My newest latest method for near flush stoma and belly fold. Updated.

[Shamrock4806]

I've been tirelessly working on this method and I think I've found a winning formula.

Consistent wear time of 3 days or even more sometimes..I feel like a normal human being almost.

#1 problem? The PASTE WASN'T HARDENING UP!

Quitting coffee! It was just being ejected from my stomach along with stomach acid out the stoma and caused the skin burns to be severe. So I only drink tea now with a good bag on as the tea can cause diarrhea also, just not as acidic as coffee.


So this is the ingredients list for those with an Ileostomy with near flush stoma and a belly fold.

However tips included can be useful for others with different Ileostomy body contours etc.

Coloplast products

Sensura Mio convex one piece (you won't need to remove the bag with this method to clean) however two piece wafer is designed to last longer, like 3-5 days.

Brava No-Sting Paste

Stoma powder

Extra large barrier strips moon shaped

Coloplast four hook otosmy belt

Adhesive remover spray in the bathroom along with plastic bags to dispose of used wafer.

Spray skin protectant


Other ingredients

Flat wooden coffee stir sticks or tongue depressors to remove stuck on paste and apply new paste

Toilet paper to dab dry and remove paste off stir sticks, dan up spew before it hits the skin, etc.

Plastic dish sponge with scrub side used to remove fine paste film from around the stoma on undamaged skin only. Or to exfoliate the skin. Gently!

Blow dryer near your bed as well as all tools and supplies within easy reach.

Plain disposable plastic cups to hold against stoma while traveling from shower to bed, just in case.

Water bottle filled near toilet along with antibacterial dish soap.


1: I prepare my new wafer/bag by sealing the bottom and cutting my hole to the apx size of my stoma. If you don't know then wait until your in the shower with the old wafer removed and the area cleaned, then test fit and cut to fit. If an oval stoma, then cut an oval. I don't let the new wafer get wet. I cut the wafer hole just a hair bigger than my stoma. It does swell a bit when it comes out and I don't want it to get stuck or rub on the wafer edge.

2: After I cut the wafer hole, weaken the stiff portion of the convex bubble so it's more curved horizontally and flexible. Do this evenly, the wafer should be moon shape curved when your done. Set aside and keep it dry. A one piece I do apply petroleum jelly to the inside bag through the wafer hole so paste won't stick to it.

3: Rinse the stoma area so it's free and clean..Then use a flat coffee stir stick etc. to gently sideways scrape off any residue paste etc off. I do not use fingernails as they tend to dig and scratch the skin. Get fungus under the nails. I use toilet paper to remove paste off stick and discard. Next I use the rough part of the plastic dish sponge to oh so gently sandpaper off any lingering residue and exfoliate the skin. Be gentle and sideways strokes, never on damaged skin.

4: I wash the area with water only (Dove type soap maybe) and after any spew that gets on the skin. It contains oils which affects bonding. Paste and adhesives need clean, dry, dust and oil free skin to bond to. Keep all other soaps, shampoos, conditioners, lotions, ointments etc. from going onto your adhesive areas. It will interfer with bonding or dry out the skin and be painful. You want the skin to have its normal moisturizing level it does on its own.

5: Once the stoma has quit spewing, which timing ones bag change when the stoma isn't active is best. Usually after a fast but not when hungry and then it just keeps producing bile. So I eat applesauce and wait until it dies down. However many wait until a leak occurs to remove a water and then after eating or drinking something that causes diarrhea and the stoma just won't stop long enough to do anything. So sitting in the shower seems to be the method to wait it out unfortunately. I now eat during the day and nothing at night and just before bed the take a shower and replace the bag, then sleep only on my back for the paste etc to set up and not drip out. Less bag dumps in the middle of the night this way also.

6: Dry off and use the plastic cup to hold against the stoma in case of a sudden discharge. If spew gets on the skin anytime before a wafer is securely adhered, I go back to Step 4 and start over. Spew contains oils, needs to be removed with water.

7: I lay on my back and use the blow dryer and toilet paper to dab up any moisture. Never wipe wet..I use a fresh dry toilet paper area and always dab to remove small spew trying to get out and keep the area dry.

8: I blow dry the area well. Wounds will eventually form a dry crust on top and that's what I want. So keep drying it out and do a dry finger test, it should feel dry and not slippery skin. This is extremely important step. Wounds only if possible, get a one grain high only light dusting of stoma powder.

9: I test fit my wafer and make reference marks on the wafer flange edge and my skin. I just use a little paste for this as the next move requires paste. Remove wafer and set aside.

10: I spray two coats of skin protectant over the entire adhesive area allowing 30+ seconds to dry well after each coat. This locks in the stoma powder and not wiped away using adhesive wipes.

12: Now around the stoma I place two full rings of paste, one behind the other. Peal the backing off my wafer. Line up the reference marks and gently press the wafer on. Press around the stoma so the paste gets right to the edge of the hole, not onto the stoma hole or it will cause a clog. I press the flange down and hold to seal to the skin. Wait like this for some time for things to set up.

With a one piece with petroleum jelly applied beforehand through the wafer hole to the inside of the bag, that extra oozed over the stoma paste will detach and be flushed out of the bag during a dump, as long as the stoma hole isn't blocked it should be okay.

13: Once it sets up, I apply external barrier strips all around attached to the wafer flange. I don't miss any part or a leak will spew through on me. I ensure the strips are centered left and right under the hooks and meeting at the bottom which may put a slight gap at the top. I use a cut filler piece there to keep shower water out. Now i wait laying in my back, to let that thick paste set up. I take a rest for about an hour or more, all night on my back is best. Because the paste needs to be hard BEFORE applying the belt or going vertical or what happens is it squirts it out, drips down or onto the stoma on me. If i stand up too soon runny paste will just leak out also. The thick paste is required for really holding onto the wafer when one bends over slightly like when sitting or trying to stand. This is what causes the wafer to detach and leak. So I'm basically floating the wafer on paste and it works great.

14: After the paste feels hard though the bag and around the stoma. Apply the belt and not too tight. Just a gentle pressure, one finger underneath tension. If I can rest longer on my back then great. I usually try to time a bag change with sleeping. With a pillow under each arm and my upper body slightly elevated as to drain spew into the bottom of the bag. I've learned rolling on ones left side causes blowouts and on the right side causes the wafer to dig into the skin and causes graneoluma to form.

15: Washing and rinsing the bag. Dealing with pancaking issues. Use two drops of antibacterial dish soap after a dump followed by water to wash the bag while on the toilet. I do not squeeze the bag or try to push pancaking material that gelled up around the stoma it will force my wafer off and cause leaks. Instead add water again and seal, go lay on my back and get the water up around the stoma and gently massage the area to loosen hard spew. Leave one drop of the dish soap and a little water to control odor from the next dumping.

16: Altering my diet. I don't want that stoma moving much, which it will do if under pressure, like it's trying to clear chunks of undigested food (solid vegetables) or thick spew. So I concentrate on only eating things I know will turn into near liquid upon exit. This way it just drizzles out. However very liquid spew can tend to leak more as its tiny and exploits the smallest cracks around my stoma seal. So something not too runny, but not to thick. This comes from experience and getting a copy of a eating guide from a nutritionist.

[Shamrock4806]

With a near flush stoma in a belly fold which is rather difficult to keep a wafer attached, I much prefer watery output so the stoma doesn't extend much and disturb the careful seal I've created to keep a bag on long term.

I do drink plenty of water and an electrolyte drink occasionally. I ensure I'm urinating and it's a normal yellow or clear, not dark orange or dry which would indicate dehydration.

As a new Ileostomate, you may find my next paste of information beneficial.


Gas is usually a diet issue as digestive enzymes breaking down your food produces gas as a byproduct. However certain foods cause more gas than others. A list is provided as part of my paste guide below.

Could be a reaction between meds as well. 


Nighttime dumping is just a fact of life with those who have an Ileostomy. But there are things one can do to reduce the nighttime dumping and get some sleep.

1: With a good bag on, eat from am to about 2 pm. Frequent small and nutritional meals. After that only very small hunger avoiding tiny snacks. This will give time for your stoma to clear out and not fill the bag during the night as much.

2: Sleep only on your back with your upper body slightly raised, with pillows under each arm to train yourself to remain put. This will avoid a lot of issues and cause content to drain to the bottom of the bag.

3: Train yourself at night to tap your bag to check if a dumping is required. Feel around the stoma if a pancaking bubble is forming because if ignored it will force the wafer off and cause a leak or a blowout even.

4: After each dumping, put in a couple of drops of liquid antibacterial dish soap into the bottom of your bag followed by some water and gently (don't squeeze!) wash it out. Follow by two rinses where one (if necessary or in the case of pancaking) lay down and massage/rinse the upper part of the bag and dump. Then perhaps a final rinse. Leave a drop of the dish soap and a tiny bit of water in the bag to control future odor. Say goodbye to stinky bags!

5: Clean stoma area in shower using nothing but water (maybe Dove like soap, risky) and after each spewing as it contains oils that interfere with adhesion, apply nothing else. Blow dry area very well so even wounds feel very dry to the touch. Adhesives like rings, paste, wafer flanges and barrier strips only stick to clean, dry, dust and oily free skin. Alcohols used get trapped under things and cause allergic reactions. Antibacterial liquid soap works best to kill infection and clean the skin of oils, drys out wounds to allow bonding. As long as nothing else added to it at factory, why I prefer to use antibacterial dish soap free of any aloes or skin lubricants. 

6: If you use paste, consider using no-sting paste free of alcohol. Premix some paste with stoma powder to get it to activate and spread a 1/2" thin ring around stoma focusing on wounds first using a flat stick to press it down. If it doesn't stick then remove, and discard off stick using toilet paper. Blow dry and try again. Then about 1/3" away from stoma, put two thick rings of paste, score the tops and sprinkle in a little stoma powder, mix and cover any powder with paste or it interferes with bonding to skin and wafers.

7: If you use a ring, stretch to the size of your stoma and any gaps you press the ring flatter and closer to the stoma to cover the skin. Rings are good for flat areas and good clear skin. Paste is better for unevenness, wounds, dips or graneolumas on the skin.

8: With a wafer hole cut to be just a hair bigger than your stoma (cut an oval if your stoma is oval) press the wafer on and ensure paste or the wafer does NOT cover the stoma or it will clog. You can test fit the wafer and make reference marks on the edge of the flange and ones skin to line up later with. Some weaken their wafer horizontally so it flexes some for bending so it's not so stiff, like for belly folds.

9: Diet and quantity control is important for those with an Ileostomy.

Signs of a clogged stoma.

No output or only watery output under pressure for a few hours after eating. Could be caused by a covered stoma by improper application of an appliance, typically hole is cut too small or not lined up correctly or paste covering the stoma. Also could be caused by eating hard food. Remove appliance if necessary and wait in shower washing output away. If badly clogged a severe pain will appear and a trip to the ER is necessary.

Unfortunately very high and frequent output will ensue after clearing for quite some time which will likely making putting on a replacement appliance difficult. Use stool thickening tactics (below). If going to an ER, bring your own otosmy gear and a change of clothes as hospital likely doesn't carry or doesn't know how.

What is "pancaking?"

Pancaking occurs when a vacuum in the bag (likely do to a clogged filter) or super thick stool blocks stool from depositing to the bottom of the bag. Thus can force bag off and cause leaks. Controlling what one eats and by mixing and consuming stool thickening and stool softening foods at the same time in your mouth to get a balance. For instance eating toast mixed with tea in your mouth so the dry bread is soaked and the tea causes more runny stool. To resolve a pancaking issue is to go dump, then flush the bag with two drops of antibacterial dish soap and water, then add fresh water and seal up, go lay on your back and get the water up near your stoma and gently massage the pancaked output loose. Do not squeeze the bag or try to dislodge pancaking output by pressure as that can cause the wafer to detach as well.

To resolve pancaking caused by a vacuum, after the bag is washed and clean, insert a tongue depressor or flat stick into the bag from the bottom and push the two clinging plastic pieces apart. Then seal the end and roll the air up towards the top of the bag so there is a ballon of air around the stoma.


What is "ballooning?"

Ballooning occurs when foods eaten produce too much gas and the filter gets clogged (likely due to laying down) and thus forces bag off and causes leaks. You can "burp" the bag of excess gas while dumping or just opening it up a little and pressing the gas portion out. But the best control method is diet control.

These two conditions can cause premature bag replacement and leaks which burn the skin. It's better to replace the appliance if there is any continuous stinging pain, don't just live with it. Keep an eye on your otosmy supply and have ample reserves.

I've found that caffeine, in coffee, tea and even chocolate causes diarrhea and can assist in controlling flow so stool is more liquid..however coffee makes output very acidic making burns far worse. Dried Chinese Crispy Noodles, Cheerios or applesauce (peeled apples) are the exact opposite, a stool thickening food. By mixing these with other foods one can manipulate their stool output and counter the issues above. Also the severe thickening helps in cases where one has severe diarrhea and unable to reattach a new bag due to high flow.

Eating Guide

Partially copied from my nutritionists guide. Ileostomy Nutrition Therapy from the Academy of Nutrition and Dietetics. (This handout may be duplicated for client education.)

My recommendation is to see a nutritionist for the full guide as not all can be pasted here

I've added my own observations to further clarify 

Chew all foods well to the consistency of paste.

Foods That May Cause Blockage (very bad avoid!)

Apples, unpeeled (unpeeled and applesauce are excellent thickeners, don't eat the skins or the core, chew well)

Bean sprouts, Cabbage

Casing on sausage (inside fine if no tough parts, avoid swallowing if a chunk is felt) Also sausage like meats like pepperoni and salami contain indigestible bits.

Chinese vegetables (stir fried crunchy, too hard, need very soft veggies with no skins)

Coconut, Coleslaw, Celery (avoid)

Corn (grits also, corn anything doesn't seem to dissolve in stomach)

Cucumbers (skins bad, inside chewed up good seems okay, no seeds)

Dried fruit, raisins

Grapes, blueberries etc. (skins and seeds the problem.)

Green peppers (red, yellow also) pureed or very very small seems okay in small amounts 

Mushrooms (doesn't dissolve in stomach) pureed or very very small seems okay in small amounts 

Nuts (totally avoid)

Peas (mushy interior okay, like pea soup, skins a problem)

Pickles (skins a problem, inside if chewed up good seems okay, seeds not)

Pineapple (liquid okay, mushy parts fine, hard parts not, rather risky as parts of mushy may not digest)

Popcorn (totally avoid)

Relishes and olives

Salad greens (diarrhea nightmare too)

Seeds and nuts (avoid)

Spinach (doesn't digest, pureed perhaps)

Tough, fibrous meats (for example, steak on grill, well done, tough parts especially, over grilled chicken or dry pork chops. Juicy grilled or pan fried chicken, shredded pork in juices, medium rare steaks, hamburger better.

Vegetable and fruit skins, (any avoid)

Whole grains (no grits, rolled oats oatmeal seems to be okay, oat cereal is an excellent thickener)

Foods That May Cause Gas or Odor

Alcohol, Apples, Asparagus (stink), Bananas, Beer, Broccoli (clog hazard)

Brussels sprouts (clog hazard)

Cabbage (clog hazard)

Carbonated beverages

Cauliflower, Cheese, some types

Corn (clog hazard), Cucumber

Dairy products

Dried beans and peas (clog hazard)

Eggs (don't digest in stomach)

Fatty foods, Grapes

Fish (cooked salmon in small portions may not, nor stink, same for raw tuna)

Green pepper (red and yellow also, clog hazzard)

Melons, Onions (clog hazard)

Peanuts (clog hazard) Prunes

Radishes, Turnips

Soda and sipping using straws, (drink from glass instead)

Seafood (oh God does it stink!)

If your having pancaking issues a small amount of something above (like having a soda during a meal) could introduce some air into your diet and thus into the bag. Also by avoiding too much thickening foods by themselves which often contribute to pancaking.

Foods That May Help Relieve Gas and Odor

Buttermilk, Cranberry juice, Parsley

Yogurt with active cultures (Greek yogurt)

Foods That May Cause Diarrhea (looser or more frequent stool)

Alcohol (including beer)

Apricots (and stone fruits)

Beans, baked or legumes

Bran, Broccoli, Brussels sprouts

Cabbage, Caffeinated drinks

Chocolate

Corn (in my experience corn anything doesn't digest in stomach, just passed through and out, kernels/popcorn will clog)

Deep Fried meats, fish, poultry (KFC, supermarket rotisserie chicken very bad, and anything soaked in brine)

Fruit juice: apple, grape, orange (small amount okay)

Fruit: fresh, canned, or dried (small amount okay)

Glucose-free foods containing mannitol or, sorbitol

Gum, sugar free, Licorice

High-fat foods, High-sugar foods

High salt foods (KFC, supermarket rotisserie chicken)

High seasoned foods (like blackened)

Milk and dairy foods (small amounts okay)

Nuts or seeds (bad, clog hazard)

Peaches (stone fruit, one rarely okay)

Peas, Plums (stone fruit)

Prune juice or prunes

Soup, Spicy foods

Sugar-free substitutes

Tomatoes, Turnip greens/green leafy

Vegetables, raw

Wheat/whole grains, Wine

Rice (very soft 1/4 cup in mixed in food okay), refried beans (1/4 cup okay) pasta (one cup max).

Any foods soaked in brine or deep fried (rotisserie chicken, Kentucky fried chicken etc)

Solent nutritional meals 

Foods That May Help Thicken Stool

Applesauce (unpeeled apples, no cores)

Bananas, Barley (when OK to have fiber)

Cheese (processed cheese food a clog problem, use real cheese)

Dried Chinese Crispy Noodles (severe thickening, mix with other food that causes diarrhea)

Marshmallows

Oatmeal (when OK to have fiber)

Pasta (sauces may increases symptoms) (in my experience more than a cup of pasta causes diarrhea)

Peanut butter, creamy only, nuts clog (may make skin greasy)

Potatoes, no skin (skin clogs, more than a cup may cause diarrhea)

Pretzels (salty may cause more flow water consumption)

Metamucil, mix or crackers (mix in cup of water and drink before it gells up)

[Shamrock4806]

More new trick info!

Instead of using a wooden stir stick and applying paste, I just squeeze out of the tube about 50% and press down onto the skin in one motion. One loop tight against the stoma onto very well clean, dry, dust and oily free skin then another loop around it.

I coat the inside bag through the previously cut wafer hole of my one piece convex with petroleum jelly, this prevents the paste from sticking to the bag when it oozes out slightly over the stoma and causes a pancaking issue. With my near flush stoma as long as I don't cover the stoma hole I'm good.

External barrier strips all around, wait about an hour for the paste to harden up while laying on my back and then applying my belt and I'm good to go!

I think I had a bad bunch of paste, why I needed to mix stoma powder in it.

Unfortunately everyone's situation is different and we each have to find out what works best. I share because I learn things that others could benefit by and save themselves a lot of trouble.