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My choice of product is Coloplast one piece convex (1/8") with four belt hooks. (I rinse from the bottom)
My stoma is oval 30mm long and about 20mm wide. However this procedure could help others with other sized stomas as it's just a sheet and appliance hole change to match.
I use a Protective Sheet and their no sting paste as well as an alcohol based paste on top to marry to appliance. I have an skin allergy to alcohol.
I also have a high output otosmy, which careful attention to diet and food quantity is in order to prevent runaway diarrhea which makes putting on a bag impossible. Read this for vital diet info:
viewtopic.php?p=230224#p230224
Skinless apples are your friend, eating one after a night of fasting so your output is only bile.
I do not remove my belt now except for a bag change, ensure its tight enough and if it gets wet in the shower I then just lay on a towel and blow dry. I've learned removing the belt causes weakness to occur and leaks, just like a hot shower causes adhesion to loosen. So it's bird baths with lukewarm water in-between bag changes. I have a tub bench and a shower wand sprayer.
Since I have a near flush stoma, a convex appliance is required to push the stoma up and out. Thus I use a one piece appliance as not to remove the belt with its pressure and thus weaken the bond causing a leak. So to rinse I have to do so from the bottom. I was using a 10% mouthwash with water mix, but it was bulky and expensive. So now I've switched to dish soap and water combination. Works better. Likely will use anti bacterial dish soap in the future.
I'll know when a bag change is due, I'll feel a small sting begining which is an sign of a leak. So I'll stop consuming regular food and drink only water (like overnight) and eat a skinless apple (the skins clog). And wait for the output to thicken (I use clear bags to see this) and become less frequent. Then head to the shower after removing the bag.
If I can, I'll fast all night so morning output is only bile, then eat the skinless apple and wait a bit, then do the whole removal and hot shower routine. Making sure body has stopped sweating is important for proper adhesion of paste and adhesive.
I'll usually take a nice hot shower at this time after the bag is removed because ordinarily hot showers when a bag is on causes the skin to sweat and causes adhesive to loosen. So it's usually very light bird bath type showers with very lukewarm water daily if the bag is on.
This is my ideal procedure:
Empty then remove old appliance using no sting (non alcohol) based spray adhesive remover working from the top down. Discard into plastic bag and seal.
Clean area with moisturizing soap and water only. Regular soap will dry skin of oils and itch. Wait until stoma quits spewing, give a final wash and rinse. Good time to take a morning shower, before eating if possible but stoma may not behave as it's expecting food and produces bile. Maybe a small adsorbent type morning snack like crackers (a skinless apple) to get it to behave long enough to get a new bag on.
A good time to trim any hair around area, however close shaving may cause ingrown hairs and cause irritation. So instead I trim down to about 1/8" as this doesn't interfere too much when adhesive moves or during removing.
New appliance application.
Dry skin area around stoma thoroughly using a blow dryer. Pay special attention to the gap around stoma that it's spread out and thoroughly dry. The stoma will self lubricate itself later so it being a bit dry for a bit won't hurt.
If stoma output gets on bare skin, repeat above moisturizer soap and water procedure or else risk fungus infection. Do not touch stoma with harsh/dry toilet paper or it may bleed causing issues later. Rinse with water or damp soft rag.
Any bleeding needs to be stopped before proceeding. Either on its own or by using something that causes it to stop. BleedStop, iodine, piece of toilet paper etc. perhaps. Not enough experience here luckily. Prevention is better than cure.
Again ensure skin area around stoma, not the stoma itself, is completely dry to the finger touch. It should feel slightly rough to the finger tip. Not dragging smooth or slippery. It seems the drier and less oily the skin is the better the paste sticks.
Any stoma output on skin needs to repeat above procedure. Perhaps even sitting in shower for awhile until stoma calms down. Then a final moisturizer soap and water wash and pat dry. Then blow dry at station with supplies ready. Finger touch dry.
Apply stoma powder very lightly to damaged skin only and blow/wipe away excess, clean and dry where it got on good skin. Also be sure to cover the gap between stoma and skin with powder and that it was dry beforehand by spreading out and blow drying well on there. Adhesion in this area is the first line of defense against output. Clumped powder will not hold the paste.
If one has fungus infection then use medicated foot powder even on good skin (instead of stoma powder) and blow/dry wipe away excess..too much powder will prevent adhesive adhesion. Especially in that gap.
Again if stoma output gets on the skin start this entire process from the top over again. It's because stoma output contains oils and simply wiping away won't do. Something needs to bind to the oils and remove it. Moisturizing soap and water. Some use rubbing alcohol however it can be a skin irritant and sting damaged skin for quite some time.
Cover the entire adhesive area and around stoma with a coating of skin protectant and dried well using the blow dryer. I use Flonaze (the nose stuff) as it contains an antihistamine and stops damaged skin pain, makes the skin baby smooth which eases appliance removal. Spray into cap and pour around stoma/skin gap and around to edges of adhesion area. Blow dry well. The gap right next to stoma often doesn't dry completely so take some extra time to ensure it's dry or all is lost.
The way I apply the Flonaze (or any skin protectant) is by not spraying it, like what comes in many products. Rather I remove the pump sprayer (if possible) or spray into a cap (like with Flonaze) and pour the skin protectant around the stoma thick and spread it out onto adhesive areas of the clear skin. This way the area closest to the stoma, where skin gets easily damaged, has the most protection. However it needs to be gently and thoroughly blow dried or else it removes itself and then the bile starts burning the skin again. I've had leaks and didn't realize it because the skin protectant was so thoroughly applied I didn't feel diddly for at least 9 days, it just dried up and started growing mold at that point.
Once thoroughly dried, the skin protectant will provide coverage if stoma output gets on top of where it's applied. So it can be simply damp water wet rag cleaned and blow dried. Other unprotected areas of the skin need soap and water cleaning to prevent fungus infection. Repeat stoma powder and skin protectant on areas where stoma output got on skin and it was washed and removed. Ideally it's best to have an absolutely quiet stoma and that only occurs by careful monitoring of one's diet and output flow. Watching for an ideal opportunity when it appears to be ebbing.
Next to apply the stoma no sting paste. Rings can be used for sufficiently extended stomas of 1/2" or more and very healthy skin. Otherwise it's paste and the protective sheet in my experience.
Before applying no sting paste one needs to do a drag finger test on the skin. If finger drags smooth or slippery, the paste will not adhere to the skin around the stoma. If the finger tip feels the skin is slightly rough, very dry and bumpy that's a good indicator it's dry enough to accept paste. Again make sure gap is well dried as it takes longer to do so than open skin areas. I can't stress that enough, make sure the skin immediately around the stoma is absolutely bone dry.
Apply no sting paste around and away from stoma, never touching it as it ruins the paste with liquid/oils and won't stick after that. Spread close (but not touching stoma) using a flat stick concentrating on skin damaged areas first, especially where output first hits the skin. A tapered edge right to the stoma gap about 1/16" high and about 1/2" wide all around the stoma. You'll know it's a good stick because the paste will stick stronger to the skin than the stick your spreading it with. If not, then clear and dry area again and repeat until it does. The paste repels liquid so if it's not sticking it won't even under pressure and you'll have a leak.
If stoma output ruins things, remove paste by scraping sideways and off. Clean area using extra soft toilet paper (not on stoma itself as it will bleed) then with water damp rag and blow dried again. Powder and skin protectant. Repeat finger test procedure above.
Apply no sting paste so it's bare coating all around the stoma about 1/2" wide. Concentrate on damaged skin areas first as these are the hardest to bind paste to.
Next prepare the protective sheet (prepare in advance is best) by folding in half and cutting a small half moon in the middle, test on stoma without touching paste and cut to fit perfectly. Peel and apply pressing around paste area and getting paste closer to the stoma. Especially in the gap. Excess touching stoma or oozing out is removed. Some no sting paste fill may be required. If sheet is covering scar tissue that's still healing (takes years) then I trim it off and away along its edge. When the appliance adhesive and extra strips are applied, a small air gap over the scar tissue is created by the trimmed away protective sheet thus reducing itching issues caused by the scar healing. The main protection from stoma output is by the ring of paste. The adhesive holds the pouch on and so some gaps is okay as long as the edges are sealed from a major leak getting out. Since my stoma hole is on the side, I ensure the sheet hole is right up next to it to deflect pressure from output. Any gaps between the stoma hole and the sheet are placed on the opposite side of the stoma where output should be on top by then.
What I do is have a preprepared pouch with a 20mm x 30mm hole already cut, then use the circle waste piece to use as a guide to cut two notches 30mm wide in the center of the folded protective sheet. Then, because my stoma is oval, cut a half moon the rest of the way creating a 20mm x 30mm hole in the protective sheet.
When applying sheet I do a slight scrunch and fold the sheet slightly to fit the belly grove created.
Now once the sheet is applied a perfect ring protecting the skin around the stoma is made. Forcing output away from skin and on top of the sheet. That is if successful bonding of no sting paste and the skin occurred. And that depends upon the steps above.
Next apply a 1/2" thin ring of smoother alcohol based base around stoma on top of the sheet slightly away from stoma and flatten closer. Remember pressing the otosmy appliance is going to squeeze paste closer to stoma and could cover it and the hole creating blockage which we don't want. Alcohol based paste stings damaged skin for awhile and one may be allergic to it if it remains in extended contact with skin. However on top of the sheet and no sting paste the skin is protected. Avoid using alcohol based paste to fill gaps around stoma next to the skin, use the no sting paste for that.
Also during this stage adjust to fill any dips in skin with alcohol paste so it's level for the appliance as it's flat and stiff. Blow dry the paste a bit to get it activated.
The sheet is providing sideways pressure protection (like what occurs with pancaking, pushing the paste off the skin) for the paste similar to what a ring does. But rings don't adhere as well as paste and difficult for uneven skin or crevices. Too much paste causes problems too.
I now weaken the appliance with a horizontal fold as I was having irritation issues I think is being caused by stress of the stuff appliance on the skin. When I apply it, like the sheet, I do a slight scrunch as to fit the appliance better with the belly fold that is created. Big improvement when sitting for long periods of time.
I peel backing and apply appliance over stoma making sure hole or stoma is not covered or blocked. If this occurs then peel just the appliance off holding the sheet down using a flat thin sticks in between to hold the sheet down. Clean excess from hole and reapply.
Press the whole mess down using ones palm, some have suggested using a heating pad, great idea. I use the bottom of a stoma powder bottle to press evenly around the stoma. Apply extra adhesive strips over belly button gap, and around where hooks are. Make sure bottom is covered all around, a small gap near the top okay as leaks unlikely up there. I now use a large extra adhesive on the weakest side where belly button and scar is. I also use a tiny bit of petroleum jelly just on the scar to prevent adhesive bonding and as a moisturizer. My scar is in the stoma side of the belly button so I also add a tiny piece of toilet paper there to prevent adhesive stress irritation. If adhesive sticks to scar it itches.
The advantage of adhesive strips is extra holding strength and containing substantial leaks a bit. Especially with a convex appliance. Instead of a full blowout, a small runny leak below will warn you an incident has occurred. But I rarely see anything like that anymore.
Apply belt. Make sure it's tight. Take a nap.
A good bag on should last upwards of 3 days. My record using this method is now 9 says. If an itching sensation occurs under appliance it usually means a fungus infection. Especially if one wants to stick something in there to scratch it. If the bag adhesive area feels tight, it might be because of severe temperature changes, especially heat or poor otosmy posture. Could be the skin is shedding and adhesion is being lost. Likely a bag change will be needed soon, like within a day. I found out having the protective sheet or appliance adhesive directly on scar tissue is problem as it's pulling or healing. Why now I use this method instead.
To test for tiny leaks touching the skin, i gently press through appliance around stoma itself and any hard sting usually indicates a leak, It will grow in intensity so one could delay changing appliance a short time to allow stoma spewing to reduce itself (quit eating and drinking, eat a skinless apple). But don't suffer with the pain too long as the problem gets worse and makes it even harder to remedy. A very lite sting while pressing may indicate a sufficiently covered area of previously damaged skin and not a problem as it's healing. You'll know if it's a real leak, the sting will intensify until you want to rip the damm appliance off.
Note: I now use a backing soda + water rinse and leave a little inside the bag to neutralize acid, helps with small leaks to lesson their impact.
Do not scratch while cleaning the area around stoma with your fingernails despite the desire. Fungus will be fed and grow under the nails and transfer to scalp and other areas of the body. Scrape to clean using a small flat discard type stick. Use medicated anti fungal powder (instead of stoma powder) if a fungal infection occurs.
Those with substantial protruding stomas of 1/2" or more with perfectly healthy skin around may not require this intensive procedure and get away with simply washing and drying well and applying a barrier ring, pressing the ring closer to the stoma and then apply the appliance. I wish mine were such the case but it's not.
Not only do I have an almost flush stoma, but the stoma hole is off to one side right next to the skin/paste edge where the two meet thus pressure is forcing itself right in that crack between skin and paste. So I had to reinforce the paste sideways using the Protective Sheet. I tried a ring and the stoma output pressure forced its way right under it. So this no sting Brava paste is very sticky stuff provided the skin is very very dry..but requires reinforcement.
I see from others experience that I have a difficult case so hopefully this procedure will assist others.
