This topic is about managing frequent leaks and blowouts for someone who has had an ileostomy for over 40 years. Recently, they have been experiencing issues with leakage and need to change their pouch multiple times a day. The challenges are due to a new parastomal hernia, a stoma that has shrunk and is almost flush with the skin, and uneven skin around the stoma. They are considering whether a complete stoma revision might be necessary. Here are some helpful tips and advice:

1. Sealing and Barrier Rings
- Consider using Eakin Cohesive Seals or Hollister Adapt barrier rings to help stop leaks and even out the skin.
- If Eakin rings feel too thick, try thinner options like Sure Seal Rings or newer silicone seal rings, which some people find cause fewer reactions and have similar wear times.

2. Flange Choice
- Since the stoma is flush with the skin, switching from a flat to a convex flange or wafer might help. Many have found this change solves similar leakage problems.
- Pairing the convex wafer with a belt can help maintain pressure, and belt use might be reduced once the convex system is effective.

3. Hernia-Specific Products
- Coloplast offers a line of appliances specifically designed for people with parastomal hernias. You can contact them for free samples.

4. Supplemental Adhesives and Edge Security
- Use Skin-Tac or Torbot Bonding Cement (if you’re not allergic to latex) under the wafer.
- Reinforce the outer edge with Leukotape or similar medical tape after applying the wafer.

5. Skin and Stoma Assessment
- Schedule a visit or tele-visit with a WOCN/ostomy nurse through your supply company or hospital to:
- Re-measure the stoma opening.
- Check for any peristomal skin issues like yeast, weeping, or creases when seated.

6. Cleaning and Prep Technique
- Use UniSolve to remove all old adhesive and dry the area thoroughly.
- Apply a skin-prep wipe and sprinkle karaya powder before attaching the new wafer.

7. Belts and Support Garments
- Wear an ostomy belt around the clock, especially while troubleshooting leaks. Many options are available on Amazon.

8. General Tips
- Request multiple samples of rings, flanges, convex systems, and belts from suppliers like Convatec, Hollister, and Coloplast.
- Keep communication open with healthcare providers, and consider surgical revision if conservative measures do not resolve the issues.