This topic is about dealing with persistent adhesive failure at the top of an ileostomy appliance. The person is experiencing leaks and poor adhesion, particularly at the top edge of the wafer, which is causing anxiety and limiting daily activities. The stoma is positioned high under the right breast, and the appliance tends to pull downward due to a very active ileostomy. Here are some practical tips and advice to help manage this situation:

1. Warm the adhesive before applying it. You can use a hair-dryer on a low or warm setting to soften the flange. If a dryer isn't available, simply press a warm hand over the wafer for about 5 minutes.

2. Make sure the skin is completely clean, oil-free, and dry. Avoid using soap, wet wipes, or cleansers. Instead, rinse with plain or sterile water, pat dry, and let it air-dry for at least 5 minutes. After applying a no-sting skin prep, use a warm dryer again to create a tacky base.

3. Consider adding flange or wafer extenders or medical tape for extra hold. Options include ConvaTec Ease Strips, Hollister curved strips, Coloplast strips, pink Nexcare tape, or any elastic tape. Many vendors offer free samples.

4. Reinforce with additional adhesives like Torbot Skin Tac Adhesive Barrier Liquid or Torbot Liquid Bonding Cement.

5. Use barrier rings or protective sheets to prevent seepage under the wafer. Standard barrier rings can be placed around the stoma, and a second ring can be added underneath on the second day for longer wear. Coloplast Brava Protective Sheets can also be used by cutting a hole to fit your stoma size and placing it first before attaching the wafer.

6. Support the pouch to reduce downward pull by wearing an ostomy belt or abdominal wrap. This helps carry the bag’s weight and prevents the top edge from lifting.

7. Ensure a proper fit by cutting the wafer and any ring to the exact size of your stoma. An ill-fitting hole can compromise adhesion.

8. Take your time during changes. Follow a slow, step-by-step routine, as rushing or changing while the stoma is active can lead to failure.

These suggestions aim to improve the adhesion and comfort of the ileostomy appliance, helping to reduce anxiety and allow for more normal activities.