This topic is about dealing with the challenges of sealing a flush, downward-facing ileostomy using a Coloplast Sensura Mio convex pouch. The person is considering switching from a barrier ring to Coloplast alcohol-free stoma paste due to ongoing issues with skin irritation and leakage. Here are some helpful insights and advice shared by others:

- The ileostomy was created 3 weeks ago, and the current setup includes a Coloplast Sensura Mio convex one-piece pouch. The stoma is almost flush with the skin and points downward.

- The current routine involves using multiple layers of stoma powder and a liquid skin barrier (a method known as "crusting"), followed by a barrier ring and then the pouch. However, this has led to painful, irritated skin and leakage issues.

- The person is considering using stoma paste instead of a barrier ring. They have Coloplast alcohol-free paste, which is chosen because it doesn't sting like alcohol-containing pastes, but they find it thick and difficult to spread.

- They are seeking tips from others who use only paste with a convex appliance.

Here are some suggestions and insights:

1. Applying stoma paste:
- Squeeze the paste onto the wafer or flange around the cut opening. Moisten a finger to smooth it out, apply the wafer, and press gently with warm fingers. Wipe away any excess paste that squeezes through, as warmth helps set the paste.

2. Barrier ring techniques:
- Pinch the inner edge of the barrier ring into a shallow wedge before placement to guide output over the ring rather than underneath.
- Trim the wafer so that less than ⅛-inch of skin is exposed, and position the ring right against the stoma.
- Keep crusting layers to one or two light coats, as a thick, crumbly crust can prevent the ring from sticking.

3. Skin protection alternatives:
- Marathon cyanoacrylate skin protectant can replace repeated powder/skin-prep layers. Apply a single thin coat only.
- Nu-Hope non-adhesive barriers are designed for severely irritated peristomal skin.

4. Paste tips for sore skin:
- Dab alcohol-free paste on individual sore spots with a Q-tip if a full bead is unmanageable.
- Be aware that paste is harder to clean off the skin than rings, so remove it gently and patiently.

5. Product comparisons:
- Hollister barrier rings are firm yet moldable, and Hollister Adapt stoma paste has a toothpaste-like consistency but contains alcohol.
- Coloplast alcohol-free paste is thicker and denser; warming the tube or kneading it may help with flow.

6. Positioning issues:
- If the stoma orifice points directly at the skin or ring, there are device options to deflect flow upward, though the product name is not recalled.
- A very flush, downward-facing stoma may continue to cause management difficulties, so consulting an ET/WOC nurse about revision or alternate convexity is recommended.

7. General advice:
- A fresh ileostomy at 3 weeks may still change shape, so professional follow-up is advised to address stoma height, orientation, and skin integrity.