Need help with measuring and changing my ileostomy bag - skin irritation issue

Hey everyone! So I'll be five weeks post-op on Tuesday from an ileostomy, and even though I thought I was getting the hang of measuring and changing my bag (I'm a perfectionist where I actually lose sleep over things), my confidence has just been knocked as I changed my bag a few days ago and my skin is quite irritated and red. I change my bag every two days, if everything feels fine and there's no itching or stinging, but when I'm measuring my stoma I just can't get it right whatsoever. I use a measuring guide but there's either a gap at the top or a gap at the bottom of my stoma, and I assume this is the cause of the irritation.

Some questions for you: Are you having trouble changing your bag or your wafer? If there is a space between your stoma and the wafer, you can experiment with Eakin seals around the stoma to block output from burning your skin. Also, there are powders and creams available to help heal the soreness. Contact your ostomy nurse, if you have one, or the nurse at the company who makes your wafer for suggestions. Be sure to use adhesive remover wipes when removing your wafer to keep from damaging your skin from so many changes. Clean the skin with a mild aloe soap like Convatec makes or cleansing cloth that Coloplast makes. Then use a protective barrier wipe swabbing the entire wafer area—AllKare is a good one. Then I use an antifungal powder to prevent yeast from forming. Then I take another protective wipe and pat down the entire area, I remove the backing from the wafer and apply Skin Tac around the edge of the wafer. Then I use a hair dryer to warm my skin and the back of the wafer for a few seconds and then I apply the wafer to my skin in front of a mirror to try and be sure that it is positioned properly. Then I hold the wafer to my skin for several minutes to be sure it is adhering and there are no gaps.

If there are still gaps, give it another shot with the hair dryer and keep holding. Things you might try are using an ostomy belt or underwear with a pocket to keep gravity from putting too much pressure on the wafer. Try not to let your bag get too full before emptying as a full bag exerts a lot of pull on the wafer. Carry pink tape and scissors with you for a surprise leak.

I have a urostomy, so our output is different, but the wafer problems are much the same. I can go an entire week before needing a change of wafer by following the above regimen. Hope some of this will help.

Hi Gracie! Thank you so much for your reply! Some of the products you named can't be bought over here in Ireland, but my routine the last few weeks has been taking my old bag off. I use pure water wipes and give my stoma a clean. Then, I use some paper towels to dry and measure my stoma as best I can. I use some Hollister Stoma Powder, wipe off the excess, and then put a Hollister barrier ring on my wafer of my bag and stick the whole bag on together... It's more about getting the right position and making sure no skin is showing. That's my real problem.

MJC, there is little I can add to the excellent replies you have received.....I might suggest that you ask for samples of other brand products, not all of them are compounded from the same material and some work better on different skin types than others. In my experience, I had to try 3 different brand wafers before I found one that worked the best. The same goes for the skin preps. I tried one popular brand, Cavilon, that simply would not work for me. You might also try putting the barrier ring directly on your skin and gently squishing it to a very close fit to the stoma shape. The wafer itself can be a little looser fit if you form the ring close. Good luck, you will master things given a little time and patience.....just like the rest of us have. Regards, MMSH

Hi! I do suffer from the same problem as my skin can be irritated and red around my stoma. I do use a special type of powder that I apply to the irritated skin around my stoma. The powder I use is from Coloplast and seems to work for me. I may need to apply it once every two weeks depending on how irritated my skin is. It would be wise, however, to ask a stoma nurse or dermatologist to prescribe what powder best suits you just to be safe :)

From the sounds of it, you need to find a good barrier spray or barrier wipe and really crust it on the skin. Most stomas are not perfectly round, so what I do is I cut slightly bigger, and I mean slightly, and fit my whole stoma into the wafer hole. I change my bag on Monday and Thursday, and if needed, I can typically last up to 5 days or so without changing. If you don't wet the stoma powder slightly, the bag will not stick well to the skin. The less you change the bag, the better because there is less chance of ripping off and irritating the skin around. I don't even use stoma powder with every bag change because there is no need for it really. I use an adhesive remover, damp napkin or tissue, skin barrier wipe or spray, adhesive spray, put the barrier ring on, put the bag on, then coloplast barrier strips around the edges of my bag's wafer.

Hi David, thanks so much for your reply. I use the Hollister stoma powder, which I find very good for my skin. I always had sensitive skin, so I think my skin just needs to adapt to the adhesive on the bag. It just gets frustrating after a while when your skin is so irritated that you don't want to put a bag on and just go without.

Hi Maddie! Thank you so much for your reply. I have my stoma nurse coming up to me this week, so I'm going to ask her about a barrier spray because I think it would really benefit me! Hopefully, it will work.... It can be so annoying when your skin just feels irritated all the time. x

Hi MJC

I too am 5 weeks post-surgery and also now experiencing very sore skin around the stoma. It feels like a burning, stinging sensation and like it is coming from the actual stoma.

Just wondering how you are doing energy-wise and when do you think you will be back to where you were before the surgery?

Also, is your ileostomy permanent and did you need to have a pan-proctocolectomy?

Hi Fi

So great to hear from you! Hope you're doing well! I completely understand where you're coming from with your skin complaints....it's so sore and even when you move it hurts even more. I had been really sick since March 2017 so I actually can't remember what I was like before all this but I'm doing a whole lot better than I was! Hopefully I will have my stoma for a year and then have it reversed but then I need more surgery...but if it keeps me going I have no problems ‍ X

Hi MJC

Thanks so much for your reply.

I'm delighted you can have your stoma reversed in a year.

Unfortunately, no going back for me so I'd better become good friends with it, I suppose!

Hope things settle down for you soon. X

Hi Fi, well hopefully that's the plan but things could change...depends on how well I'm getting on. It will take time to become used to it as I am in the same boat but I think if it gives you more freedom and keeps you healthy that's the main thing and the most important...I really hope everything goes well for you now and in the future xx

I have had both a colostomy and now an ileostomy. My suggestion is that the stoma sticks out enough to prevent leakage through the wafer that you will be wearing. When I had my colostomy done, it was a nightmare. But now, with my ileostomy, it is much, much better - no leakage. Now, this is important: make sure you get a parastomal ostomy belt to prevent a hernia. This is nothing more than a stretchable, breathable nylon belt with an opening for your stoma and bag to fit through. Your incision will be a little sore, mostly when you are moving around or while riding in a car. Nothing major - it will get better in a short time. I can relate to your fears on surgery because in two weeks, I will be going in for the removal of my anus.... GOOD LUCK

Hey Ozzi! Thanks so much for your reply! I've started to get more comfortable now changing my bags and I'm not as hung up as I was with getting leaks... I'm going to invest in a belt because I have been hearing great things about them! I'm not as sore as I was... I'm still finding the certain ways I'm wearing clothes a bit uncomfortable, so I have started to wear things certain ways, but apart from that, I am doing okay! Really hope things are good for you in the future, Ozzi. Thank you again for your reply. x

If I drink too much pop, the acid in it starts to eat away the inner part of the wafer prematurely. If the sores are really bad, I burn them shut with silver nitrate sticks. They don't hurt too bad right at the skin around the base of the stoma, but further out you sure feel it. You can try moving away from cutting your wafer and switch to Convatech's mouldable wafer. They will lightly roll back, once applied, and fit snugly against the stoma.

The other issue I had with my skin was an allergic reaction to the adhesive but only from the tape barrier and not the wafer. That was a pain as until I figured out what it was, the tape didn't stick to my weepy skin. I now use Duoderm cut into 3 strips to frame around the wafer and that keeps it held good for about 6 days. It makes a better seal than any tape, however, the stuff is expensive if you don't have your supplies covered by insurance or your country's health care.

Lots of good advice on here, using some type of barrier ring will definitely help. Using a hair dryer to heat the ring and the wafer will also help it to stick. I also use a belt on my wafer to prevent leaks.

I found out that I was allergic to the adhesive remover that I was using. Once I figured that out and stopped using it, the irritation cleared up almost overnight. Now I don't use anything except Eakin barrier rings. They're very sticky and protect the skin around my stoma and prevent leaks.

Once, when I had taken a course of antibiotics, I developed a yeast infection around my stoma which caused a lot of irritation.

I'm going to suggest being very conscientious about the products you use. You can do your own skin patch test on your abdomen to find out if you are sensitive to things before you actually use them.

Good luck!

Three suggestions that have helped me:

1) I only change my pouch (ileostomy) as part of taking a shower. Your stoma has no problem with water, and the shower spray helps to get your skin really clean without any potentially irritating cleansing products.

2) Let your skin breathe. Give your skin a good ten minutes or more of air before putting on the new pouch - it will do your skin wonders. If your stoma is not cooperating, stand at the toilet and let output fall directly into the toilet. If your stoma is cooperating, you can hold some toilet paper under or around it to catch any rogue output. Even a little bit of breathing seems to really rejuvenate the skin.

3) Don't be afraid to pull off and re-position your pouch if you have it partially on and you notice some skin showing. Pull it all the way off and try again (assuming output is not messing things up). It seems counterintuitive, but when I do that, the pouch seems to hold even better. If it looks like there is a little gap, don't just live with it - pull it off and try again.

Thank you so much for your reply, Spinbot! That's really great advice! I will have to try some of those tips in the future....my skin's not too bad at the minute as I seem to be getting the barrier ring nice and snug around my stoma, so long may it last!

Thanks again for your reply.

I've had a colostomy for eight months now - letting the skin air a bit really helps. I also use aqueous cream to wash the stoma area in the shower. It doesn't seem to affect the adherence of bags and helps my skin. Serena (Dublin)

Thanks so much Serena! Yeah, I had a shower recently without my nag in, and I left it off for about 20 minutes, and it felt great! The aqueous cream is a great idea! I will have to try that! Thanks so much for your advice. x

Hello Jane, I have had Rosie (my stoma) for a little over 4 years now. She came into my life as a result of rectal cancer. I still remember those early days of trial and error, but we rubbed along fine and now have our routine. I discovered early on that Coloplast Sensura 2-piece system worked best for me. Also, Convatec barrier paste. It comes in a tube and I apply a bead of it around the hole I cut on the wafer. It really gives a good seal between my skin and any leakage. If I do get a wee bit of irritation, good old calamine lotion takes care of it and it dries fast. I change my bag at least once a day and wafer twice a week on average. You might also try putting a smear of Vaseline on the front of the wafer and inside the pouch. It helps things slide and clean up easier. Take care of yourself, I know it's all a bit daunting at the minute but it will get easier and you will be a dab hand in no time. Take care and God bless.

Sincerely, Gail

Hi Jane, I have had a bag since 2005. My stoma nurse measured mine and I have had no problems since. What county are you from? I'm from Mayo.

Hi, Jane. You haven't posted lately. Hope all is going well.

Ok, remember to use your skin barrier wipe. It will help the skin to be less raw. Also, you can use the stoma powder. Make sure your seal is good. I use the barrier rings because it is a better seal than the paste. Just pick the stoma hole that best fits your stoma with about 1/8th of an inch around it. Is your stoma flush with your skin? Mine is, so you might do better with the two-piece convex wafer and moldable wax ring. Hollister has a really great assortment. Call them and ask for some samples. Your ostomy nurse can help you with the raw skin as well, so be sure to call and make an appointment to visit with him or her. Good luck!!

Are you using a one or two-piece bag and barrier? You might do better with a two-piece and maybe not change the skin barrier so often, just your bag. I change mine twice a week on Monday and Thursday.

I have a colostomy, going on 2 years. I had the same problem you have. I also use water wipes. My stoma nurse told me to leave at least 1/8 between my pouch and my stoma, and make sure it is fitted tight. I take a warm washcloth, apply it to the pouch, hold for a few minutes, then cover with a dry washcloth folded in quarters. I hold that against the pouch for a while and I don't have to use a hair dryer. Also, for irritation, try using the stoma powder. After the wipes, while still wet, use the powder, then brush or use the bottle to blow off the excess. Then use a barrier. I use Adapt No Sting Skin Protective Wipes. Then another layer of stoma powder, then again the wipe, and then apply my pouch. Nothing else. It took 3 changes to heal my skin, every 4 or 5 days. Now I can go 6 or 7 days between changes. Make sure the area is completely dry before applying your pouch (It sounds funny). I have a small piece of cardboard I fan back and forth to help dry the area.

I hope this helps.

Hello, I'm new to the group. My operation was in January, and my stoma completely retracted around April, so I don't have anything to measure but a hole, which is an approximate calculation. Unfortunately, my skin had moments that were bloody and extremely irritated. My nurse used a protective ring, which was much worse when I took it off. So, I spent 24 hours without a bag or anything. I cleaned with antibacterial soap, and then applied Desitin maximum strength. My skin recovered like new, no more irritation. So, I change the wafer on Mondays and Thursdays. I take it out, clean the area, shower, and remove all adhesive residuals with no sting universal remover from Hollister. And I make sure I have at least 2 hours without a bag and apply just Desitin in the area, including the whole area covered by the wafer, using one dry disposable washing cloth and my underwear so it wouldn't move, and then apply a new wafer. Oh, and before applying the wafer, I use Cavillon non-sting barrier film. I had the one-time applicators, but now I have the spray. Just make sure that everything is air-dried before applying the wafer, otherwise, it would not stick. If there is anything else I can help with, please do not hesitate to ask me anything.

Good night!

After applying my pouch, I use a warm washcloth folded twice into a square, hold it against my pouch, then a dry one for a few minutes. This heat seems to work great. I don't have to use a blow dryer.