Need help with leakage

[Louise13]

My colostomy surgery was 5 months ago. I am still having problems with leakage (meaning stool making its way between the wafer and the skin instead of through the hole in the wafer into the pouch). Some days I have to change the wafer three times, sometimes it will last 5 days. The products I am using are SenSura Mio Flex 2-piece Convex barrier, Eakin rings, Stomahesive powder, No-sting barrier spray, SenSura Mio closed pouch, Coloplast Brava Elastic barrier strips, and adhesive releaser spray. If I am not very very careful removing everything my skin tears and bleeds. From the stoma out a quarter of an inch the skin is red and seeping, sometimes bleeding. I've been to the local ostomy clinic several times and gotten conflicting advice. Here are some specific questions and I will be grateful for any advice!

1. How do you clean the skin? Where it's not leaking I have bits of the Eakin ring stuck. Water and paper towels do not get it, and soap is not much better. I have to scrape it off with my fingernails. Ugh. I tried a nail brush once and boy howdy, not doing that again.
2. How big should the hole in the wafer be cut? I've been told to snug it right up to the stoma and also to leave 1/8 inch clearance.
3. I lost a LOT of weight during the illness leading up to the surgery and my abdomen is very saggy. Do I lift and spread the skin with one hand and put the wafer on with the other? Or do I stand or lie down and just put the wafer on as is?
4. If I haven't been smart enough to ask the question, please answer it anyway!

[ot dave]

Hi Louise,

Welcome to the boards!

Here is a copied reply that I made just the other day, about basically the same topic! It doesn't all apply to you, but some of the information might be beneficial here...

If the stoma is above the surface of the skin, then a regular flange should be just fine. If the stoma is flush with, or below the skin, then a convex flange is probably your best bet.

The most popular seals for around the stoma are the Eakin seals or the Adapt Barrier rings. You can use the whole ring, or just parts of it if you can identify a singular spot that is giving you issues. The seals act like an o-ring in a garden hose and help to keep output from getting under the flange. I've had good success with those over the years. I currently have a deep divot on my 9:00 that I use 1/3 of a seal to fill in with when changing.

If I were guessing, I would say that the powder and paste is most likely giving you the most trouble. In fact, I would avoid using it unless absolutely necessary. There are indications for its use, but mostly, they cause trouble/leaks. If you don't get the powder completely covered with a skin prep, then it is the equivalent to using duct tape to hold your towel down on the beach...it's just not going to work. I only use powder when I have an infected pore that gets deep and needs something to fill it in to make it flush with the skin. Even then, I make sure I spray multiple layers of skin prep over the powder. Skin prep wipes have their uses as well, but create more issues when covering powdered areas. Skin prep sprays like Cavilon, in my opinion are superior to any skin prep wipes.
Paste is a misnomer...it has no adhesive properties at all. It should only be used to fill in dips and divots that can be completely covered on all sides by the flange, otherwise they create leaks. There are a few folks who find the "paste" beneficial, but I think you will find most folks avoid it like the plague. I haven't used paste on my stoma since 2009...which is when I got my ostomy!

I always apply my pouch standing in front of the mirror to allow my natural anatomy to be in place for placement of the flange. Supine placement can work too, but for me, standing is most effective. I wouldn't apply the flange sitting down, I think that would create to many creases/wrinkles in the skin to make an effective application.

Hollister makes a spray that another poster here says is very effective for him. Here's a link: https://www.shopostomysupplies.com/p-ho ... spray.html
Again, avoid the paste as much as possible.

Clean dry skin is the best platform when applying new flanges. Don't clean with any soaps that have oils or lotions. The oils and lotions interfere with good adhesion. I change my flange once a week on Wednesday evenings. When I do change, I will shower and wash around my stoma with ivory soap, then I wash around it again with Hibiclens (surgical scrub soap that you can get at a pharmacy) to kind of sterilize it and kill any possible bacterial culprits. I then go lay on my bed and watch some tv while the skin "breathes" a little before I apply the new flange. Now, I have a colostomy, and I have some control over it since I irrigate. With an ileostomy, she may not have that kind of time to allow an uncovered stoma, but she will eventually figure out when her stoma is more and less active.

I would start with eliminating everything under the flange, especially the powder and the paste. and only use those as a last resort. If the "naked" flange doesn't do the trick, I would then move to using a seal/barrier ring around the stoma. Also, I make sure that the hole in the flange is about 1/8" bigger than the stoma to allow a little skin to be seen. If the flange is sitting on, or touching the stoma, the continuous output of mucous onto the flange will also reduce adhesion and create leaks.

I know this is a lot of information. Hopefully something here will get you started down a more successful path.

David

[fapope]

I have had a few leaks in my time and so have developed a procedure quite similar to David's. In my experience using stoma powder compromised adhesion too much. I use adhesive remover spray to remove my bag and most of the adhesives etc. It should easily come off with remover spray. Although it is expensive. I then shower and wash without a bag. This leaves my skin very clean and neutral. After drying with a towel, you can do a secondary dry with a paper towel and then use a travel hairdryer remove any residual moisture on my skin and pores. Minute amounts of moisture can compromise adhesion. In cooler weather I also warm the ostomy bag at the same time. This will give a better bond to your peristomal skin. A convex bag combined with a wearing a stoma belt for half an hour can also help. Ostomy bag adhesive needs warmth, time and light pressure to cure against the skin. I have tried barrier rings and stoma collars with limited success. My best results came from just using a stoma paste adhesive. I use a nozzle width smear around the stoma hole of my bag and then apply in the normal manner. This will also seal your skin around the stoma and protect it from output. I use the Hollister Ceraplus bag. These bags have a second adhesive strip extending past the flange which will hold in any leaks. Whether you stand up or lie down to apply an Ostomy Bag is some
thing you you to experiment yourself. A recliner chair my be a good compromise.

[Snowgoose]

Louise,
All good advice has been given. One thing they didn't speak to is the leftover pieces of Eakin seal you are scraping off with your fingers. Don't do that, just leave them there, they will blend with the new wafer and probably come off with the next change.

I have empathy for your damaged skin. I have found the best treatment is to wash the area with Zest or unscented Dove (I've never tried the Ivory). I use tissues and a hairdryer to dry the skin. Then apply any skin barrier wipes or spray. When the skin heals stop using as the wafer will stick better without the skin barrier wipe or spray.

Good luck to you. Leaks and damaged skin are the worst!

[fapope]

A quite effective home treatment for inflamed skin is: Lightly finger smear the area with Calamine. Dry thoroughly with a hair dryer. Then do your normal bag application procedure. Adhesion is still very good and some improvement is normally overnight. Works well on itchy skin as well or as a preventative.

[Louise13]

Thank you all so much! I am following your advice and have not had a leak in 2 weeks, which is an all time record. I am very, very grateful!

[ot dave]

Thank you all so much! I am following your advice and have not had a leak in 2 weeks, which is an all time record. I am very, very grateful!

That's good to hear. Nothing better than a leak free flange!