Topic Explanation:

The discussion centers around a person who is 9 weeks post-surgery after a Hickman procedure, dealing with a painful stoma fissure. The individual has a convex stoma bag due to the stoma being initially recessed. After gaining weight post-surgery, the stoma has protruded slightly, but a small, painful hole has developed where feces occasionally exits. The stoma nurse suspects a fissure but has not provided a clear course of action. The individual is not restricting their diet and is seeking advice on managing the pain and the fissure.

Advice and Insights:

1. Consultation with Healthcare Professionals:
- It is advised to see the surgeon as soon as possible for a professional evaluation of the stoma and the fissure.
- Consider seeking a second opinion or another stoma nurse if the current one does not provide satisfactory advice.

2. Understanding the Condition:
- Clarification is needed on whether the issue is with the size of the stoma or if there is a separate hole causing the problem.
- It is important to differentiate between a stenotic (narrow) stoma and a fissure.

3. Managing Pain and Discomfort:
- The use of Eakin Cohesive Rings is recommended for protecting irritated skin around the stoma. These can be shaped to fit the stoma and help improve comfort levels.
- Regular communication with the stoma nurse is crucial, especially if the pain increases or if there are changes in the stoma's condition.

4. Emotional and Physical Adjustment:
- It is normal to feel distressed and lack confidence when dealing with new stoma-related issues. It is important to not blame oneself for these complications.
- Adjusting to the presence of the stoma and managing its care can be challenging, but support from healthcare professionals and community forums can be beneficial.

5. Practical Tips:
- Frequent bag changes may be necessary due to high output and to prevent skin irritation from feces sitting in the bag.
- Monitoring the condition of the skin around the stoma is important to prevent further complications.