Assistance please

Devil_Doc · Post by **Devil_Doc** » 2020-04-27 22:59:23

Hello. I just got a colostomy on March 9th and since I got it, I've had problems with output sneaking underneath the wax barrier ring. I empty it very frequently and I'm not sure how to stop it. My skin around the stoma is very irritated because of the leakage. I've tried several different types of barrier rings and they all do it. I lost a bunch of weight when I was sick right before the surgery so I'm not sure if I actually need a barrier ring. My skin is pretty flat in that area due to the weight loss. Do I need a wax barrier ring or is that something only needed to make the area flat? I haven't been able to get any answers from my GI Dr's office because they closed due to the COVID-19 virus. I never even had a follow-up appointment with them after surgery. I'm not sure if I'm doing something wrong or if I'm using products I don't need to be using. I use the powder on the damp, irritated skin around the stoma, then use the skin prep pads around the area the wax ring and wafer are going to stick to my skin. I feel like I'm doing it exactly like the videos I found on Youtube, but the output still gets between the wax ring and my skin. Any ideas? Thank you!

Post by **ot dave** » 2020-04-28 09:50:42

Hey Devil doc,

Welcome to the boards. I'm a less is more kind of ostomate. When I had my original surgery in 2009, my stoma was just about perfect. The skin around it was flat and smooth, and I really didn't need anything under the flange. In 2016, I had a hernia repair that left me with a divot at about 9:00. I now fill that divot in with a 1/3 of a barrier ring each time I change. It works as it should. Generally, the barrier rings are usually pretty effective. Nothing is 100% effective however...
I would recommend caution with using the powder. If you don't get it completely covered, it really reduces adhesion of the flange. It's like trying to use duct tape to hold a towel down at the beach! For me, the skin prep pads are good when you're not using the powder. When I need the powder, I always use a spray. For me, the pads tend to push stuff around and I don't feel like I get it covered well. With the sprays, you can get multiple layers of covering without ever moving the powder.
I know the skin is irritated. When this happens to me, I make sure that I rinse out the pouch with warm water after every bowel movement. This helps to remove the output off of any exposed skin, it increases the longevity of the filters for me, and it always feels like a new, clean pouch.
As a colostomate, one thing to investigate would be irrigation. Check out the irrigation forum, there are sticky notes at the top with lots of good information. With irrigation, I go 24 hours without output most of the time. Occasionally something I eat, like salmon, pizza, or things fried in peanut oil set my system off. Different oils get me, even some nut oils like almonds...go figure! With irrigation, I don't typically have movements throughout the day. I don't have to drain/empty pouches. No output gets on my skin. I don't have leaks because there is no output. And, I can get an appliance to last 7+ days. Might be something to look into when you are ready.
I would recommend starting from the ground up and just use a flange on your next change and see if the leaks continue, then start adding stuff like rings, skin preps, etc.
Also, make sure the opening of the flange is about 1/8" away from the stoma. I typically like to see some skin around the stoma after I've applied my flange. If it is too close, the mucous from the stoma will compromise the adhesion as well.
Hope some of this helped. Others will be along with tips/recommendations of things that work for them.

David

Devil_Doc · Post by **Devil_Doc** » 2020-04-29 01:11:26

Awesome. Thank you very much. When you referred to the spray, do you mean a skin prep spray? I'll have to look for some. The skin prep pads took me a while to figure out because they were just wiping the powder off. I tried to use a drop of water to dampen the powder like the ostomy nurse showed me when I was in the hospital, but I think that was causing a larger problem. I'm still a little queezy when it comes to touching the stoma so I don't think I'm ready for the irrigation yet. I'm a little freaked out by it and having a hard time just wiping it off when I change the bag. Are you using a 2 piece appliance? Because I can barely see through the bag to see how close the edge of the flange is to the stoma and I'm using a 1 piece. That's what the ostomy nurse said I should use so I kept with it. I only had about 2 hours with the nurse and I was heavily sedated so I didn't ask very many questions. I think I was still in shock that this was happening to me when the nurse came in. He did give me an Edgepark catalog so I'll look for spray when I leave this site. Thank you again for your help. Stay safe and have a great night.

Jack

Post by **ot dave** » 2020-04-29 13:28:09

Jack,
The spray I was referring to is called cavilon, and it comes in a small pump bottle. Much easier to use than the wipes.
I do use a 2 piece system, so yes, I can see around the stoma. Makes irrigating and changing to a small pouch to sleep in at night.
Feel free to contact all of the manufacturers. They will send you free samples of their products. Find something that works best for you. It can be a trial and error process for sure.

David

ron in mich. · Post by **ron in mich.** » 2020-05-02 07:09:30

Hi Jack your ostomy is new yet and your stoma may be shrinking, when I had resection surgery and my stoma moved from right to left it was about an inch and a quarter in diameter but now its down to an inch, I used the template that I get in the box of wafers to measure my stoma and cut the hole that's closest to my size. I have a dip in my skin at the bottom of my stoma so I use a piece of ring to fill that in but that's all I use but I make sure the skin is dry before putting on the wafer.

Murph00 · Post by **Murph00** » 2020-05-03 08:51:08

Hey Jack,
The first few months after getting your colostomy are the absolute worst. It takes a fair bit time to figure out what products and techniques work best for you. Just know that it will get better.
I had the same issues when I first started and like you and Dave I had no luck with the powder. Waste under the wafer was a huge problem. I was recommended a Hollister Adhesive Spray #7730 by a nurse and I've never looked back. I also have a valley or fold in the skin right beside the stoma and this spray helps the wafer stick tightly to the contours of your body. I have a hernia so I apply my wafers laying down so that my skin is relatively flat, which allows the wafer to adhere better. I'll usually lay there for at least 5 minutes to allow the adhesive time to set.
A small can, roughly $35 will last several months and is available through most ostomy suppliers, Amazon, and Walmart.

Just another option,
Good luck
Murph

fapope · Post by **fapope** » 2020-05-17 06:25:27

Good practical advice above. I am from Australia and most of our Stoma Nurses are doing telephone consultations. Can you do the same ? Consider eliminating the powder and dry your peristomal skin with a hair dryer. You are not going to get much to adhere to moist skin. Fungal Infections also thrive in a moist environment. My skin is also flat around my stoma. As such I get the best seal with Hollister Karaya 5 Adhesive paste. I don't need to use collars or barrier rings. You may however get satisfactory results by using a adhesive spray or paste together with barrier rings ? I cut my bag to a close fit and smear a nozzle width bead around the hole of my stoma bag. I feel Adhesive spray would works as well. So you could experiment with both. A convex bag may well give a better seal. I like to wear a stoma belt when I change bags as this light pressure help the bag adhesive cure against the skin.

steiconi · Post by **steiconi** » 2020-05-19 01:35:29

Most of the manufacturers have ostomy nurses on staff who can he!p you identify the source of problems, and send you free samples to correct them.

Try a two piece system so you can see what you're doing.

Is the skin around the stoma itchy and have little red dots? That might be a yeast infection, which tends to loosen wafers. You need Rx nystatin powder.
Have you tried contacting your doctor's office to see if you can get an appointment by phone or email? I emailed a picture of my rash and got a Rx. Your regular doctor can do that part.

BTW, you didn't even have a follow-up with your surgeon in March? Yikes.

Spend a little time getting to know your stoma. It'll be with you for a long time.

I second the advice to use as few products as possible.

And try irrigation. Ask for irrigation samples from the manufacturers, and watch some YouTubes. My doc told me to wait 3 months after surgery, I've heard others started right away.

Good luck!

Here is Charles in Texas' list of manufacturers; it's a few years old and may need updating, but can get you started.

COLOPLAST http://www.coloplast.us/about-us/colopl ... lsrc=aw.ds (888) 726-7872
ConvaTec http://convatec.com (800) 422-8811
Dansac http://www.dansac.com/ (800) 699-4232
Hollister http://www.hollister.com/ (888) 740-8999
Marlen Ostomy Care Products http://www.marlenmfg.com/ (216) 292-7060
Eakin Cohesive Seals (800) 345-0473 http://www.eakin.eu/categories/2/patients.aspx (800) 345-0473
Genairex http://www.genairex.com (877) 726-4400
Nu-Hope(800) 899-5017 http://www.nu-hope.com/
Ostaway http://ostaway.com/ BagItAway.com Ostomy Supplies (Ostaway x-Bag) Providing a more discreet solution for ostomy pouch disposal (800) 774-6097
Osto- EZ-Vent http://www.kemonline.com/content/home/ (888) 562-8802

The Phoenix Magazine for Ostomates http://www.phoenixuoaa.org/ (949) 600-7296
CAVILON by 3M No Sting Liquid Bandage, http://www.shop3m.com/70200763947.html? ... (800) 228-3957
Colo-Majic Liners http://www.colomajic.com/colo-majic-liners/ Toll call (604) 988-2707
Torbot Skin Tac http://www.torbot.com/ (800) 545-4254
CliniMed

SeaQuest · Post by **SeaQuest** » 2020-05-19 21:43:28

One additional item that I've begun using that I don't see listed above is a rice bag. Whenever I prepare to change appliances, I throw a small rice bag in the microwave for a few minutes, and then lay it on a towel (or other garment) placed on top of the adhesive; this helps activate the adhesive. After I complete the change, I place the rice bag on my abdomen to help finalize the seal. Please note that you should put some sort of cloth between the rice bag and your skin as it can get very hot. I've actually melted the plastic on on my bag so I always place something on top of wherever the rice bag is being placed.

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