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Newbie needs help.....Leaking under wafer....any solutions?

Posted by stayn2busy, on Sat May 02, 2009 12:22 pm
Four weeks ago, my husband suffered a ruptured diverticulitis and ended up with a sigmoid colostomy. He is thin build (after 10 days of ice chips only)...really thin, and his stoma is basically almost flush with his skin. Every appliance we have tried since surgery, has leaked. If the whole wafer doesn't come off unexpectedly, or when we change it, there is a patty of stool under the wafer on his skin that has caused skin break down to the point of bleeding. We have tried Convatec, but he has an allergy to that tape; Hollister sent a convex ring to try and that bag just came off the next day, with a collection of stool under the wafer; yesterday we tried the eakin ring which was very moldable  and I was hopeful the solution, but it too pulled off last night on our way home from dinner. Right now we have a Coloplast shallow convex wafer on and I'm keeping my fingers crossed.  He is using the closed end, disposable bags with filters. Surely someone out there has had this problem and found the solution. We are lubricating the bags on the inside to make sure the stool slides to the bottom and doesn't collect around the stoma, but still every bag / wafer has the same problem. Our ostomy nurse at the hospital told us we'd have it figured out about the time he's coming back to have his reversal.....I want to figure this out before August. Please help!
Past Member
Reply by Past Member, on Sat May 02, 2009 4:15 pm
First off, don't hesitate to call the stoma nurses or doctors for help! They are there to help and will do so.

Second, is the skin surrounding his stoma flat or recessed? If it is recessed, there are wafers that will fit into that area.

Third, is the appliance not holding onto the skin because the skin is irritated and weeping? If it is, he can soak in a tub with no appliance on and sooth the skin. Then dry it off with a soft towel and apply Maalox (yes, the stuff you drink for stomach upset) to the irritated skin with cotton balls and allow it to dry. You can help it dry with a hair dryer. Then you can apply the appliance.


I also use Convatec products, but my skin is so sensitive that the adhesive they use wreaks havoc on me. So in between the wafer and my skin I use skin barrier made by Coloplast. The Coloplast part number is 3210. This is a 4"x4" barrier and they have other sizes.


I have had weekends that were just a pure hell because my skin got so irritated. Once, I went through a dozen appliances in less than a day. eeeek. Call the hospital where his surgeon works. They usually have someone from each department on call during the weekends so someone will be able to help you with this. Plus they will also notify your doctor and the stoma nurses and keep them up to date.


Paul
Reply by stayn2busy, on Sat May 02, 2009 8:29 pm
I appreciate your tips. His skin around the stoma is mostly flat. On his raw bleeding skin I've been applying stomahesive powder, brushing off the excess, spraying convatec skin barrier on & letting it dry before putting on the wafer....that's what the ostomy nurse told me to do. I'm guessing you don't have any trouble with the appliance sticking when you use the maalox?? I will give it a try....it's unreal how fast the skin around the stoma breaks down. If I can't stop the stool from leaking under the wafer, I'll definitely try the coloplast wafer that you described...maybe that would protect his skin. Thanks again for your help! Karen
Past Member
Reply by Past Member, on Sat May 02, 2009 9:02 pm
The Coloplast barrier will protect his skin, but it has to be healed first. I have tried all the powders and such too, but the only thing that worked to heal the skin was Maalox. It is a vicious cycle. You need to heal the skin to get the appliance to work properly, but the appliance is preventing the skin from healing.....

Another question. Are you buying the wafers already cut to his stoma size or are you cutting the hole out yourself? Is it a tight fit around the stoma?
Reply by stayn2busy, on Sat May 02, 2009 10:16 pm
His stoma is oval, so I've been using the cut to fit and have been getting it pretty snug around the stoma.....then I thought maybe I was getting it TOO snug, so I would leave less than 1/8inch around...and still the leaking stool under the wafer. I've tried the stoma paste (what a mess) and still the leakage. The coloplast shallow convex wafer that I put on last night is still holding --- I'm keeping my fingers crossed! Of course won't know if it's leaking until it falls off or we change it and find the stool underneath   I will be getting some Maalox tomorrow. Thanks!
Reply by eddie, on Sat May 02, 2009 10:47 pm
Hey, I had this problem with my ileostomy and used the hollister convex ring and the convex barrier device, please don't be insulted but are you sure you are using the convex ring correctly, it has been my experience as a nurse that most people think it goes on with the flat sise down, anyway hope this helps
eddie
Reply by stayn2busy, on Sat May 02, 2009 11:23 pm
Thank you for your input, but yes I did have it on correctly. I'm not sure why it didn't stick, but when I used it, the whole wafer came off within a few hours. His skin is very broken down & bleeding so that may  have attributed to it not sticking. They sent me two of them, so I might try it again once I get the skin healed up. I also tried the Eakin ring and really like it too, but it too allowed leakage underneath. I've ordered some hollister convex barrier samples too. This is just so frustrating, not only adjusting to life with an ostomy, but having to deal with the bag not staying on and the skin breakdown. This forum has been great....lots of good ideas. Thanks!
Reply by eddie, on Sun May 03, 2009 12:50 am
if the skin is broke down that is a problem, what i did was dry my skin with a hair dryer set on low, them apply a layer of skin powder any brand will do be sure to blow off excess or brush off then apply the ring & barrier. Then I would hold it firmly down for a few mintes, I have also used tape around my barrier to help it stay firmly on. Another idea is too use a belt to help keep it in place, believe me I do know how frustrating this is if you can get the barrier to seal the skin will heal up fairly quickly , it is fairly painful too. Good luck please let me know if you find an idea that works, this worked for me but i did have to go to a convex ring as well as barrier too
eddie
Reply by sierragoldie, on Sun May 03, 2009 10:45 am
I have had problems with lifting wafers and here is what I do which helps...most of the time.  When I begin to change my appliance, I take the barrier ring, and the wafer, and put them under my hip to get them warmed up to body temperature.  I clean the skin, let it dry, (and especially if the skin is raw and irritated I don't hurry this process, letting the skin stay open to the air for as long as possible.)  Then I apply the powder and use the gel protectant to moisten it.  Then I put on the barrier ring positioning it as close to edge of the stoma as possible.  On top of that I put a ring of stoma paste, and the then apply the convex wafer, pressing down on the interior of the ring to insure it is a firm contact.  Then I apply latex free tape to the sides of the wafer.  Then I apply the bag, and pull up my underwear and my bedcovers and place the palm of my hand over the area and PRAY! for about five minutes.  Then, and this is important, I get up and walk around.  I think if you stay in bed and roll over to the side it puts a crimp in the wafer that will be more prown to leak.  (I call it having a blowout)  God be with you all.
Nurse
Reply by Whoa, on Sun May 03, 2009 1:16 pm
Staynbusy

Great advice from everyone.

I would add:  check what happens to the stoma when hubby is in a sitting position.  If it is flush, often there are creases at 3 and 9 o'clock .  If this is the case, prepare the skin as you did (powder, dust off, No Sting skin prep or Cavilon....or if using Maalox I would do it short term and stil prep it after).

  At the 3 and 9 o'clock creases, place a small piece of Eakins (about 1/2"long) and push into place to make skin contact.  Caulk where it meets the stoma at 3 and 6 o'clock.  I'd cut the opening no more than a sliver larger than the stoma.  Use your convex wafer and you can add an Eakins if you like.  Whatever 2 piece pouch you use, add a belt, should be fairly firm which will help pull the edges down for a seal.  Have your hubby lay down with hand over appliance a good 20 minutes before getting up.

Sometimes convexity works for flush stomas, sometimes you find a more flexible appliance does the trick with the fill ins.  The problem with the flexible appliances (ie, Microskin or Coloplast has some very flexible ones also) is that they don't usually have belt loops.

I would continue working with his stoma nurse.  My first couple of tries with educated guesses can fail too, and I try to add what I need.

Hopefully his skin is mostly just irritated around the stoma?   Occ. people get contact dermatitis from the skin barrier itself and the skin basically falls apart and weeps...causing leaking.   You would know if this is the issue by the pattern on the skin; skin will appear red or weepy/blistered in the exact pattern of the offending irritant.  If this is the case, switching brands is suggsted.  I have patch tested skin in the past, no reaction, but with entire appliance on over period of time, the skin has reacted.   Just wanted to check if this was ruled out.

Fingers crossed you get this solved.

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
Reply by nncc, on Sun May 03, 2009 7:44 pm
you mentioned that your husbands stoma is oval...I use the moldable wafer from convatec.  its a 2 part system and the moldable area eliminates really measuring the stoma, which i found a bit painful when my skin was flaring.  You just roll open the hole to fit the stoma and peel off the backing and stick it...it molds itself to the size and shape of your stoma....I love it becasue i really hated measuring and cutting....
Reply by stayn2busy, on Sun May 03, 2009 9:10 pm
Thanks everyone for the wonderful tips!!! That makes good sense about the skin folds when sitting and causing creases. Most recently used a coloplast convex barrier....very stiff, all pectin without tape, which he said was uncomfortable; along the edges it didn't stick, started curling up. I've ordered some convex barriers from Hollister...hopefully they'll arrive within a few days. I SO APPRECIATE EVERYONE'S INPUT & TIPS. Thanks so much!! karen
Reply by stayn2busy, on Sun May 03, 2009 9:16 pm
NNCC,
I just used my first moldable barrier sample ---and I must say it was very nice not having to trace & cut. If this one prevents the stool from leaking under the barrier, I think I would like to use them, definitely much quicker. The one I just put on is from Convatec, and unfortunately, his skin really reacts to their adhesive, but it was the only convex barrier I had. Thanks for your input, this site has been so helpful!!! karen
Reply by andyangiet, on Mon May 04, 2009 1:42 am
It took me a while to find the right bag and wafer for me. I use a two piece coloplast. It is convexity. My stoma only pokes out a 1/2 an inch maybe. I also use a belt, it really seemed to help. When my skin get really bad I use the skin barrier and powder also. I put the powder on and dab the powder with the skin prep. Let it sit for a bit and use a eakin seal that I put on the wafer part first and then put the whole thing with bag already attached on and hold it there. Sometimes it will sting but I just hold it there and get a good hold. Then I put a belt on for extra support and try not to eat or drink anything for a while so you won't have the stool coming out right away. It is tough, I went almost two years wearing the wrong bag for me. I don't have any ostomy nurses around me and the doctors would tell me to do this and that but with them not knowing much about it, they would tell me to do things that would not make the bag stick to my skin. I have to drive an hour and a half to see an ostomy nurse. If you are don't use any type of soap or body wash around the area. Even the stuff they give you from the hospital. I had one of the reps from Coloplast tell me that. It leaves a residue on the skin and for some people make it hard for the bag to stick. I feel your pain and frustration. I would cry sometimes cuz my skin was so raw and it hurts so bad all the time, another thing that work depending on what kinda of skin problems is the powder you use for you athletes feet in a yellow bottle. That helped me out clear stuff up fast, when it was raw and bleeding. I hope you find out a good solution. It is hard to function when your bag won't stay on.
Reply by funnygurl, on Mon May 04, 2009 1:52 am
Leaks are a problem for everyone I know,  and especially at the beginning.  I warm up the moldable convatec flanges and use extra stoma paste where the leaks usually happen.  Maalox does work as strange as it sounds.  Also the 4 inch skin barrier under the flange has worked for a friend who had similar skin probs in the beginning.   For some of us this is life with a permanent ostomy.  I taught high school for 2 years with an ostomy before retiring.  You have to find what works through trial and error.  Everyone's skin and stoma are different.  You are very lucky his can be reversed.
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