This topic is about dealing with persistent bleeding and poor adhesion around an ileostomy stoma. The person who shared their experience had emergency surgery and has been facing challenges with keeping their pouching system attached. Recently, they have been experiencing heavy bleeding at the skin-stoma junction, which causes pain and makes it difficult for the wafers to stick. Despite multiple hospital visits, a solution hasn't been found. They are currently using stoma powder to dry the area and are seeking advice on how to heal the wound while still using a pouching system.

Here are some helpful tips and insights:

- Check the size of the wafer opening and when you measure it. Measure the stoma at its widest point and cut or choose the hole size accordingly. A hole that is too tight can cause bleeding, while one that is too loose can lead to leaks. Keep some wafers or bags with only a starter hole so you can custom-cut them to the current size each time you change them.

- Add cushioning and sealing with barrier rings or seals. Use convex or flat barrier rings or seals to protect the junction between the skin and stoma and improve adhesion. Some options include Coloplast Brava Protective Seal, ConvaTec Eakin Seals, or other convex barrier rings if the stoma is flush or retracted.

- Use the "crusting" technique for damaged skin. Alternate light layers of stoma powder with a barrier wipe or skin prep to create a protective crust over irritated, weeping skin before applying the wafer.

- Strengthen overall adhesion step-by-step:
1. Thoroughly remove all residual adhesive from the previous wafer.
2. Let the skin dry completely (a hair dryer on cool or warm can help).
3. Apply skin prep if tolerated.
4. Place a barrier ring or seal around the stoma.
5. Dab Skin Tac (adhesive wipe or liquid) on the outer skin where the wafer tape will sit.
6. Apply the wafer (consider convex or moldable styles—ConvaTec and Hollister both make moldable barriers).
7. Warm the wafer with a hand or hair dryer and press gently for 1–2 minutes.
8. Add barrier extenders or strips around the wafer edge for extra security (straight strips from Coloplast, or extenders from any of the three major manufacturers).

- Try different barrier formulations if the current ones fail. A weak wafer adhesive can be the entire problem, so experiment with other brands or stronger adhesives once the skin is healthier.

- Avoid excessive rubbing when cleaning, as this alone can trigger bleeding.

- Document the problem for clinicians. Take photos of the stoma and surrounding skin at different times, and of the removed wafer’s back surface, to help nurses or surgeons see what is happening between visits.

- Seek specialized help. Arrange an appointment (in person or virtual) with an ostomy nurse. ConvaTec offers free virtual nurse consultations. If local staff are unhelpful, contact the original surgeon’s office, send photos, and request a review.

- Aim for a typical wear-time goal during healing. Change the wafer every 3–4 days until the skin settles; longer wear times can worsen irritation.