This topic is about managing an ostomy appliance when you suspect a contained leak. The person sharing their experience often deals with leaks by the end of the day, but recently woke up with one, leading to skin irritation and frequent appliance changes. They are unsure whether to change the appliance early or risk further skin damage by waiting. Here are some helpful insights and advice:

1. Change your appliance immediately if you feel a leak, as burning or itching usually indicates one. Delaying can cause more skin damage.

2. If you're changing your appliance 1-2 times a day, it might be a sign of a fit or product issue. Consider getting an assessment from a Wound, Ostomy, and Continence Nurse (WOCN) or an ostomy nurse.

3. For high output:
- Replace large amounts of plain water with Oral Rehydration Solutions like Hydrolyte or Liquid IV, and sip no more than 4 oz at a time.
- Try cutting back on coffee and reducing total fluid intake. Add foods like milk, yogurt, protein, applesauce, oatmeal, bananas, rice, and pasta to thicken the output.
- Discuss with your doctor the possibility of using loperamide (Imodium) or acid-reducing medications like omeprazole.

4. For appliance fit and application:
- Ensure the barrier ring fits snugly around the stoma. Some prefer it flush, while others leave a small gap.
- Warm the ring and wafer before applying, and hold them firmly in place.
- Check the tension of your belt; it should not be too loose or too tight. Some people avoid wearing belts while sleeping.
- Consider using a double-ring technique with a Hollister 2-piece system.
- Use adhesive-remover spray or wipes to remove the wafer gently.
- Clean the area with non-moisturizing soap and dry thoroughly.
- Use non-sting barrier films to improve adhesion and soothe the skin.
- For raw skin, try using hydrocolloid barrier extenders before applying the wafer.

5. Product suggestions and alternatives:
- Consider trying different products like Coloplast Sensura Mio Soft Convex, Hollister 2-piece systems, or Salts Convex one-piece.
- Request free samples from companies like Coloplast, Hollister, and Salts to find what works best for you.

6. Positional and clothing tips:
- Side-sleeping with a leg pillow can help prevent pooling. Avoid tight waistbands and consider using suspenders instead of belts.

7. Skin care and healing:
- Allow your skin to air-dry when possible. Use stoma powder only for broken or weepy skin.
- Consider using zinc ointment or antibiotic cream, but make sure to wipe it off before applying the barrier.
- If burning persists, check the pH of your output. True bile is alkaline, so an acidic burn might indicate excess gastric acid.

8. If leaks continue despite trying these tips, schedule an evaluation with a certified ostomy nurse and a gastroenterologist to explore possible bile-acid malabsorption and to reassess your appliance fit.