This topic is about dealing with stoma bleeding that might be caused by the wafer or moldable ring rubbing against it. The person experiencing this issue has noticed small spots of blood on the wafer when changing their colostomy pouch. They have tried a few solutions but are looking for more advice on how to prevent irritation and bleeding. Here are some helpful insights and tips:

1. It's normal for a stoma to change shape and size, and minor bleeding can occur because the stoma is a vascular organ.

2. To prevent the wafer from irritating the stoma:
- Keep the wafer opening slightly larger and use a moldable or barrier ring to seal the area. Stretch or flatten the ring before placing it snugly around the stoma. Cut the wafer 1/16–1/8 inch (1–3 mm) wider so the hard edge doesn't touch the stoma.
- Some people flatten the ring like "pizza dough" or cut it open on one side to fit it around the stoma, trimming any overlap.

3. After cutting the wafer, smooth the edges with your finger to avoid sharp edges.

4. If there's a dip under the stoma, fill it with ostomy paste or moldable strips before applying the wafer.

5. For irritated skin, use the powder and skin-prep method: dust the area with ostomy powder and then "lock" it in with a skin-prep wipe to help healing.

6. Consider barrier alternatives for stomas that change shape frequently:
- Try Salts Dermacol Stoma Collar or Trio silicone rings. These can be very moldable, but adhesion may vary. Using a thin ring under the wafer can improve hold.
- In emergencies, some people create temporary collars from soft materials like toilet tissue.

7. Routine skin care practices to reduce irritation:
- Rinse the pouch each time you empty it to prevent output from pooling around the stoma.
- Occasionally shower without the appliance to let the skin breathe. Hold a towel over the stoma if output is active.
- Gently wash the peristomal skin with Head & Shoulders anti-dandruff shampoo during bag-off showers. The pyrithione-zinc formula can help keep the skin healthy.

8. If the stoma is nicked during cleaning, apply light pressure with tissue and use a cool hair-dryer setting to help it clot.

9. If bleeding becomes frequent or the stoma color changes, consult an ostomy nurse. Persistent or heavy bleeding can be cauterized if necessary.