Changing Barrier During High Output: Tips & Experiences?

This question is for my fellow high-output friends. Have you ever had a problem (i.e., leakage or such) that required you to have to change your barrier during the day when your stoma just wouldn't cooperate and slow down? I've so far been able to avoid such a disaster, but often wonder what I'd do if I had to change my barrier at any time other than when I first get up (i.e., when my output is predictable and my motility meds actually do something). I've asked ostomy nurses how I should go about it and most just give me that blank stare. One sweet soul told me to get on all fours with a bucket directly under my stoma to catch my output while I get the new barrier and ring ready for application. I've never actually tried that, but have given it much thought. I guess I should have asked where the hell do I get a bucket from when I'm out and about???

The other thing that sticks in my mind is when I went to an ostomy support group just a few weeks after getting my ostomy. The instructor was adamant that we ostomates always keep our emergency ostomy supply kit on hand, no matter what. So for those first couple of years, I'd drag a plastic shopping bag around with me with enough stuff (wipes, towels, ostomy supplies, etc.) in case I was out and about and needed to change my barrier. I no longer carry that kit around. And that's because I've come to realize that the few times I have sprung a leak, that kit was useless. There's no way I'd attempt a full-blown barrier change mid-day at work or in the mall or wherever I was, except maybe at home. So each time I've had a leak or blowout, I'd simply clean up as best I could and then tape the shit out of it (pun intended) to keep the barrier on. That has always worked, although the skin around the stoma doesn't like having crap on it for very long before it starts to get upset.

My worst accidents (only 2 or 3 times) have occurred when I've fallen asleep for too long and woke up to a fully pressurized bag of crap, that as soon as I moved to get up let go where my stoma is flush with my skin on one side. Those few times really sucked and resulted in me doing lots of wash in the wee hours of the morning. But when that happens there's only a few more hours until I'd be getting up to change my barrier normally, so same deal...clean up, tape up, and wait it out. Now one night it happened early (before midnight) and I did decide too much of the barrier was compromised by leakage and gave it the old college try to change the barrier. Of course, I took my motility meds first, then waited about 2 hours without eating or drinking anything...and I was able to pull it off successfully, although I went through a lot of supplies and it was a little nerve-racking.

So...having said all that...how have you managed to change your barrier during times of high output? Any tips would be appreciated.

Thanks,

Bob

I have had to change my appliance several times during the day. So far, I have always been at home when I have had to change it. I put a "chuck pad" (the pads they use on hospital beds) on the ground to catch the output. I also take off my clothes so I don't have to worry about getting anything on them. I keep a stack of cloth baby washcloths nearby and try my best to use those to wrap my stoma as I am preparing my skin for my new appliance. Oh, and I do all of this standing up. I have found through trial and error that this works best. The last thing, I keep Lysol wipes handy to wipe up anything that didn't land on the chuck pad.

Picture of chuck pad. I use Covidien or Medline, which you can order from Amazon. You can order the cloth washcloths from Amazon too.

Hello Bob. Your post puts me in mind of the lyrics of the song: " Those were the days my friend- I thought they'd never end". 

I haven't had this problem since I began irrigating, but before that it was a regular occurrence. I used to tout around a bag full of spares - including clothes, in a sort of 'boy-scout/be prepared' approach. However, I will admit that this only gave me peace of mind before the event. when the distasters happened It seemed no less of a 'B****' nuisance, than if I had not prepared at all.

I embarked on a campaign to try to get organisations to improve their toilet facilities to cater for people like us. I was quite surprised and disappointed to find that almost all toilets do not have facilites suited to our particular needs (That included the hospitals where these operations take place!!) So-called 'disabled toilets' are often geared up for wheelchair users and parents with children, but are pretty useless for when things go wrong for us. What I did find was that 'DAY CENTRES' had the best toilet and cleaning up facilities for ostomates and they were williing to allow me to gain access to use them as and when I needed. They also now advertise that anyone with our problems will be allowed access to their facilities as and when necessary. Of course, as far as I know, this is only local to me at present. However, I do think that there is a willingness on the part of Day Centre staff to try to be helpful to people with this sort of need, and I feel sure that if anyone approached their local Day Centre, then there would be a favourable response. 

Best wishes

Bill

I've had to do that a couple of times, but I just get in the bathtub instead of standing in front of the toilet. I lay everything out on the edge of the tub and make my change. If there's output, it's all in the tub and easy to clean up.

Hi Ron,

Thanks for the reply. Smart move using the tub...........just a bit tough to do if out in public. The one thing I've found is that even if I do spring a leak, as long as I stay vertical my output tends to drain down into the bag and not out the area that's leaking. The leak is almost always caused by pressure and appears at the weakest point of barrier adhesion. So if my barrier isn't falling completely off my best bet is to do a tape repair and head for home. My nightmare would be if my barrier came completely off while out and about. In that case my response would be to grab a towel from my car (assuming I'm near my car) and contain the mess while driving home as quickly as possible. Not sure what else to do. Now there are times of the day, on days I don't eat or drink for some periods, that my output might allow a quick barrier change. But with my luck that wouldn't be when I need it to be.

You gotta love this crap, eh?

Regards,

Bob

Hi, as a woman, I use large purses to carry my packet. I did have to change during the day and just used a restroom because I carry my stuff with me, or at least how about keeping it in your car but somewhere close by.

Hi looking,

My problem isn't with having supplies on hand... it's that my output is almost continuous during the day, so keeping output off my skin around my stoma (after I've cleaned the area and am preparing the ring and barrier) until I can get the new barrier on is sometimes impossible. Think of it like trying to put a bandage on a wound that won't stop bleeding... except with a wound you can put pressure on it to stop the bleeding long enough to get a bandage on. With a high output stoma all you can do is hope there's no output for the 10 or 15 seconds it takes to open a barrier ring, stretch it to fit, put it on, and then slap the barrier on. And if there is any output during the process, I have to start all over again. That's why I usually just clean up the leak and add tape around the barrier so I can get home and deal with it under more controlled conditions.

Regards,

Bob

Hi Bob, my first answer to your question (what to do about changing during active times) was quite "flip". Just go with the flow!!! I'm trying to be funny. I've had my ostomy for 50+ years since I was a kid of 15. Back then, in the old days of ostomy supplies, I was flying by the seat of my pants. But I won't bore you. The last 25+ years have been relatively easy and predictable. I didn't have much of the small intestine removed (but my ex-husband did), but each of us had to determine the best time to change. Early morning is best if I didn't eat late at night... Generally speaking, a few hours after a meal or shortly before a scheduled meal is the best time. Mostly, it's a crapshoot, literally and figuratively. I eat when I want, shower when I want... love the pool, beach, etc.... and historically my pouch stayed on for the length of the activity, and I chose when to change. But there are times that I spring a leak or have a nighttime blowout or a bad case of the runs, which eats away at the wafer. As I got older (and got spooked), I tried carrying a change of wafer, bag, wipes, etc.... and to be honest, had to use them a few times. But most of the time, a good roll of tape suffices until I can get home and change. I did go to camp as a teen and changed at night, in a stall, with a cup of water, my supplies, a flashlight, and a lot of bees flying around... My appliance came off when I got out of the Dead Sea (in Israel), and that was a real mess. I changed in a dressing room, took a shower..... and had to reuse the same wet pouch. Thank goodness for tape.. As for changing during very active times.... I prepare all my supplies, have them on the toilet tank...... and change over the toilet.. After cleaning my skin and using the prep and powder, I just pray that nothing runs until I get the new wafer on. Sometimes, I fold strips of toilet paper to wrap around the stoma to catch a liquid leak, but I've also had massive outputs that sprayed the walls... Then, I sigh, laugh or cry, clean up and try again. My least time has been about 3 minutes, but I average about 10. If I've misjudged my timing, and I'm really active, and the pouch and wafer are off, I just wash up, put a towel over my belly, and then relax in bed until I slow down. But that's a rare situation... I hope that answers your questions. I use Convatec, 1-piece system, with a convex wafer.... Best of luck, Marsha

Hi Marsha,

Always glad to hear from you, as you're a wealth of knowledge, but more importantly experience. I really can't imagine what you went through as a kid dealing with all you describe.......my hat's off to you! You pretty much nailed the experience of changing the barrier at the exact wrong time of the day. My favorite line from your post is "I just pray, that nothing runs, until I get the new wafer on." because I've been there many a time, and that is exactly what you do. Even when I change it in the morning when things are calm, every once in a while an unexpected random bowel spasm can really screw up the whole changing operation. So I'm like you.......if I have a blowout or similar leak I just clean up, tape and go until the timing is better. The only thing I don't like about that is any crap (let's call it what it is) that leaks under the barrier sits on my skin until I change the barrier. This usually makes the skin red and I just have to be careful to not repeat the incident while any of my skin is already irritated. I always try to avoid any runaway skin condition issues, as I've learned they can be a bear to get under control.

That's the best thing about this site..........no matter what the issue.....others have been there (and some still are) and at the very least reinforce that you're not alone and the only one dealing with this bullshit.

Thanks,

Bob

Bob:  I always change sitting on a stool in front of my bathroom sink.  I throw a towel over my lap, just below where the stoma is, and place a doubled paper towel where any stoma product might flow.  Because I always change first thing in the AM, I usually have no flow, but on those times when I have had flow, or had to change during the day, I noticed that the flow seemed to have a regularity to it, i.e., there would typically be about the same amount of time between spurts.  I also keep a towel with a couple more paper towels on it at my feet.  So, timing the slow, I'd stand to press on the new barrier.  Any flow would be onto the floor then, but the barrier would be quickly in place already.

Hey Bob - I'm was scanning through the responses and I'm not sure if anyone has mentioned this but I think your question is mostly dealing with how to handle the output during the day when you are most active and have to change? ;(I may be wrong)

However, I have found that when I am in this situation I eat a few marshmallows or a spoonful of peanut butter or a cup of applesauce and that seems to "gum up the works" just long enough to allow me to change with the least "clean up" necessary.

Sometimes PB on the marshmallow! Nummies!

K

Hi K,

I've heard more than a few folks mention the marshmallow thing, which I find very interesting. I don't think it would work for us short gutters because they're all sugar, which would upset the osmolarity in the bowel, causing a massive dump of water and bile into the bowel to try to dilute the sugar content. Those with full-length small bowels would be able to reabsorb most of that dumped water before reaching the stoma, but us with very short small bowels would just have massive liquid output. But I did buy a bag of marshmallows to give it a try... I just haven't found the time (or courage) to give them a try. But now that you reminded me... maybe this weekend!

Thanks,

Bob