This topic is about managing a loop colostomy three weeks after surgery, where the patient is experiencing persistent minor leaks beneath the wafer and irritation around the stoma. Here are some helpful suggestions and insights to consider:

1. Re-measure the stoma regularly, as its size and shape can change quickly in the initial weeks after surgery.

2. Take a photograph of the stoma and send it to your ostomy nurse. This can help them make necessary adjustments before your next appointment.

3. If there is a shallow dip under the stoma, fill it with stoma paste. Remember, paste is meant for filling dips and grooves, not for sealing leaks on flat surfaces.

4. Consider whether using barrier rings is beneficial for a low or retracted stoma. Adding height with a ring might shorten the spout and increase leakage. Some people find better results with just a soft convex wafer.

5. Persistent leaks from a retracted or irregular stoma might require surgical revision to bring the stoma further out. An ostomy nurse can provide advice, but only a surgeon can make anatomical corrections.

6. For skin care:
- Clean the area with a soap that is free of dyes, fragrances, and lotions, such as a Cetaphil bar. Rinse and dry the skin thoroughly.
- Use barrier film only if the skin is already irritated; otherwise, skip it to improve adhesion.
- Consider using products like Marathon or 3M Cavilon Advanced Skin Protectant on damaged skin for extra protection.

7. For applying the wafer:
- Warm the wafer with a hairdryer on low heat before applying it.
- After placing the wafer, press it for about 2 minutes, then wear an ostomy support belt for around an hour to ensure a snug seal.

8. Try changing the appliance while lying down. This position can help the stoma protrude slightly and flatten any abdominal creases.

9. Reach out to various manufacturers like Salts Healthcare, Coloplast, Hollister, and Convatec for free sample kits. Different convex depths, moldable wafers, or cut-to-fit systems might better accommodate an irregular stoma.

10. Avoid packing or filling the mucus separation without surgical guidance. Most separations heal gradually once leakage is controlled.

11. Long-term control of leaks is unlikely without an adequate spout. If conservative measures do not work, pursue a surgical assessment, even if the referral process is slow.