This topic is about managing colostomy leaks for a young man who is dealing with severe kyphosis, which causes his body to hunch over. This posture creates a deep fold in his abdomen, making it difficult to keep the colostomy pouch in place without leaks. Despite trying numerous products and techniques, the issue persists, leading to skin irritation and frequent pouch changes. Here are some helpful tips and insights shared by others who have faced similar challenges:

- Eliminate air gaps under barrier rings by removing the backing, applying a Salts Aloe Ring, and using an empty tape spool to press and seal the ring flat.

- Ensure the stoma and its placement are adequate. The stoma should protrude at least ¾ inch. If it's poorly sited in a fold, surgical re-siting might be necessary. A surgeon or WOC nurse should evaluate the type of colostomy, as irrigation might be an option for sigmoid or descending sites, potentially eliminating the need for a pouch.

- Apply the wafer while the patient is in the posture that causes the fold, usually seated. If the fold is rigid, build up the hollow by cutting a barrier ring in half, stretching and rolling it into "clay" cylinders, and packing it around the stoma to level the surface before applying a two-piece barrier.

- Choose high-adhesion convex systems and extenders. Some users have found success with Coloplast SenSura Mio (soft or deep convex) for its strong adhesive properties. Convatec light or deep convex Durahesive pouches have also been helpful. Reinforce with Coloplast Brava Elastic Barrier Strips or Hollister CeraPlus Barrier Extenders. Experiment with different wafer orientations, such as square versus diamond.

- Protect and heal the peristomal skin first. If the skin is broken, nothing will stick. Use Marathon or 3M Cavilon skin protectant before applying the wafer. Brava Protective Sheets under a Convatec pouch can shield fragile skin. A "skin-soak" drying prep (stoma powder + barrier spray) may improve adhesion. For pain and weepy skin, apply 2% Lidocaine gel for 5 minutes, wipe off, then clean and dry before pouching.

- Manage output volume and consistency. Eating bananas and taking scheduled loperamide (Imodium) 90 minutes before meals and at bedtime can help thicken liquid colostomy output. Consider formal irrigation if the anatomy allows, to minimize daily output.

- Reach out to manufacturers like Coloplast, Convatec, Hollister, and Salts for free samples, adhesive recommendations, and remote WOC nurse consultations. Keep requesting trial products until a reliable combination is found.

- Remember, persistence is key. Many have found that with continuous experimentation, guidance from a knowledgeable stoma nurse, and the right convex system, even severe fold-related leaks can be managed. Keep testing different configurations until you achieve an acceptable wear time.