Bag change output control

[Smithamd]

So it has been nearly 3 months since my husbands surgery and we have still not got a hang of the bag changes. And his skin all around the stoma is red and sore to touch. From what I have read , it looks like his is a retracted stoma . It kind of sinks in below the skin level. Sometimes when he takes shower or stands up it pops out a little. But other times it just sinks in. To make matters worse during the change he constantly gets output from the stoma which makes it impossible to keep the area dry before change. Because of his dehydration issues he constantly drinks water , even during nights. So there is no specific time when he has not eaten or drank anything. We tried the marshmallow trick but that is not helping much either. The eaken rings keeps coming off the skin when i try to stick it. And i can see stool seeping below it as it has not stuck well. The eaken rings does not seem to be working in his case as they want it to. Any more ideas on this ? With all the other things going on with him this is making things even more difficult for us.

[Lockhart305]

Sorry to hear your having issues, I'm 2 months in and have used a couple different brands of products. I now use the Convatec moldable brand waffer and it seems to work well for me. I do not eat late the night before and I get a little exercise the morning of my change to try and get myself emptied out. This seems to have helped me out. I don't think there is any perfect system but maybe this will help.

[texazgal]

I second the Convatec moldable, but in the convex version since your stoma is so short/flat. I would also suggest Cavilon skin protector spray to help keep stool off the skin. And I know it is hard to keep a Ileostomy dry enough to change, but it absolutely must be dry for the barrier to stick. Maybe a hair dryer and be quick when it is dry.

[Smithamd]

So do we use the moldable wafer along with eaken ring ? Or just the wafer directly?

[texazgal]

I'd try it both ways and see how it works. I DO use a seal with the moldable, but it might work without one.

[Smithamd]

Thank you skillet and texazgal.. will try to get a sample and see how that goes.

But I am also looking for ways to not get output during the change which is our biggest challenge right now. We are not able to keep the area dry. We end up using atleast 2 rolls of toilet tissue during a change to keep the area clean. And still end up with wet areas.

[texazgal]

Before you get samples, I need to change my recommendation. What you want to try is not the moldable. That doesn't work well with retracted stomas. You need to ask for the Durahesive pre-cut barrier with convex-it by Convatec. This is the same adhesive but won't roll up over the stoma. I don't know how to deal with the constant wetness. Maybe fasting for a time?

[danilynn]

I have what my WOCN has told me is a very wet stoma. It's also prolapsed, so those two issues together plus scar tissue can make changes a challenge. Instead of toilet paper (which falls apart on me) I have for years been using these dry washcloths:

https://www.amazon.com/CliniGuard-Dry-D ... B000FDBQ8W

They're napkin-sized and I find that to be too big so I tear them into smaller pieces before I do a change. I take the old stuff off, clean around my stoma (I use water only, no soaps or cleaners), and then I dry as thoroughly as I can and start putting on my new wafer. I add bits of an Eakin seal to fill in some low areas and as I get those set I am constantly setting pieces of my dry washcloths over them to try keep them as dry as possible. After I get everything in place I do one more pat around my stoma to get up as much moisture as I can and then I stick the wafer on. It's not perfect but that's what I've found to work best for me.

I hope you find a solution. Good luck!

[egerfin]

If changing the pouch first thing in the morning before eating or drinking does not help there is a product out there call Stoma Genie (stomagienics.com) that allows you to manage output while cleaning the skin and changing the barrier. It requires that you use a 2 piece system if that would work for you. It can be custom made to fit your stoma if you have an odd shape. (I am not a rep for the company).

You should be using a convex barrier with an Adapt Ring or Eakin Seal and heating it up with a blow dryer prior to application. You can get better adhesion with Hollister Medical Adhesive Spray-apply it to the barrier AND your skin prior to using the blow dryer.

You can also place a small tampon into the opening (os) where the stool is coming from to stop the flow while you work.

Hope this helps.

[cdogtom]

good ideas above but also see a wound nurse for their experiense,with the skin redness i would think about using a film under the wafer,see the wound nurse about this ,good luck .

[steiconi]

You might want a stoma nurse or doctor to check out the skin redness. Fungal infection can cause that and weeping skin which prevents wafers from sticking.