Old_guy wrote: 2024-08-28 21:32:23
So, once I put on a ring and a one piece bag, the stoma is just sticking out above the bag plate. I'm thinking of trying a convex system. Good idea to try? I figure some companies will send samples. But one sample seems insufficient to test out.
You don't need a convex system if your stoma is sticking out above the skin surface all on its own. That's what the convex does it (along with a belt) places downward pressure around the stoma to get it to push itself out and spew on top of the ring or paste and into the bag. The stoma can extend itself out, why it's so important to cut a (slightly) bigger hole in the wafer so it can extend into it. If too small of a hole or one that is misaligned, the stoma will push the wafer section off and cause leaks.
I've found out (recently here) that with a belly fold and a convex is not the way to go (unless I want to lay flat all day). However I have a near flush stoma, so it's out a little bit. Thin rings or a thin coating of paste works for me. A thicker ring can be used but one has to make it slightly larger than the stoma and press so the heat of the fingers melts it a little so it will mold thinner as one presses closer to cover the skin next to the stoma.
I use paste because I'm still suffering from leaks caused by the stiff convex (wrongly advised by a professional) with a belly fold, so I have skin damage which with paste I can better ensure it's sticking to the damaged skin and remove sections of it if it's not and redo. With a ring it's more ideal if the skin around the stoma is healthy and flat, no bumps or damage, it's much faster and easier than paste as long as one gets it on right the first time.
So with a belly fold and entirely different wafer is needed, one that flexible so that it can bend with body changes like sitting and laying flat or standing. Stiff wafers seem to be better for standing or laying down (or for convex purposes) only or with those with a flat belly that doesn't create a belly fold right where the stoma is when they sit or bend over.
I'm doing something very different myself, I use a thin level of paste around the stoma and ensure it's sticking well to protect the skin. (I will likely move to using a thin ring when the skin is finally healed and my leaks have stopped.) Then I place a precut protective sheet in top of that which is flexible and absorbs moisture (from the skin) and thus adheres very well. I coat the protective sheet with paste within the hole area as to protect it from output. Then I'm cutting a huge 60 mm hole in my convex wafer basically to get rid of it's stiff convex part and turn it into a bag almost. I'm folding the gutted convex horizontally and heating it so it stays bent about 22.5 degrees. Then pasting it on with a ring of paste around the hole edge to seal contents in. So I'm using the protective sheet as a wafer and the remaining portion of the gutted convex as a pouch. I apply my belt and the system stays snug in my belly fold now.
It's extreme and there are other products that have flexible wafers already and if you have a belly fold this is where I would look at. Using a ring or paste depends upon the condition of the skin surrounding the stoma. If uneven or has damage, then in my experience paste is better provided it's properly applied and the right kind. Not all pastes are the same. Some have alcohol in it and stings, some people are allergic to it. There is very sticky no sting paste and that's what I use. It's more costly but I only use a thin amount. For huge amounts on top of the protective sheet (not touching the skin) I use the cheaper alcohol based paste.
So this is my current situation trying to use up my wrongly advised product by modifying it before finding something that fits my needs better. Or invent something myself as I can basically do anything on top of that protective sheet really. I'm just needing to remove output, the skin protection issue is solved.
FYI I've had my illeostmy since Sept 2023, I'm still learning and I've found the only ones with enough experience doing this are not the professionals, but ordinary people that use this stuff daily and have to out of necessity solve their own problems.
My apologies if I'm very verbose, but you can take time to review things later and come up to speed quickly that just a quick response that might not be your real solution. You need to understand how this all works because we are all our own educators. You could hire someone but those that have worked on every sort of patient body type and can instantly tailor something to your needs the first time are extremely rare, there may be just one really good expert in any hospital and they get paid well. Something a home nurse isn't always as capable. Many don't like doing wound care neither according to what I've been told by them.
So take your time and read, learn all you can online. It's a lot to take in and there isn't any easy answers. But I'm trying.
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