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This method has been over two years in development. I am now achieving close to a 100% success rate with a consistent 6 day wafer wear time, even with a hinged stoma located in a belly fold, with a chest scar divot, with minimal pain. Given the difficulty of this type of stoma, this is likely close to the best achievable outcome. I'm always improving and update this post to reflect that. Average wear time for this type of stoma is typically only 3 days.
This process is personalized to my body contour and an oval-shaped stoma. Some adjustments will almost certainly be required for others. That said, it should provide a strong starting point for anyone dealing with a similar stoma configuration. The instructions are detailed and thorough—please read carefully and take your time.
Number #1 help was losing weight and eventual calming of the abdomen area to reduce swelling and causing the stoma to finally protrude 3/4" out above the skin surface. I now weigh myself daily to keep within an ideal weight as not to submerge the stoma again.
Another is maintaining a diet low in fats, using a little olive oil chiefly as my only fat spread out over the day. This coats the intestines and the overall low fat reduces the bile amount that attacks barrier adhesives (pastes or rings). So with more acidic/enzymatic output = more skin + wafer damage.
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Diet Timing and Output Control
Wait until the stoma has quieted by observing the pouch and ensuring output has stopped for hours.
Eat small, nutritious, non–diarrhea causing meals throughout the day.
Eat more during the morning and early afternoon when the bag is fresh. About every 4 oz every 6 hours until daily nutritional needs (RDA) are met.
Eat and drink less later in the day or when a bag change may be needed soon, allowing the system to clear. (About 4-5 hours) however don't be hungry or the system does a bile flush, but afterwards it is a good time.
Diet balance that works best for me:
High protein
Medium carbohydrates
Very low fat: 5% – 12% Daily Value per serving. Saturated fat: keep it under 10% DV (ideally under 5%) Trans fat: 0% only
Drink all day watered down oral rehydration solution (sweetened version, no artificial ingredients) as mostly one is always losing electrolytes with an illeostomy. Intestines have to absorb water as colon out the equation.
No artificial ingredients, salty, fatty, fried, overly spicy, type foods, no alcohol or hardly any caffeine. No leafy greens, V8 or juice for veggies.
Rather plain meals work out great. Well cooked plain rice. Garlic mashed potatoes with no chunks or skins, plain juicy chicken with no skins or not brined, plain pasta with butter but without tomato sauce, pita bread, ground lean beef, Greek yogurt, no sugar added applesauce, V8 or juice for veggies (no solid veggies).
No solid fruits, vegetables or seafood, only as juices, sauces or soups. (Soft avocado fine). Low in fiber, foods that will digest in stomach acid. Remember there's only a straw like hole down there. Avoid nuts, seeds and tough parts of meats, even baked potatoes (skinless and mashed is best) that won't digest fully. Chew food well is paramount!
Mornings are generally the best time for a bag change after any bile flush, before breakfast. But being able to wait still on ones back for awhile (about 3 hours) for the paste to adhere good is best.
Ensure one gets RDA of calories, protein and nutrition for the day.
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Products Used
Brand: Coloplast
Bag: Sensura Mio convex drain-able one-piece, 2" wide
Accessories:
Brava No-Sting Paste
Brava Skin Protectant Spray (smoother and less holding power but covers a larger area) or PREP Dabber Bottle (creates a rougher surface around the stoma for better barrier adhesive hold)
Stoma powder (thin dusting to create a dry crust on leak wounds, must secure afterwards with skin protectant or PREP Dabber.)
Extra-large moon-shaped barrier strips
Tools & Supplies:
Ostomy scissors
Small plastic trash bags
Plastic or metal butter knife (for paste removal)
Toilet paper
Additional Items:
Oil-free eye makeup remover (shake before use) available in the cosmetic isle of supermarket or drug stores. For removing old paste and deep cleaning the skin.
Cocoa butter, scar gel (for skin and scar tissue)
Petroleum jelly for sensitive scar tissue (optional)
Two toilet paper tubes nested together or similar (for even wafer application pressure around the stoma) important!
Coffee stir sticks to apply lotion to scar tissue under adhesive when I can't get my fingers greasy like before handing barrier adhesive strips. For cleaning out my fistula.
Waterproof tape (to hold toilet paper on separate mucus fistula)
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Removal of Old Appliance
1. If no blowout then hot shower to loosen just the wafer and barrier strips adhesive not the barrier adhesive and wafer! Wash and rinse remaining body like normal while this is going on as it takes heat and time to loosen the adhesive. Leave the barrier adhesive and wafer attached protecting the skin area below it around the stoma from getting water on it. Dry off. Head to toilet. Remove rest of wafer and barrier adhesive using a butter knife.
Or apply oil-free eye makeup remover along the top edge of the wafer and into the crease while peeling downward. Trim hair with a butter knife if necessary. Shower is easier and better though and costs less in supplies. But this way is better if it's a blowout as you don't want output in the shower as it will grow foot fungus (as will urinating in the shower will too)
2. Remove and dispose of the old pouch in a sealed plastic bag.
3. Dry wipe stoma clean of output, use no water around the stoma. Important! If the skin just around the stoma where the barrier adhesive was gets wet, then the oil free makeup remover can't do it's job of entering the pores to thoroughly clean and moisturizer the skin. Adhesion will be lost!
4. Clean the mucus fistula opening (if present) if required using a rounded coffee stir stick. Sometimes there is mucus ball in there that needs to be dug out (I have a double-barrel ileostomy.)
5. Use the flat side of the butter knife to scrape and remove thick paste stuck to skin around stoma.
6. Wipe residue off butter knife with toilet paper and discard into trash bag, not the toilet (it will cause a clog one day)
7. Use eye makeup remover soaked on toilet paper to soak and thoroughly dissolve remaining paste.
8. Gently remove any stubborn residue with a soft stiff stick (and with a soft scrubby with the plain soap while in the shower later) Skin needs to be clean of any residue at this point. Avoid using fingernails.
9. Massage scar tissue with remover using on clean toilet paper to clean off old lotion and nourish skin.
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Showering
1. Wash rest of body normally and rinse. Last wash the stoma area with plain, non-moisturizing Ivory-type soap and water using your hands (they need to be clean and oily free themselves) and a scrubby pad, gently. Do this last after other washing.
2. Repeat the soap wash three times in total to remove any residue from the makeup remover or other soaps or conditioner that got onto the area or hands and will affect adhesion. This is very important! Hands and stoma area must be clean and oily free.
3. The skin and fingers should feel “squeaky clean.” all around the stoma when rubbed with fingers. This is very important!
4. Do not apply other shampoo, conditioner, moisturizing soaps, ointments or anything from putting on or running over the area or on your fingers. Skin must be absolutely clean under the wafer. No need for healing creams etc., the skin will heal itself just fine as long as there is a good bond preventing further digestive enzymes from attacking it. Other items interfere with bonding and cause leaks to continue.
5. Use a plastic scrubby to gently exfoliate the skin around the wafer area and scar tissue to remove dead skin cells and any residue.
6. Rinse with clean water only
7. Towel dry,
Setup Area on bed so I can rest afterwards without moving. (Breakfast or lunch nearby)
Blow-dry to fully dry the skin and warm it for better adhesion
8. Dab around the stoma with dry toilet paper until completely dry, especially in the creases next to the stoma. We want the barrier adhesive sticking very well to this area as it's the first place a leak occurs. Any dampness will cause the barrier adhesive not to work. So always dab with a new dry piece of toilet paper each time as to keep the area absolutely dry. This is extremely important!
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Place a towel or plastic bag under you while laying down in case of unexpected output.
If small output occurs: (your output timing is off or you ate or drank something while the wafer was off, don't do that)
Rinse away digestive enzymes with plain water and toilet paper or head back into the bathroom toilet and shower. Ivory soap likely be needed again to remove any greasy feeling. Skin must be squeaky clean.
Do not use spit—it contains salts, oils and will burn, interferes with adhesive bonding.
Dry thoroughly.
Drying at this stage is critical. I usually give one solid minute of drying after every step during bag application process waving the backing from a wafer like a fan. It's why diet control and timing is important for the stoma not to be active during a wafer change. Take the time, your bag will last twice as long as normal..
Test using old wafer backing to check fit around stoma and for height to fill in belly fold / chest scar divot near belly button. Make wafer hole just a hair bigger than the stoma all around.
Wafer Preparation
1. Roll the tail of the pouch up (blue side up) and secure it with Velcro.
2. Enlarge the wafer opening slightly bigger than the stoma.
3. Save the cut-out piece.
4. Slightly bend the wafer bubble horizontally to increase flexibility.
5. Remove the backing off the wafer and save to use as a fan and future guide.
6. Cut the saved cut-out wafer hole piece in half or three pieces lengthwise making rings. Cut larger ring into sections. Place the larger one sticky side up all around the wafer hole. Press. Add more cut from the other piece to complete the circle. Press to bond. This reinforces the wafer edge from wobble which causes leaks also to bring the more solid wafer down closer to the skin, it won't run or drip like rings or paste will.
Stack the remaining additional piece halved on top of the other added pieces at the 3 and 9 o’clock positions to fill the horizontal belly fold. This provides lateral support from paste oozing out sideways via belly folds. The wafer cutout pieces are hard and don't melt or run..paste is only supposed to be applied in thin amounts only to seal small gaps.
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Skin Preparation
Note: If your wounds are more severe, even bleeding. Then bleeding must be stopped first before doing anything. Blood is the worst as it keeps flowing and makes adhesion impossible. Special skin protectant medicine (expensive) like Medline Marathon may be required as will much more often bag/wafer changes (even twice daily) until that skin heals up quite a bit. Why it's important if you feel pain under the wafer is not to ignore it for long as the worst it gets, the longer and more expensive it is get back to normal.
1. Address any wet leak wounds:
Apply a single grain-high layer of stoma powder.
Stretch skin to reach creases.
Remove excess powder from healthy skin with slightly damp toilet paper.
Dry thoroughly about 1 minute with a hand fan.
Powder should form a thin secure crust that does not easily rub off. Remove any that does. This is important!
4. Fan-dry again for one minute.
Note: If the leak burns are very shallow and not wet, one can avoid using the stoma powder and just use the skin protectant or PREP.
5. Fungal note:
Use antifungal powder only if there is clear fungal itching. An itch so bad that you want to stick something sharp under the wafer to scratch indicates a fungal infection. Use fungal powder only to cure, usually one time will do it. Do not use fungal powder all the time as it isn't stoma powder and has less adhesion.
6: Lock it down with a light coat of skin protectant. A must for any powder under the wafer. Too thick of a coat of skin protectant creates a glassy surface and inhibits or reduces skin bonding of adhesives. (Good if your wafer adhesive sticks too much).
7. Perform a finger test:
Rub around the stoma and then rub fingers together. Any moisture, loose stoma powder or greasiness must be corrected. On both body and fingers. This is extremely important!
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Barrier and Paste Application
1. Apply either:
If not already applied: Only one light coat of spray skin protectant spray (smoother, less hold but covers a larger area) or
PREP Dabber around stoma, creates a rougher surface for better bonding.
(Never use both—they do not bond together.)
2. Go around next to stoma with PREP Dabber bottle, cover any scar tissue, twice in total. Allow to dry for 60 seconds using a hand fan. Creates a rough surface for better barrier adhesive bonding. Very cost effective product. One 2.5 oz bottle lasts about 60 wafer changes. Will sting wounds for a little bit. Cover sensitive scar tissue area twice with skin protectant dabbler bottle. Allow one minute of hand fan to dry.
2.5: Put a 1/3 cut piece of extra large barrier strip in the left belly button fold area 1/4" away from stoma, cut around belly button off sensitive scar tissue and hold for 1 minute. Cover with PREP Dabber bottle and 1 minute to dry. This is to prevent sweating under the wafer in the belly fold, it grows mold and itches due to an air gap under the wafer.
3: Cut three strips from another 1/2 barrier strip and place on the barrier strip next to the belly button scar to give it more height and fill in chest scar belly fold divot so it matches the height of the wafer adhesive. Also two small pieces at the bottom and one at top. Use the wafer backing as a guide to see the low spots. Need to eliminate the air pocket that forms in that area near the belly fold + chest scar.
4.6 Cut the remaining piece in half then fill in belly button hole, off the scar, pressing it down inside, stacking the pieces. Do not use powders or anything to try to keep air pockets under the wafer dry. Barrier strips pressed down firmly on the skin works great, stack for height.
Final assembly
1. Apply a thick flat bead of paste directly around the stoma. It should stick to the skin as it's coming out of the tube. If not then remove, address the problem if it's greasy, damp or whatever skin so it does stick directly to the skin. No need to touch or use another tool to spread paste, just pinch off end onto the skin like wiping it. When the wafer is applied it will be flattened out filling odd gaps. Fill the belly button hole and cover the sensitive scar tissue with paste.
5. Align the pouch exit downward over genital area properly, get this right!
6. Seat the prepared wafer starting from the bottom, pressing upward and centering left and right around the hole.
7. Press around the stoma through the wafer bag to spread paste and seal. Press out any air bubbles of wafer adhesive so it's flat and adheres tightly to the skin.
8. Use the hard toilet paper tube to apply even hard pressure around the stoma for 5 minutes to bond the barrier adhesive.
Note: The heavy pressure with the tube may not be ideal yet for those with recent surgeries or still have scabs. For that unfortunately requires more frequent wafer changes until the scabs heal up.
10. Press down all wafer adhesive for an additional 60 seconds. Allow NO air pockets or it will grow mold and undermine the barrier adhesive, causes itching.
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Final Barrier Strip Application
1. Apply a half of one extra large barrier strip across the left side covering the belly button and sensitive scar tissue. Do not cover the belt loops.
2. Apply one extra-large strip each around the bottom and top. Do not cover the belt loops. Ensure no air pockets. Hold all down for 60 seconds.
3. Trap some air into the bag exit and roll up to the top to force the bag off the stoma stuck perhaps with oozed out paste.
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Post-Application Care
Rest quietly for about 2- 3 hours to allow successful barrier adhesive bonding to skin. Moving or heat can pop the non fully bonded barrier adhesive off the skin.
Train to sleep only on the back. This is easy to do using a pillow under each arm for a few nights. Sleep with upper body slightly raised up as to prevent turnover and also to cause output to flow to the bottom of the bag. Concentrate on a diet that doesn't cause drier stool which clumps or is bulky or doesn't fully digest into liquid or paste. Don't push pancaked material, rather dump, then gently water bottle rinse it away from the stoma. Eat more often during the day and less before bedtime. Sleep only on ones back to feel the weight of the bag to dump.
I do not use a belt because:
It caused wafer distortion and granulomas. It pulls the wafer around because of bending and sitting and laying down movement. Friction from the belt transfered to the wafer and causes leaks. I also have a vertical chest scar divot that belts actually pull the wafer up and causes leaks. So belts don't work for me.
Barrier strips provide better stability without movement. Slightly stretched out to either side before applying provides downward pressure. If you must use a belt then you must, try to gravitate away if possible sort of like training wheels.
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Mucus Fistula Care
Fold toilet paper into quarters, with the fold on the top.
Secure with one piece of waterproof tape along the top so I can detach wet, soiled or stuck on sheets of toilet paper leaving other sheets still taped on. (Saves on tape).
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Exposed Scar Care
Apply skin protectant and scar gel sparingly just on the scar using a coffee stir stick.
Cover with 1/2 cut extra large barrier strip so it's secure on ether side.
Over time, covered scar tissue softens and improves significantly, eventually almost disappearing. It's the irritation (like from clothes or adhesives) that keeps it sensitive and painful.
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Emptying and Rinsing
Empty when pouch is ~⅓ full.
Rinse with plain water only!
Do not use soap or anything else to rinse with.
Do not apply pressure to the pouch—this forces paste out.
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Warning Signs
Persistent pain, itching, rubbing it or discomfort means the pouch should be changed. You should feel nothing for days on end if the wafer was properly applied. The problem is learning all the little tricks to avoid discomfort, that's the challenging part. A low fat diet keeps enzyme rich bile from irritating the stoma and causing leaks.
Feeling cold during rinsing usually indicates a leak—change immediately if possible or as soon as the output has died down and stopped for quite some time first.
Avoid bending over at the stomach aka "crunches" bend only at the hips. The longer one can go without doing this, like crunching out chairs, the better. Chairs are a problem. Stools are better. Keep your feet under your hips.
Daily showers are possible with an ostomy bag, the object is to keep both water and heat away less it loosens the adhesives or causes sweat under the wafer. So quicker lukewarm showers work for daily use and long hot showers for bag change times when the wafer is off.
Wafer wear times now 5-6 days, one 7 day once.
Last updated May 3 2026
