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It's been my most unfortunate experience that a vast majority of so called "professionals" in wound care are not experienced, likely because they don't have the pain feedback like a real patient has.
First off your going to need to wait, preferably with the otosmy bag still on, until the flow has ebbed quite a bit. Obviously not eating and drinking will assist. However be careful, dizziness comes from dehydration. Be in a safe place.
Taking a shower and cleaning the area around the stoma works, (don't use soap as that removes skin oils and causes itching) but you don't want to overheat your body so that it's sweating as this will complicate putting the bag on later. So warm showers, but not hot ones.
Now you might have to wait in the shower until the flow has subsided. Using a constant rinsing to remove the flow away from your body before it can do any damage to the skin. If your shower doesn't have an endless warm water, like mine, then you should have a bidet on the toilet where you can sit and rinse the stoma clean almost endlessly. Ensure the crotch area is clean.
When on the toilet rinsing, ensure blockage so that an squirting, if it occurs, doesn't shoot out past the toilet. Naturally have toilet paper (Charmin is very soft and gentle on stomas) in the way if it does.
I find certain things I eat will cause high fluid like output and others will cause it to solidify more making for less trips to the restroom. I'm also prediabetic, do this may have something to do with it. You'll have to experiment for yourself but brown rice (prediabetic friendly) mixed with food seems to solidify the output as it absorbs liquid in ones system. Soda crackers works great for me but require advanced planning obviously.
https://sirona-cic.org.uk/wp-content/up ... -bleed.pdf
Items to avoid eating is anything that you have a hard time chewing as it likely will have a hard time digesting and may cause a clog which is bad. I found nuts especially are bad, carrots, corn, some beans, tough portions of meat (veins and grizzle), mushrooms and onions in larger sizes pieces, green beans and other tough fibrous plants. Uncooked, undercooked rice is a problem also.
Once the stoma has finally stopped spewing or that it's so low that it can be dapped up with a piece of very soft toilet paper, you can head to your stoma station where you should have all your supplies laid out and pre-prepared as much as possible (cutting your water holes to size ahead of time for instance)
My stoma station is my bed, with a large mobile plastic case containing everything I need, the bed reason is I remain still for a few hours or minutes after application to ensure proper adhesion, allowing products to dry thoroughly.
On the bed, as everyone with an otosmy should have, is a large soft fiber rubber backed floor mat one can buy at a hardware or office store. This is to protect the mattress from blowouts and sudden unexpected outflows.
Okay here we go.
After leaving the toilet or shower with a piece of Charmin covering your stoma, head to your bed and lay down. You should have a waste bucket with a plastic bag inside for medical waste located close to put trash in.
Dry around the stoma area with toilet paper and allow the skin to dry out, especially stop sweating. Some use a hair dryer and I think this is an excellent idea.
Examine your stoma carefully, especially spreading out the skin around it as it could be damaged.
The products I use are as follows:
1: For active bleeding: BleedStop or StopBleed powder first. Remove dry excess. BleedStop may not hold long term. So expect another bag change soon, like the next day. But bleeding should stop and wound healed some. I find if this far damaged skin that daily bag changes required as scabbing occurs which flake off, causing leaks. So more frequent bag changes with this sort of damage.
2: For slightly damaged skin: Medline Marathon (needs a doctor's prescription or perhaps not?) very GOOD stuff, purple, forms a instant scab. Squeeze to fill skin right next to stoma and then finger spread it out excess further around stoma area. But concentrate on immediate area around stoma, we need to form a good seal there. Don't waste the stuff, it's expensive. Use on top of BleedStop if applied. Marathon is porous.
Note: All this stuff does really is reduces the sting when paste (or perhaps rings) are applied. If one can't get it, then a double thick layer of Skin Barrier liquid dried 30 seconds between coats) poured out of the bottle seems to work well. However when paste is applied expect a more intense (but temporary) sting on damaged skin.
Note: Two things changed at this point. Started cutting a larger oval hole (instead of circular) and stopped using Marathon since it's hard to acquire. My granulomas have disappeared and the skin is rapidly healing. Hurray!
3: Skin Barrier protection, various makers but I find the 3M Calivon (Advanced even better) works good. I find the pump sprayer the best as I can remove the pump and pour a little around the stoma filling the crack and uneven spots, then spreading it out further to cover adhesion areas. Can be used on top of previous products above and highly advised..Or wherever adhesive or stoma output could touch, but not on the stoma itself, it's naturally protected. I find two thick applications allowing for drying works extremely well.
4: Damaged skin like red bumps (granulomas) which can bleed thus causing leaks need to be addressed (going to try silver nitrate sticks or heat.) Edit: No need, they are healing fast on their own.
https://www.oakmed.co.uk/help-advice/ad ... uses-them/
However I find with sufficient barrier spray coating (2 thick poured coatings with 30 seconds of drying) tends to cause them to decrease. Without it and they tend to increase. Note: wafer hole size cut too small can cause stoma to push appliance off skin and cause leaks which causes these red bumps.
May try hydrocolloid sheet, Brava Barrier Cream, silver nitrate sticks, Orabase Paste, Flonase, phenol and trichloroacetic acid (TCA) at a later time perhaps.
5: Skin barrier wipes: I'll use this further outside around the stoma area to cover as they usually don't have a lot of liquid. It also tend to wipe off powder in the process. Same coverage requirements as skin barrier.
6: Stoma and foot powder: I often have problems with these despite dry wiping them off well as it reduces adhesion. Foot powder to combat yeast infections caused by stoma output. What I did learn is one has to apply these first to the skin, then dry wipe, then cover with barrier film, then repeat. Still adhesion isn't great, use until yeast issue is resolved, may cause higher bag change frequency. Good for weeping skin.
7: Barrier rings: Good if one has undamaged smooth very dry skin around stoma. Very important to stretch and get tight right next to stoma or uncovered skin will be burned by acid. Thin one for the first application and pressing it tight right around the stoma, second one on top to mold with and create a more level surface to bond with wafer. I find paste is better as it can be fixed and used to handle uneven areas, the rings can't as easily and may need to be chopped into pieces to level to match appliance.
8: Ostomy paste: Very versatile and can be applied over uneven and damaged skin (first treated with above methods). Again the skin area right around the stoma needs to be filled in when it's dry or it doesn't stick causing leaks. A first thin barrier to fill in cracks and make a smooth surface, will dry quicker than a huge amount. Be very thorough here as any mistakes and your going to regret it. Don't leave the slightest gap or else you'll wind up taking it all off and redoing it later. Check with a small handheld mirror. If you mess up and stoma output ruins things, just head to the shower or bidet and clean and start over. I can't stress this enough, the area right around the stoma is your main line of defense against the acid. Paste may sting damaged skin, but its a good sting, soon to disappear. Unlike an acid sting which is endless. Once a thin layer has been applied and dried, a thicker second layer to take care of uneven areas and bond with the wafer section of your otosmy pouch system.
A quick method I've found is to squeeze a ring around the stoma and using the nozzle in the same motion, level the paste so it's more or less flat on top to quickly marry to the pre-prepared pouch system. If Marathon not used, prepare for a more intense temporary sting.
9: Otosmy pouch system you use (I use Coloplast convex) should be pre-cut and adhesive removed or backing partially started for a quick application once the layer of paste (or barrier ring) has been applied. You don't want stoma output ruining your day. Apply and press down with pressure the wafer area right around the stoma to get the heat and pressure to bind items together and to your skin. This could take a few minutes of heavy pressure. After that I just lay on the bed for a few hours/minutes and allow products to dry and set. Extra adhesive strips applied if required, don't cover the hook holes, pull gently up without trying to pull wafer from skin.
10: Otosmy belt, after a few minutes of heavy pressure it's time to get the otosmy belt on. One should always have a few preset ones just in case one needs washing. Be careful not to move too much, just enough to slide belt underneath and hook on, evening the tension. I use Coloplast as their belts are wider, have four hooks instead of two and seem to hold better than two hook system of Hollister or Conventec.
11: You should feel it's a good application. If any constant pain (other than an itch under the adhesive) may require removal and redoing. You don't want to suffer or damage more skin as it takes time to heal or worse you'll get an infection, resulting in an hospital stay.
Itches under the adhesive area may be caused by a reaction between bare skin and the adhesive, peeling up a bit and spraying some skin barrier film may work. Cover the area better next time.What NOT to do:
Don't get your wafer hole size wrong. Make sure there are no major sharpies after cutting. Check the size of the template you are currently using and check it is not rubbing against your stoma. Oval stomas are possible so the circular circles on the pouch are only guides. There should be 1-2mm space around the stoma to ensure the edge of the hole is not rubbing against your stoma. The paste or the ring is going to cover the skin in between and be flexible to what the stoma is doing, like protruding further outside the body. The stoma needs to protrude through the hole in the otosmy appliance and if it pushes up against the appliance then it can cause it to separate from skin causing a leak. (My stoma is oval and recessed, ah ha!)
Don't apply paste or ring to wafer section then apply to skin. Bad move. Apply everything to skin then the wafer last. You need to seal around the stoma well to prevent leaks.
Don't rush, be through and systematic, perfecting your technique.
Don't use too much paste or too little. May have to use a more layered approach to allow drying.
Don't assume if it's wet underneath it's going to bond, take off and start over, dry well with toilet paper around stoma getting all the little cracks dry.
Don't try to plug leaks or bare with the pain, just go ahead and replace before more damage occurs which takes longer to heal.
I hope this helps you and I will be refining my personal successful procedure further in the future so expect edits of this post.
Your input is welcome. I'm learning just like everyone.
Good luck.
