This topic is about managing the challenges of dealing with acidic, leaky output from a stoma, which can cause severe irritation to the skin around it. Here are some practical suggestions and insights to help manage these issues:

- Stoma Shape and Revision
- Ideally, a stoma should protrude about an inch. If it's flush or retracted, it can lead to leaks and skin damage. Consider consulting an ostomy nurse for convexity options or a colorectal surgeon for a minor revision if the stoma remains at skin level.

- Convexity and Sealing Shallow Areas
- Try using convex wafers along with an elastic support belt to maintain pressure on the convexity.
- Fill any "dimples" with barrier materials like barrier rings, paste, or sheets. These can be trimmed and layered to create a level surface.

- Product Sampling and Brands
- Explore different products such as Hollister two-piece systems, Coloplast SenSura Mio, and Brava paste and powder. Consider using 3M Cavilon no-sting barrier spray or swabs, and belts like Nu-Hope for support. Cetaphil unscented soap and Head & Shoulders shampoo can help soothe irritated skin.

- Topical Skin Routine to Calm Acid Burn
1. Remove the appliance and gently clean the area with a water-dampened soft paper towel.
2. Optionally, shower using unscented, lotion-free soap, avoiding hair-product rinse water over the stoma.
3. Dab the area dry and apply a thin film of 3M Cavilon or a similar product.
4. If using the "antacid method," pat a liquid antacid onto the red skin and let it dry. A mild burning sensation for about 15 seconds is normal.
5. Fill any dips with Brava paste or barrier sheet pieces, dust Brava powder on weepy areas, and seal with another light coat of Cavilon.
6. Warm the new wafer before applying it to help it mold to the body, and hold firm pressure for 10–15 minutes.

- Medication and Dietary Ideas
- Consult a physician about bile-acid–binding medication like Cholestyramine, which can thicken output and reduce acid burn.
- Review your diet for acidic triggers such as alcohol, soda, and certain foods, and ensure you stay well-hydrated.
- Eating a few marshmallows before changing the appliance can help slow output.

- Belt Options for Leak Prevention and Hernia Support
- Thin retention belts can help keep pouches secure. Wide Nu-Hope belts with a plastic ring provide constant pressure over convex wafers and are available in various widths for additional support.
- Specialty belts like the Stealth Belt are available for sports, and the StomaGoggle can be used for showering or swimming.

- Paste Purpose Clarified
- Remember that paste, such as Brava, is not an adhesive but acts as a caulk to fill gaps between the stoma and wafer, preventing acidic output from reaching the skin.

- General Tips
- Always request free samples from different brands like Hollister, Coloplast, and ConvaTec until you find the right combination.
- Aim to change the appliance every 3–5 days once leakage is controlled, as frequent changes can perpetuate skin injury.