Topic Explanation:
The discussion revolves around the challenges faced by a new ileostomy patient, Josh, who prefers sleeping on his side but experiences leaks almost every time he does so. Despite trying various equipment and adjustments, including different brands and types of ostomy barriers and wearing a belt, he still faces issues with leaks primarily when sleeping on his side. His output is described as very liquid and acidic, which he suspects might be contributing to the barrier breakdown and subsequent leaks. Josh is seeking advice on how to manage or eliminate these leaks to improve his sleep quality.
Advice and Helpful Insights:
1. Sleeping Position Adjustments:
- Consider sleeping on your stomach with one knee raised to create a gap between the ostomy bag and the mattress, which can help prevent the output from pooling around the stoma.
- Try sleeping on the non-stoma side with the belt tightened for better seal maintenance.
- Use a pillow under the knee to create a semi-side sleeping position that might help reduce leaks.
2. Equipment and Application Techniques:
- Ensure the skin around the stoma is completely dry before applying the barrier and bag. Using a hair dryer can help achieve this.
- Apply pressure with your hand on the barrier for several minutes after application to improve adhesion.
- Consider using products like Eakin seals or ostomy paste to fill in any gaps or creases around the stoma, despite some ostomy nurses advising against paste due to potential skin irritation.
- Experiment with different types of barriers, such as those with deeper convexity, to see if they provide a better fit and reduce leaks.
- Check if the stoma protrudes enough (ideally at least an inch); if not, consult with a surgeon about possible revision.
3. Dietary Adjustments:
- Use Cholestyramine to thicken the output, which can help manage the liquid consistency.
- Eating marshmallows can also slow down the output temporarily.
4. Protective Measures:
- Place a protective pad on the bed to simplify cleanup in case of leaks.
- Use skin protection products like Marathon for sore or irritated skin around the stoma, and consider alcohol-free barrier films to protect against friction and fluid.
5. General Tips:
- Give your body time to adjust to the ileostomy, as the stoma size and skin condition may change, affecting the fit of the
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