a nurse come to my house every week, but your health is your responsibility and they are there to help you accomplish that.

Good luck

Ed

Hi, sorry to take so long answering. I have been very unwell in the hospital for weeks, but I'm not saying that for sympathy (I can hear all the groans! LOL). I was in for over a month and am on a break for two weeks, then back in for further surgery on my stoma. They have to relocate it and remove more of the ileum. I will be in for about a month as they have booked me into intensive care to be in an induced coma for approximately a week. Then I go to the ward for rest and recovery and some rehab before I go home.

Just wanted to say thank you to all the lovely people out there who have been a friendly ear, shared a joke, or opened their hearts to me. A sincere thank you.

One last word on the skin problem and bags, etc.

I changed back to Hollister two-piece. I alternate between one-piece bags one month and drainable the next, which is convenient for going out. The one-piece midi opaque sit nicely under any clothes and don't suddenly make an inconvenient appearance.

I have been using some extra products which some people may find useful. I buy Hollister stoma skin wash. It is color-free, pH neutral, and has no moisturizer, so no problems with adhesion, and it calms the skin. (It isn't designed to lather). I also buy Cavillon spray, which I use after I have washed and dried the skin, then spray the whole area that is the stoma and the surrounding abdominal skin with the Cavillon spray, and it works. The wipes are good for the stoma itself, but the spray is perfect for under the wafer. Lastly, Hollister also makes a medical adhesive spray. The first thing I do is cut the wafer, remove the backing, place it on some ceran or clear plastic wrap (anything really that won't stick), and turn it adhesive side up. Spray sparingly but making sure the whole surface is covered (I use my fingers to evenly distribute it, but then you need adhesive remover immediately to clean your fingers or you will stick to everything, trust me I've done it!!). Wait five minutes and then apply it to the skin. It works perfectly and remains in place for 3-5 days. You can leave it longer, but if you have sensitive skin, I wouldn't recommend it.

Thanks to one and all. I hope to be back online asap. Lorraine

Forgot to say, Hollister also now does a cap that can cover a stoma for showering, etc. Good luck.

I have been cutting my own holes recently because the company sent the wrong size. My stoma is not a circle, more oval, but not a symmetric one. Do I need to leave a millimeter around the stoma? I have a sore area below my stoma, unsure if this is from the flange. My nurses seem reluctant to let me put anything on it though.

Unrelated to the topic, but how long does it roughly take a stoma to calm down after op? I am still on a no fiber diet but my output is constantly watery and my stoma never seems to stop. It's been almost 8 weeks now.

I hope everything goes well in the hospital. I worry about my stoma a little as it protruded a lot at the top and left but is quite shallow at the bottom and right, causing problems when I try the non-convex bags. There is just so much to learn about life with a stoma, and about all the bags and products available.

I use pre-cut wafers....why can't you order them?

Hey Scord, not sure you got an answer to your question.  You know, we seem to take things for granted when all is going well and we forget we were once in desperate need of help.  I hope I can help.  If the sore area is very close, almost touching your stoma, it's from the stuff coming out of the stoma making contact with bare, unprotected skin.  If it's a centimeter or so away from the stoma I think a change in your prep can help.  I try to allow no space between the stoma and the flange without "choking" the stoma and I use Cavilon barrier wipes on the skin surrounding it.  The sore needs to get healed and there are lots of folks here to tell you how to accomplish that.

Good luck,

Mike

Hi tudibird.... If you don't use, please try a barrier ring. It goes on before the wafer, tight around the stoma, then the wafer. It's a buffer between your skin and the wafer. I finally tried it and now will not bag up without one. If you get the moldable kind, you stretch it to fit your stoma.....truly a blessing in my case.

Tracy

If you have an ostomy nurse, listen to her....not all home nurses are trained or knowledgeable in ostomy care as a whole or the basics....hope your nurse changes it for you tomorrow. Take your supplies and moldable ring, ask her to walk you through the fit and cut before you leave her....keep us posted, hun.

I’m about 5 weeks post op and also down to 1 1/8”. I’ve done cut to fit Hollister for the entire time until today. I tried a sample of  ConvaTec moldeable wafer today. I’m not sure I got the opening correct and wonder if it’s too snug. 

On a side note, the barrier ring is super helpful with skin breakdown. Also using the “crusting” method with stoma powder and barrier film cleared me up in a week.