This topic is about managing some challenging issues after having an emergency colostomy. The person who shared their experience is dealing with several problems related to their stoma and is looking for practical advice to make things better. Here’s a breakdown of their situation and some helpful suggestions:

- The person had emergency surgery in March due to a large part of their colon being necrotic. They now have a permanent colostomy instead of the preferred option of reconnecting the bowel.

Current challenges include:

1. Persistent leakage: Standard flat appliances aren't working well. A convex one-piece bag with wide-arc flange extenders offers some relief, but the stoma's position near the navel makes sealing difficult.
2. Retracted or sunken stoma: The output doesn't drop into the pouch, and attempts to fix this with air, pleating, and lubricants haven't worked.
3. Thick, sticky stool: This makes emptying the pouch hard. Rinsing helps but uses up supplies quickly, and insurance only covers 20 bags a month.
4. Skin breakdown around the stoma.
5. Complicating medical conditions: Chronic dehydration, congestive heart failure, and kidney failure limit fluid intake, and meals are reduced to once daily.

The person is seeking advice to improve the appliance seal, manage thick output, and protect their skin.

Additional context:

- The surgery was done at a medical center in Beaver, not at UPMC.
- Due to heart issues, the person spends most of the day reclining, usually on their side.

Advice and insights offered include:

- Consult an ostomy nurse for:
- Assessing whether the stoma is truly retracted or if it's normal movement. Surgical revision might be needed if it's genuinely recessed.
- Confirming the type of stoma and the exact length of the colon removed.

- Appliance and skin-care tips:
- Ensure the wafer's opening isn't cut too tightly, as irritation might be due to an adhesive reaction rather than contact with output.
- A convex system is suitable for a recessed stoma. Use it with barrier rings or stoma paste and wide-arc flange extenders to improve the seal near the navel.

- Emptying technique:
- Gravity helps; try to sit or stand upright, even briefly, when emptying to help the output fall away from the stoma.
- Warm-water pouch rinses are okay and shouldn't cause skin problems if done correctly.

- Positioning:
- If medically allowed, spend short periods upright to aid pouch drainage. Prolonged reclining can cause stool to pool on the stoma.

- Medical follow-up:
- Clarify whether a total colectomy was performed, as an ileostomy behaves differently and produces thicker output if fluid intake is limited.
- Heart and kidney failure may require sodium restriction. Discuss with the cardiac/nephrology team how much fluid and electrolyte replacement is safe.