Need help with final issue with stoma

[Shamrock4806]

Okay guys and gals I'm stumped here and could use your assistance.

I have a recessed illeostomy stoma that I'm using a convex, an hydrocolloid sheet and no sting paste.

With the paste and then the sheet applied first I can fill gaps and squeeze the no sting paste closer to the stoma to ensure better coverage and this tends to work. (Appliance applied over that)

However my problem is I'm unable to get the skin next to the stoma to heal. What happens is the stoma comes out and then the acid burns the skin very close to the stoma.

What I'm suspecting is occurring is the paste is just not fluid enough to fill that gap.

Something more fluid is required that can be brushed on right around the stomas edge.

Yes I tried skin barrier and even flooded the crack around the stomas edge, allowed it to dry, but this doesn't seem to work.

I need something more like the consistency of painters caulk in a tube designed for tiny crack application.

Any suggestions?

[Shamrock4806]

Okay I got a brush on version of NewSkin, which is a liquid bandage. Three coats dried thoroughly the label says is waterproof.

I'm going to try this the next bag change and get back with you.

[Shamrock4806]

Okay, the NewSkin didn't work. Problem got worse.

However I ran out of the sheets so just had to use the convex pouch, no sting paste put on thin and before that I applied Flonaze (yea the nose stuff) as a skin protectant according to advice from an ostomy nurses online site.

I did use a safety razor to trim down any hair in the area first.

The Flonaze was applied to both slightly damaged skin as well as red irritated skin.

The pain went away immediately and I blow dried it so I could then apply a thin 1/16" layer of paste carefully and thoroughly close to the stoma, then applied the pouch, extra adhesive and the belt.

Note it's very important that if stoma output wets the skin that the paste is removed, the area cleaned and thoroughly blow dried before proceeding over again.

Things seem sweet, no irritation or pain. We will see how it holds up long-term.

Day two status same. No problems.

[ron in mich.]

Hi Shamrock what you need is to go back to your surgeon and get a stoma revision and have the stoma stick out at least an inch, after having a stoma for 30 some years and scar tissue pulling mine in and to the side causing skin issues also blockages i had revision surgery and now i use a flat wafer and a brava ring and no more raw skin.

[Mara]

I agree 100% with ron in mich. I also had a stoma revision several years ago due to mine becoming quite flush....no more issues even though I have gained a bit of weight since my surgery back in my late teens....

I use an Eakin seal, Convatec faceplate and pouch....nothing else and change once a week...

[Shamrock4806]

Stoma revision?

Sounds like that's the answer as mine only sticks out about 1/4 inch.

However I have terminal cancer and was given less than a year to live. Surgery was performed back in early Sept of 2023.

It's now 10 months later and I'm still alive, so I guess if I have to go back in for more surgery I'll ask them to fix it right this time.

Thanks for responding.

[Shamrock4806]

I've realized what my problem is, the paste is water resistant and some areas around the stoma is not completely dry thus not sticking.

I mistakenly thought the paste would absorb moisture and it doesn't.

I'm using a blow dryer to dry the skin out, but it doesn't seem to work where the skin is damaged, likely weeping. I guess I could resort to using powder but found it interferes with paste skin bonding also.

And this morning, despite not eating or drinking all night, my stoma was ejecting gooey sticky bile and severely hampering my efforts to get a bag on. I can only guess I was hungry although I didn't feel hungry. Maybe because the body was expecting food and thus was producing bile in anticipation.

You know you think you got this thing licked and something else shows up.

Anyway now I've developed a test if the paste sticks or not. I apply it and press down using a coffee stick and slightly pull up. If it sticks to the skin then half or so remains. If it parts completely away from the skin it's too wet and I remove and hit it with the blow dryer and try again with a fresh batch of paste.

If and when I get a nice thin layer stuck to the skin around the stoma I'm good. This sticky paste sticks so well that even in the shower it remains stuck on.

[Shamrock4806]

Okay came across some more detailed information about stoma powder and correct use.

How to Use Stoma Powder:

Wash and dry the skin around your stoma thoroughly

Apply a small amount of stoma powder to the irritated open skin

Only apply stoma powder to raw and moist skin

Gently brush away excess powder using a soft tissue.

The powder will stick to the open raw skin.

No stoma powder should be left on the surrounding skin because it will not prevent irritation and it can interfere with the adhesion of your ostomy system.

Once your skin heals and it is no longer moist, stop using the stoma powder, it is not meant to prevent skin irritation

Ah ha! Okay charlie.

And crusting involves putting a skin barrier film on top of the area, even with powder to protect. Okay

And one more thing, I have an almost flush stoma, being it's sticking out about 1/8 - 1/4 inch usually but not always. It's not a recessed stoma, however the convex is certainly the correct pouch system to use for this to try to keep it out and not go flush.

Let's see it's been 10 months since my surgery and one of those months the nurses changed my pouch and were horribly screwing things up that I learned wrong and couldn't do it at home correctly. Another hospital got me on the right track with a convex but didn't teach me the final nitpicks of stoma powder, just applied it to the whole area as my whole area was weeping from irritation. So naturally as things healed the bag wasn't adhering because powder is only supposed to be applied to weeping skin, not healthy skin thus losing the adhesion factor.

So now it's been 9 months of me having to suffer and even the otosmy nurses I've seen as outpatient haven't gotten my sh*t straight.

Okay we will try better next bag change.

[Shamrock4806]

Okay say two and I've sprung a leak, feeling that consistent burning pain.

So this time I did the crusting method using powder on weeping skin and Flonaze as a skin protectant.

Then applied the sheet directly over that, bending over to get a tight skin fit, no paste first. Filled the gap between sheet and stoma with paste. Applied convex.

We will see how this goes.

[Shamrock4806]

It lasted a whole hour maybe.

Laying on my back I noticed this bubble forming around the stoma, thinking it was a pancaking issue I pressed to push the output away. A few minutes later feeling the leak run down my belly.

The output forced its way under the sheet no problem.

Good thing I use the extra adhesive strips which contained most of it..

So no, paste must adhere first as it's water (and likely acid) resistant.

So now what I'm thinking is the sheet provides what exactly? A uniform pressure on the paste and allowing some flexibility for the convex?

Anyway lucky for me the stoma behaved and I was able to quickly and efficiently put another sheet and bag on.

Hopefully it holds for longer than a day or two this time.

[Shamrock4806]

Okay day two and this is the procedure I followed.

Washed stoma area with moisturizing soap and water, blow dry well.

Weeping or damaged skin area only received stoma powder and excess blown away with drier. Good skin with powder on it cleaned and blow dried so none remains there.

Entire adhesive area covered with Flonaze (aka skin protectant) and blow dried well.

Non sting paste applied slightly away from stoma and pressed down using a flat stir stick closer to stoma..making sure paste does not touch oily/wet stoma.

Use something stiff and flat with hole (like a new pouch without adhesive backing removed) press over area and remove. Half of paste should stick to both. Any areas where the paste got removed from skin needs to be removed and discarded, then addressed to dry again (wash, dried, stoma powder, skin protectant, blow dried) paste patch and test adhesion again using a flat stick.

Once non sting paste about a half a tube output in thickness is spread around and sticks successfully to the skin, apply the precut sheet and press down around stoma. Any paste protruding over stoma is removed and discarded as it's oily and wet, useless.

So now we have a good bond and seal around stoma protecting the skin. The sheet provides sideways support vs the stoma output sideways pressure to keep paste in place.

Next alcohol paste (cheaper, flows easier) a half tube output applied around area slightly away from stoma to be pressed closer. Too much and it will cover stoma and block, causing a problem. This is to provide a seal and take care of any unevenness between sheet and appliance.

Apply appliance and press down and hold. Apply extra adhesive and belt etc.

All this pretty much has to occur with stoma output (or blood).not oiling or wetting the skin or the paste. So the timing of having a period of no stoma output is vital to success. So there is a time issue and usually after a long period of not eating or drinking usually results in a dry stoma. However I had one where the stoma kept producing an oily bile because I was likely hungry and the body was expecting to eat.

This above procedure is for non bleeding skin only.

To stop bleeding I use BleedStop first until it works then remove excess, like a stoma powder. Unfortunately it's really difficult to adhere paste to bleeding skin as it takes time for a scab to occur and with stoma output being uncooperative...getting it working with bleeding skin will require near daily appliance changes and possible infection could occur. So if your bleeding it means the problem has gotten severely out of control and may require professional assistance. Especially if there are lumps or other issues.

[GeorgeS]

Mentioned in another thread, I said I discovered I was alergic to rubbing alcohol and initially that was my irritant I constantly dealt with having to heal up. The bile issue now is about the only thing I have to deal with besides tearing of skin if I remove my wafer too fast.

On the occasion when I was dealing with the raw meat skin from alcohol cleaners, my nurse first assumed I had some fungus issue and suggested using foot powder to kill any fungus. Yes, but not as crazy sounding as nose spray

Because of the alergy to alcohol on thin skin areas, I use iodine. It seems to have a tiny amount of oil if used too thick but also using the foot powder, I basically crusted the area enough the adhesive on the wafer doesn't stick and I can use the belt to hold it in place. Your mileage will vary obviously since you have a more flush stoma. But anyway, this healed a few of my hard to heal skin times.

[Shamrock4806]

Mentioned in another thread, I said I discovered I was allergic to rubbing alcohol and initially that was my irritant I constantly dealt with having to heal up. The bile issue now is about the only thing I have to deal with besides tearing of skin if I remove my wafer too fast.

On the occasion when I was dealing with the raw meat skin from alcohol cleaners, my nurse first assumed I had some fungus issue and suggested using foot powder to kill any fungus. Yes, but not as crazy sounding as nose spray

Because of the allergy to alcohol on thin skin areas, I use iodine. It seems to have a tiny amount of oil if used too thick but also using the foot powder, I basically crusted the area enough the adhesive on the wafer doesn't stick and I can use the belt to hold it in place. Your mileage will vary obviously since you have a more flush stoma. But anyway, this healed a few of my hard to heal skin times.

Iodine? Great idea, I assume it's painful though. I tried a antiseptic liquid bandage once and it stung like heck. Will give it a try though. But right now I have no seriously damaged areas, only a small irritated spot that stoma powder and skin protectant works if I manage to get paste to stick.

The Flonaze (with the stoma powder first) works great as a skin protectant and stops the pain as soon as it's applied, likely the antihistamine? Give it a shot. Spray vertically into the cap then pour and apply.

https://morethanmyostomy.com/2023/01/23/flonase-rocks/

I agree foot powder works on the fungus areas. Itchy areas under the adhesive is a good indicator. Fungus needs to be fed and it's stoma output on the skin that causes it. Just like urine on the feet (showering) feeds foot fungus.

It's important to first wash the area using a moisturizing soap, rinse and dry well using a blow dryer before applying any powder, protectant or paste/ring. I learned if I do this nearly everytime stoma output gets on the bare skin, it reduces the chances of a fungus infection. However once sufficient skin protectant applied and dried then a bit of output on that isn't going to do anything and can be simply cleaned and dried well and the rest of the process can proceed.

Problem is too, foot powder, like stoma powder, has to be lightly applied to be well dried skin, excess wiped off and skin protectant applied and well dried over it. (crusting)..or the adhesive or paste won't stick.

I think your skin tearing issue will start to disappear if you start using Flonaze as a skin protectant for the entire adhesive area (clipping down, not shaving, long hairs also) It coats the skin and makes it baby skin smooth which makes an appliance just peel off.

I use no sting spray adhesive remover working from the top down so the remover sits between the skin and the adhesive, no tearing.

But yea scabbed areas do tear unfortunately and most difficult to resolve. Seems like more frequent appliance changes are needed when there are scabs because they detach and acid then gets under them.

I swear by using a blow dryer now, I developed a test to see if the skin will be accept paste to stick or not. I drag my finger around and if it's smooth (or slippery) it won't stick. But if my fingertip feels dry and slightly rough skin I know it's good. As you likely know, our palms don't have any pores where skin oils come out, our palms are lubricated by rubbing open skin elsewhere. So if the fingertip feels dry during my test means the skin is trying to absorb oils and thus dry enough to accept paste (or ring if you use those)

I also first concentrate on getting paste to stick to the most irritated spots first. Seems my stoma hole is on one side and almost flush, making that skin area next to it prime target #1 for output sideways pressure which can force paste off the skin and underneath.

I agree with you about alcohol, it's the worst thing to use around a stoma, guess they get into the habit of using it for everything. I hope the industry is getting away from using it around stomas. But hospitals are all about administration and costs, not creature comforts unless you have the big bucks. Seems the best otosmy nurses are the patients themselves.