This topic is about managing the challenges of having a very small, retracted stoma, often referred to as an "innie," along with a concurrent fistula. The person dealing with this situation is experiencing frequent leaks, skin irritation, and odor issues, which are making life quite difficult. Here are some helpful tips and advice to address these issues:

1. Consult a Specialist
- Seek an appointment with an ET (Enterostomal Therapy) nurse or a wound-care specialist. Many insurance plans cover these visits, which can be done at home or in a clinic. They can provide professional fitting, measurement, and product selection to avoid the trial-and-error approach.
- Ask your surgeon to help coordinate ongoing ostomy care.

2. Consider a Convex System
- A convex wafer or barrier ring can help push the stoma outward, directing output into the pouch rather than under the wafer.
- Contact manufacturers like ConvaTec, Hollister, and Coloplast for free samples of convex products.

3. Improve the Seal
- Ensure the skin is clean and completely dry before applying the appliance, as ointments or lotions can interfere with adhesion.
- Use Stomahesive Powder on raw skin, then "crust" it with a liquid barrier spray or wipe before applying the wafer. Ostomy paste can also help fill gaps.
- Some people find that using a spray adhesive and applying hand pressure over the wafer for about 60 seconds helps activate the adhesive with body heat.
- Combine barrier rings with paste or stoma powder as needed.

4. Manage Moisture and Sweat
- Humidity and perspiration can reduce wear-time. Consider using deeper convex appliances and brands known for stronger adhesive rings, like ConvaTec, to resist sweat-induced lift-off.

5. Control Odor
- If charcoal filters fail, try covering the filter with tape or switch to unfiltered bags.
- Use commercial ostomy deodorizer drops or internal deodorizing tablets to neutralize odor inside the pouch.

6. Care for Skin Between Changes
- Allow short, supervised "air time" to soothe and dry irritated skin, but ensure a secure appliance is applied afterward.
- Witch hazel can help calm and clean the skin without leaving a greasy residue, though it may sting on open areas.

7. Adjust Diet to Reduce Leaks and Gas
- Avoid skipping meals and opt for thickening, low-gas foods like bananas, oatmeal, and rice to produce firmer output, which is less likely to seep under the wafer and cause odor.

8. Seek Emotional and Peer Support
- Dealing with persistent appliance failure can be exhausting and disheartening. Connect with supportive people or online communities, and explore resources that focus on the mind-body connection to help reduce stress.