New Problem That Has Me Completely Stumped!

[Dijenga]

My stoma has been changing sizes again, and is just over 25mm at its longest point and 23mm at narrowest for the last week. Oblong stoma, 1 o'clock / 7 o'clock orientation So, I cut my wafer opening 25mm x 28mm. 1.5mm opening all around avoids rubbing of the wafer on the stoma and "should not" allow much opening for waste to get under the barrier ring.

I usually try to keep 2 to 3 changes ahead, so I had wafers cut to 28mm x 30mm in case the unexpected happened. Shrinking stoma, no problem -- I wish.

What is now happening is that the barrier ring is forcing itself between the stoma and the 1.5mm on all sides opening. It literally all squeezes out through the opening, and if I have to "karate chop" to move stool it has even sealed shut and I have to replace. It is also allowing a lot of seepage under the ring onto the skin.

What in the world could be causing something like this? Same products, same process in changing appliance, same "activity" during changes.

Very careful to remove all old adhesive, and I make sure that stoma and surrounding area are clean and dry before I start preparing new appliance.

Stoma powder, Cavilon wipe, fan dry. Repeat. Size barrier ring so that it fits tight around stoma with no open areas for leakage to happen. Next center wafer over stoma. Hold in place for 2 minutes (circulation in hands isn't very good, so I increased the time I hold in place since early February which has slowed down the frequency of replacing appliance. Even when I punched the opening too large, never had barrier ring push through.

I live in a heated / air conditioned home (for now -- until electricity is cut off for non payment and my home gets foreclosed on unless something good happens), so it isn't a heat issue softening the ring. I do wear a belt (without it I had to change daily) but I am careful not to make it tight. I figured out a way to stop the twisting of the belt which had been tightening the belt as it twisted resulting in multiple removals and attachments every day and even at night. That hack was so freaking easy it scared me! For a couple days I kept waiting, wondering when it was all going to hit the fan.

Any ideas on what is causing this push through would be greatly appreciated.

[ot dave]

The barrier rings will swell when exposed to moisture. Mucous from your stoma and output can cause this to happen. Ideally though, this should not affect how the ring works. It should still keep output from getting under the flange. I employ a less is more philosophy to flange management. I like to only use the flange. For me, additional steps/items tend to cause me issues.

Is the surface around your stoma smooth? If it is, I wouldn't use a barrier ring. Again, less is more...in my experience.

Is there a reason you are using the powder? I only use powder to fill in an infection site that created a hole, and then cover with Cavilon spray. I find that the wipes tend to remove the powder that I just used to fill in the crevice to make a "scab" over the site. Any powder left around the stoma will cause you adhesion issues. It's like trying to duct tape your towel to the sand at the beach! If you are not having any skin issues under the flange, I would avoid the use of powder completely.

Is your stoma flush or below the skin? If it is, a convex flange me be of more use. If it is above the skin, then disregard the use of a convex flange.

When I am putting on a new flange, I use a hair dryer, heated, and blow on the adhesive. 5-10 seconds is about all the time needed. This really helps to activate the adhesion properties. And, if I have time, I will lay on my stomach after changing the flange to help make a nice seal with additional warmth. The warmth kind of activates the adhesive properties of the flange, creating a better seal all around.

Stomas will change in size for some time after surgery, that's pretty typical. But, they will also change in size during peristalsis. When they contract, they will shrink up and get small. When there is nothing to stimulate a contraction, they will relax, kind of swell up, and be quite pliable.

Hope that helps some.

David

[Dijenga]

Dave, it's a bit different. Using the barrier rings I usually get 4 days between changes. Don't waut for a blowout, just really hate those. Without the ring, I wasn't getting much more than 12 hours before there was a leak.

Since I occasionally have to go in to work if there's an IT emergency or court business for my employer, I really don't want any surprises.

[JerryNYC]

Dijenga, You do seem to be doing things right, although I never found any good use for the power. I used to use Karya powder but haven't used it in decades (I even forgot how to spell it). I use Hollister Adapt barrier rings, although I believe that they all work well. You are correct in leaving a small gap between the stoma and the wafer. If it is too close, it can injure the stoma if it presses too hard. As Dave notes, the barrier ring will swell with moisture so that it will make a tight seal around the stoma (like a gasket). It is much softer than the cut edge of the wafer, so it is not likely to harm the stoma when it presses against it. Before I apply the barrier ring, I cut it so that I have 2 half-circles. I find it fits better around the outside edges of the stoma than when I try to put it on as a full circle. The only additional thing I use are "Sure Seal Rings" (from Active Lifestyle Products". They make everything hold together more effectively.

[fapope]

I tried Barrier Rings but had better success with a convex bag (Hollister CeraPlus) sealed with a bead with stoma paste. I made my own template to get an exact fit when cutting my stoma bags. I preferred to shower without a bag. I found powder compromised adhesion too much. I always warmed my skin and the bag with a hairdryer first for enhanced adhesion. If my skin was reacting, I would finger smear Calamine over the skin and dry this with a hair dryer.

[ileo73]

Which rings are you using? Eakin, Adapt...?

[steiconi]

There are barriers that you roll back the sides of the hole, then it unrolls back against your stoma. They are very flexible and can often be used instead of a convex wafer. They don't work well with a recessed stoma, they just roll over it and cover it up.
I think convatec makes them, but I can't remember what they're called.

[Dijenga]

Which rings are you using? Eakin, Adapt...?

Adapt.

[ileo73]

I find Safe n Simple conforming seals are pretty well behaved