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It's quite elaborate but I was having severe burns likely from drinking coffee (which I've quit) so it required me to be very systematic and thorough. This may not be your exact situation.or appliance use however the things I've learned have implications for others with an ostomy and may be advantageous, why I'm posting it.
This a a very important list of diet necessary for those with an illeostmy. Certain foods NOT to eat and those you could or shouldn't. Some stuff can cause a clog (ER stat!) or cause the stoma to protrude out thus ruining your seal. You pretty much want to eat things that will liquidify upon exit or come out very wet, tiny and very mushy.
You also don't want to consume things that cause a diarrhea situation where your body just goes nuts spewing uncontrollably and you can't get it to stop to put a bag on. You'll dehydrate yourself also. Certain nutritional drinks will do this for me as well as beer.
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I have a near flush illeostmy stoma requiring a convex, a four hook belt and I have a belly fold right where the stoma is. I have a high output otosmy. It's a very difficult situation and my output was burning my skin a lot (coffee was the culprit) but I've solved almost all my problems.
If you don't know what body contour you have, what type of stoma etc. I suggest you study and take a test to find out exactly what appliance will work for you.
Paste works better if you have a near flush stoma, dips, belly folds or uneven skin around the stoma, scabs or granulomas. Or just regular smooth skin also.
Rings work better if you only have nice perfectly even and smooth healthy skin around a well protruding stoma.
I've condensed my procedure down to steps of my daily routine of success.
In the morning check bag condition if any leaks have occured and if so then:
1: Wait until stoma activity has subsided usually in the morning before eating. However if bile is in the bag I will eat very small (applesauce works) something that dries out output (no liquids) to keep digestive system busy while bag change.
If I have tiny burning leaks, I'll dump and flush the bag with a few drops of antibacterial liquid soap and water. Then rinsing with fresh water and even laying down to rinse the upper portion of the bag.
If stoma has subsided producing output I'll dump and remove old appliance using spray adhesive remover. (Keep 2 cans ready in case one runs out) Seal in bag.
2: I take a long hot shower and use something soft, flat and somewhat stiff (coffee stir stick works) to gently sideways scrap any extra stuck on glue, paste etc. (avoids getting fungus under fingernails or scratching skin)..I use antibacterial liquid soap to kill any digestive enzymes and sanitize the skin and wounds, a LOT less painful than alcohol or iodine which I don't want it sealed under paste etc. as it keeps on stinging.
3: Remain in shower until stoma output has subsided if need be. Having a waterproof chair allows rest with shower removing output. (Really only needed in case of a rare blowout now) Meal timing, food amount, using antacids dissolved in water as a bag flush/digestive and enzyme neutralizer (leave a little inside to mix with new output) and watching the bag contents can assist in reducing this wait time.
4: Dry off and proceed to appliance application area. I use my bed and it has everything already prepared and laid out to maximize time before a spewing occurs.
5: Lay down on plastic bag + towel to protect bed in case of sudden stoma discharge. Have soft toilet paper ready to dry up any fluids and water around stoma. Never wipe on wet on, always pat dry and remove, using a dry section of toilet paper each time. Use blow dryer on low to thoroughly dry area so it's really dry skin. If stoma output gets on skin, head back to shower and repeat from #3 as it's really not quiet yet. Output just on the stoma isn't a problem if it's removed before it hits the skin, it's because nothing is going to stick to the stoma.
6: If skin is damaged and weeping, then a tiny bit of stoma adhesive only on damaged areas! To dry then completely toilet paper dry brushed removed else nothing sticks to it. I then use a skin protectant spreading out to cover wherever adhesive or paste will stick. Then blow dry thoroughly and repeat another coating just around the stoma. I've found two good coats is very effective at reducing enzyme burns longer. It's important that the blow drying of the skin is very thorough at this point because the paste needs to stick well to the dry skin. So finger drag and test it's not moist in any way. This is a very important step! Do NOT put stoma powder after skin protectant unless it's covered by another layer of skin protectant because nothing will stick to it, like pastes or adhesives.
I take considerable effort to ensure the skin around the stoma is dry and not greasy or sticky at this point. I need a good bond to prevent leaks. Sometimes there is too much skin protectant and it causes separation issues or adverse skin reaction, so I'll only use no sting paste. I may have been overdoing things in the past because of the coffee causing the burns to be worse than normal.
7: Having a near stoma sized precut hole in my appliance (notched around granuloma area I have) I apply a bead of non-sting paste around the stoma away from it slightly and then fold the lump closer and down a bit next to the stoma using a wooden coffee stir stick. I can immediately tell if the paste is sticking to skin or not, if not then I remove that section, address and return to one of the above steps above depending. Skin adhesion is very important as its protecting the skin. If all the previous steps are done correctly and thoroughly then it should stick all around every time. It's important with paste that the wafer skin contact area of the wafer is covered by paste, much like a ring would. About a 1/2" around stoma. And it's important not to press down too hard that paste covers the wafer hole, only along its edge as seen through the clear bag. Paste will set up like a wall around the stoma and fill unevenness between flat wafer and ones body, so gentle firm pressure to create the seal. Don't try to force the wafer to match the body.
9: Next I take my stiff flat convex and weaken it horizontally so it's a bit more flexible for my belly fold and provides little resistance. If it's too stiff then bending pops the wafer off the skin. I pretest the hole for fit and make body marks using a little paste on the flange skin edge so I can like them up later. I had a graneoluma for awhile that I resolved by using a thicker amount of paste and less tight of a belt. Once it diminished I went back to a more normal amount of paste and kept the belt holding just a little.
10. I peel the backing off the wafer and line up with my body marks, the wafer hole to the bottom of my stoma and gently press into place.
11: I then press down gently, but firmly, with my palm and around the stoma also. The paste should not completely cover the stoma as seen through the the clear bag, a gap or hole is needed.. If covered then I screwed up and put the second layer of paste too close or too thick or pressed too hard and have to redo. With paste I have a lot of control over filling unevenness especially with a belly fold right there. Rings don't work well for me because of the unevenness, even though they do melt, that takes time and the stoma could spew in between. So I use paste, the object being to marry the unevenness of the body contour with the flatter wafer section of my appliance as fast as possible due to my high output ileostomy.
12: I then apply olive or coconut based skin lotion just to my scar tissue. Cover with some pre cut thin cardboard from appliance boxes (the otosmy supplies come in) with edges rounded, to cover scar tissue/belly button so adhesive strips or barriers will not stick to it or it itches. Put toilet paper ball in my belly button scar area to level. Cover with another square piece of cardboard..Press any adhesive areas down and apply extra large adhesive barrier strips all around, one on the left centered under the two left hooks and one on the right both meeting at the bottom as to seal any leaks from escaping. Sealing the top is important as shower water will get in otherwise. I use a blow dryer on low to heat and active the adhesive so it's on the skin firmly and smooth, this will prevent a lot of shower water from getting in, gives a nice professional looking result any otosmy nurse would be proud to see.
13: After laying for a bit to allow the paste to harden up some, I apply my belt and ensure it's not too tight but secure. Then I address my fistula stoma (double barrel ileostomy) by using a piece of low stick tape with a little petroleum jelly smeared on it to keep the stoma lubricated, to protect it from chaffing due to shirts and causing stains.. It doesn't leak much usually and sometimes harder jelly substance, which I remove with a small coffee stir stick. Stoma skin is very fragile and easily damaged so it will bleed, so I'm careful. I'll watch it and pull, clean and replace the fistula tape if it starts getting nasty.
14: Since I use a one piece convex with four hook belt as not to disturb the bond as much as possible (instead of a two piece) I rinse the bag from below using a few drops of antibacterial liquid soap, rinse twice (even.lauing down if necessary) and then leave a little inside to act as a future enzyme neutralizer.
Now if don't have to change the bag in the morning, I'll take a hot shower using waterproof tape along the top of the bag adhesive strips area, then blow dry myself and the bag as it gets wet. I ensure as little shower water as possible runs down the front, using a damp wash cloth for the chest area instead. The belt I've gotten used to it being wet and it dries itself out eventually. I'll just move it sideways a little if it's bothering the skin any. Whatever I do, I don't lift the belt up or it will cause a leak.
So if the bag is good come around lunchtime then I'll go out to someplace close and nutritious, eat a big meal or a few smaller ones and run straight home. Any chores etc are done before eating lunch because the bag is going to go ballistic for the next few hours.
I've found certain foods, like beans, may not digest fully (clog hazzard avoid!) and exit the stoma with a lot of pressure and disturbing the seal despite how well I chew it. So it's good for me to only eat things I know will basically liquify upon exit. I also don't eat foods or drinks that will raise the pH levels of the output (coffee, sodas) cause a clog or doesn't digest fully into liquid in the output. I do this not only to avoid a clog (dangerous!) but to avoid the stoma pushing itself to discharge matter which can disturb the seal and cause leaks. Also if the hole in the wafer etc. isn't right or off center, the stoma extending out can push the appliance off and create a leak. Why now I make a skin paste mark to match the tab on the top of my wafer when pre-fitting.
I do no major eating after 2 pm as to give plenty of time for lunch to process and not during the night which may lead to a very bloated overfilled bag which pressure from the stoma output will start forcing it's way under the seal and cause a leak or even a blow out. I sleep only on my back using pillows under each arm to keep me stationary. I found sleeping on either side with a belt on causes problems, blowouts and graneoluma.
Later in the evening or early am I may get hungry, but it's only very small dry snacks. Sometimes in the morning I'm hungry enough that bile just fills my bag, this isn't good as it will keep spewing while trying to do a bag change, so I'll eat a small snack, no liquids, usually applesauce works great, to stop or slow this bile generation an hour or so later so I can then take a shower and get a new bag on.
Note your situation may be different. I have a near flush stoma in a belly fold which is a bit more difficult than normal.
I hope this helps anyone else and if anyone can see something I could do differently or better, please speak up as I'm open to improving my process until I can live comfortably once again.
Again, this first post is edited to be up to date on my process. Later posts are just comments.
I was thinking, the benefits of a 2-piece system:
