Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

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Loloandamy
Posts: 1
Joined: 2019-04-08 23:52:37

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by Loloandamy »

I had the same problem. Try the Siltac silicone ones. They did not break down at all no matter how wet they get.
They come in convex and regular. It’s been a game changer in keeping my skin in good condition.
agichk
Posts: 37
Joined: 2019-03-24 18:57:19

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by agichk »

I am using the coloplast mio with the light convex barrier and really no issues yet.
WOC today at wound/ostomy appt suggested due to my wound so close to the barrier, to turn it so its longer up and down but smaller side to side if using 2 piece. I am not sure if that will help. I am also doing the Bravo ring (12037) and barrier strips now as they want to make sure nothing gets to wound. I have been told to use them when weather is warmer due to sweat etc.
check dates on all supplies as i was told to avoid products that are older as may be issue.
FAP S/P right colectomy 5/06, completion colectomy 2/10 & ileostomy 3/19
Gig' Em
flux
Posts: 25
Joined: 2016-12-07 21:13:52

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by flux »

Hello, Original poster here. Checking in, because I've continued to try MANY things (e.g. cutting a hole in a sheet of latex glove, firmly attaching it to a super large hole cut into a flat barrier, then placing that on, so the latex sheet hugs the stoma, and is thus able to move freely independent of the moving peristomal skin. etc. ...by the way this did NOT work either, because a stoma continuously excreets moisture, so after a couple hours I had a large pool of clear fluid built up under the barrier.)(Also, even though it was not at all tight, the latex damaged the stoma, causing it to have a dark cut/scab for over a week)

I tried the TRIOs again, but after 1 hour the output ran right under the ring (seems to have zero bond with the skin).
If you read my prior posts, you will see the many rings, brands, convexities, pastes, glues, etc. I have tried, yet still only get a few hours wear time on my flat, in tact, skin with stoma that extends 1 inch.

Does anyone else have any new things to try????
smashms
Posts: 1455
Joined: 2010-10-23 23:18:12

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by smashms »

have you seen a WOCN? what does your skin look like any weeping etc? i would give the brava strips i mentioned a try as these have been my savior. also try calling the manufacturers to see if they have any ideas. don't just order samples from the website actually call them and speak with one of the product reps. i have a urostomy so my output is all urine. also what kind of soap are you using? DO NOT USE ANYTHING WITH A MOISTURIZER in it as this will affect were time tremendously. i use dove. without the lotions
neurogenic bladder and T6 paraplegic ileal conduit 2/15/2011
Button
Posts: 3616
Joined: 2017-10-10 22:14:15

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by Button »

Flux:
If you have explored every barrier ring and seal without success I would suggest that the problem is less the barrier ring or seal but a more fundamental mis-step.

1. Use of soaps and cleaning towelettes
Use of soaps with aloe and mositurizers can adversely affect wafer + skin adhesion. The use of “baby wipes” or premoistened facial or hand towelettes are also poor choices for cleaning peristomal skin.

What to use? Ivory brand bar soap; Neutrogena brand sensitive skin bar soap; any fragrance free glycerin bar soap; Cetaphil brand bar soap; Basis soap by Johnson and Johnson.

For pre-moistened wipes, the Safe N’ Simple brand makes a premoistened wipe specifically designed for use around the stoma and peristomal skin. The wipes are available on Amazon and from any ostomy supply distributor (Byram, Edgepark, etc). About $6 for a package of 30 wipes.

Do not use commercial “baby wipes” of any brand.

2. Heat and warmth
A wafer has no inherent “stickiness” as a stand-alone. The bond between an ostomy wafer and the skin is dependent on heat/warmth to mediate the chemical reactions in the hydrocolloid wafer matrix that impart an air-tight seal.

I routinely pre-warm an ostomy wafer before applying the wafer to my skin. I use a hand-held hair dryer and circulate warm air over the wafer for about 45 seconds (not too hot, not too cool) OR I place a wafer in the clothes dryer for about 45 seconds OR I place a wafer on a electric heating pad (used to ease sore muscles) for 1-2 minutes.

As I use the Ekin Cohesive adaptic ring, it is also pre-warmed. I place the adaptic ring on the wafer and use my fingertips to press the ring securely onto the hydrocolloid wafer.

After applying the wafer, use the tips of your fingers to apply a firm pressure to all aspects of the wafer and to smooth its surface.

Other people use a heating pad or buckwheat pack warmednin the microwave and place over the wafer, after placing the water on the skin. Hold the heat source for about 5 minutes.

3. Tincture of benzoine
Tincture if benzoine is a nice adhesive supplementation when a secure wafer to skin bond is lacking or elusive. Tincture of benzoine is available from any ostomy product supplier (Byram, Edgepark) as well as Amazon. A few drops will provide a good degree of stick while being skin friendly.

4. Ostomy paste
Ostomy paste is a misnomer and can be a source of confusion. Ostomy late is not an adhesive. Ostomy paste is not a glue, it is not synomous to Elmer’s glue. Sometimes new ostomates apply a ring of ostomy paste around the opening/hole for the stoma in a wafer - thinking that the ring of ostomy paste is a ring of adhesive glue. It is a tactical mistake that leads to many a leak. Liquid fecal ileostomy output and urinary urostomy output will easily degrade ostomy paste and freely pass through, manifesting as ready leaks.

Ostomy paste is intended to fill small divots or creases or other skin surface irregularities. It is similar to using grout in tile work in a surface of a kitchen/bathroom.

I am sorry to hear that you are still troubled by leaks. Leaks can be a source of significant emotional distress, as they erode one’s self confidence when trying to adapt and adjust to all that an ostomy involves.
Karen
Intestine perforation, sepsis, ileostomy, 2012
Addison’s disease + endocrine failure
Palliative Care
incidentally2
Posts: 6
Joined: 2019-03-22 16:33:52

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by incidentally2 »

Flux,

I find that keeping away from the base of the stoma when putting ring/wafer on is key for me. I cut my wafer at least 2mm larger than my stoma base. My stoma base is very weepy. I also use powder around the base to soak up wetness just before applying the ring/wafer in order to keep the area as dry as possible during the application.

I found that the Brava Protective Ring is less prone to erosion than Adapt barrier ring.

I experimented with the Trios silicone ring and just can't figure out how some have found success with it. Just can't get it to stick to skin, having taken all the precautions listed in the discussion.
Kamak
Posts: 2
Joined: 2019-04-15 21:41:00

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by Kamak »

Dear flux,
Been very interested in this topic and I apologize for my first post on this site being so lengthy.
We have the same problem, although with a liquidy output colostomy. I have been searching on a number of ostomy sites for a solution and read many suggestions.
I care for my husband’s stoma and feel we are getting closer and closer to a real solution.
He had an ileostomy that was partially reversed to a colostomy in December last year. The new stoma output is thicker than the ileostomy but still quite liquid. The stoma is completely flush. The end of the bowel is sewn flush with the skin and does not protrude at all. There is absolutely no stoma spout.
This is our story so far:-
1. We are using a convex system. Haven’t tried a flat base plate. Because the stoma opening is so small, the first lot of bags we had - the convex was too far from the hole and was not helping. We now use base plates that are designed for small stomas and the convex pressure is now closer to the opening, where it should be.
2. After trying every barrier ring on the market (or so it seems), and all of them popping off after a short time; we worked out that with a flush stoma output will inevitably make its way under a ring, any ring, and then everything will just pop off. Usually after only a short time. From this fact I learnt don’t use barrier rings!!!!
We now cut our wafer (the baseplate that comes with ostomy bags) as close to the stoma as we can, and with the skin as dry as we can get it, we place the wafer over the hole and apply pressure.
3. Output was still getting under the wafer and we discovered that there was a very small crease at each end of the oval stoma (I call them the goal posts) that I had not noticed. When my husband moves around the crease/fold in the skin allows output to seep under the wafer at these points and then…..well you know what happens next.
So before applying the wafer to the skin I put a small blob of paste at each goal post. (Not the easiest stuff to apply, but we just get it there. Does not need to be perfect. Then apply the wafer and apply pressure. This has stopped the output leaking out at those points. So far I have found the Brava paste the most reliable and we are using Hollister two piece convex.
4. Because the skin and stoma are interweaved it is still not possible to keep output off the skin completely at this point. And there is quite a bit of sore skin around the opening. We still are to perfect our technique and I will post when we do, but we have started to use two piece appliances. Once the base plate is in place on the skin, I smear Sudocrem (a nappy rash ointment with zinc) around the hole of the plate, most of it going on the plastic but enough on any exposed skin to provide protection from the output. I would think Vaseline would work as well.
My husband is getting a lot of relief from these changes. I also read where one person who has had our problem for years cuts the hole of the two piece base plate larger than it needs to be, thus exposing the skin. Then once the base plate is in place she smears Vaseline around the opening. She applies the Vaseline each time she changes the bag. She now boasts of excellent skin around her stoma and goes for a few days without needing to change the base.
I intend to try that method as it is a lot easier and should work as well as what we have been doing. Will let you know how we go.
flux
Posts: 25
Joined: 2016-12-07 21:13:52

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by flux »

HELLO.. thanks to all for contributing to this investigation into a solution.

In response to Karen's points:
1. "Use of soaps and cleaning towelettes" - Yes, I am already well aware of everything related to that, and doing everything perfectly.

2. "Heat and warmth" - Yes, I am already well aware of everything related to that, and doing everything perfectly.

3. "Tincture of benzoine" - Yes, I have tried this and MANY other adhesion boosting products. None of them help. I have discovered the problem is not related to adhesion... because what is happening, is the barrier material is made to dissolve quickly if exposed to water (you can test this by putting a small piece into a glass of water), instead of being made from a water-proof material. The barrier has an exposed edge of this material, and so will always start to break down after a few minutes. (seems they were designed for colostomies and NOT ileostomies). I tried to solve this by coating the leading edge of the cut barrier with various types of 100% silicone sealant (like bathroom calks, etc), but that still does not block the output (and/or moisture from the stoma) from getting to the underside of the barrier.

4. "Ostomy paste" - Yes, I agree and do not use rings or paste as I find they do not help at all. (although a very thin ring of Brava paste around the stoma does add a few extra hours of wear time. for a total of maybe 10 hours between appliance changes.

Dear Kamak: be VERY cautious before deciding to use vaseline, or similar products, because if there is ANY residue of that remaining on the skin before your next barrier appliance, you will not get proper adhesion to the skin.

I am completely frustrated and don't have any idea what to try next. The WO nurses say they have no ideas, and the manufacturers say they have no ideas. No matter what I've tried, after 5-10 hours, the output starts eating away my skin until it's burning and bleeding. And I am SURE the problem is NOT the broken skin, because MANY times I have done bag changes every 4 hours until the skin is perfectly healthy, then the next time I try to go longer, the same thing happens again.. the barrier dissolves and the output then starts eating my skin!
Kamak
Posts: 2
Joined: 2019-04-15 21:41:00

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by Kamak »

Hi Flux - very disappointing that there does not seem to be a perfect solution. I will take your advice and stay away from the vaseline, although I think I usually clean everything well. Is your stoma flush with the skin? This seems to be the main cause of ostomates having these problems. I have googled enough to know we are not alone, and many out there are suffering like yourself with solutions that work well for many not applying to yours or my husband's specific stoma. I am at a loss to know what some surgeons are thinking when creating these problematic stomas.
A surgical revision may be a solution, although for my husband another operation is ill advised.
Button
Posts: 3616
Joined: 2017-10-10 22:14:15

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by Button »

Flux and Kamal:
Your frustrations with continued leaks are real.

The CyMed wafer would be a option worth exploring, if you haven’t already. The CyMed wafer is composed of TegaDerm like material (DuoDerm). The wafer’s contact to the skin is much more intimate and exacting then is the contact/bond of a standard hydrocolloid wafer.

If it is erosion of the hydrocolloid wafer that is the crux of your leaks, the CyMed MicroSkin wafer and its exacting skin contact may bring you relief from leaks.

It is also worth mentioning that emptying the pouch more frequently may also reduce undermining if the wafer by liquid fecal output. Empty the pouch when 1/3 to 1/2 full.

Sleep with a wedged-pillow to keep liquid fecal output from collecting around the stoma.

There are accessory products that you add to the pouch that reduce leaks by altering the consistency of thin, watery-output to a gel/jello-like consistency. “Ileo-sorb” is one such product. “Ileo-sorb” is a packet of crystallized material that you place in the pouch. Gel/jello-like output consistency can be a real game changer in reducing leaks with a loop ileostomy (which are notoriously more difficult to pouch than an end ileostomy).

Keep chatting and soliciting suggestions and experimenting, trial and error.
Karen
Intestine perforation, sepsis, ileostomy, 2012
Addison’s disease + endocrine failure
Palliative Care
flux
Posts: 25
Joined: 2016-12-07 21:13:52

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by flux »

Karen:

I empty up to 20 times a day, when it gets 1/8 full.. but that does not help anyway, because the barrier is convex, so there is output sitting in that dish 100% of the time. That fact aside, it would still happen, because the stoma tissue is ALWAYS secreting a LOT of moisture onto anything it's touching. I also think that's why the “Ileo-sorb” never worked for me.

I tried CyMed, but the barrier dissolved just as fast as Coloplast. I can't believe none of these brands make a water-proof barrier. (Afterall, the word IS "barrier" ... not "something made to dissolve the moment it starts to touch output/stoma" :evil: )
Button
Posts: 3616
Joined: 2017-10-10 22:14:15

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by Button »

Flux:

Nu-Hope offers a non-bonding wafer and ostomy pouching system. My-Hope is the only company that I am aware of that offers ostomy systems that do not require any sort of bonding with the skin. There are non-bonding systems for ileostomies, urostomies, and colostomies.

You can visit the Nu-Hope home website to see the “no wafer” ileostomy design.

Other than that, working with an ostomy nurse/professional on a 1:1 basis, in person and in-the-flesh, would hopefully reveal some answers and resolutions for you. There may well be skin characteristics or features of your abdominal topography or reactions that you have to certain product ingredients that we cannot discern with you through typed words and written responses on this forum. An Internet forum may not be the best medium to finding answers that you need.

There is an answer for you. It just has yet to make itself known.
Keep faith.
Karen
Intestine perforation, sepsis, ileostomy, 2012
Addison’s disease + endocrine failure
Palliative Care
flux
Posts: 25
Joined: 2016-12-07 21:13:52

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by flux »

I tried Nu-Hope about a year ago, and it did not help. (Just went to their website again, and now they only have belts)
My stoma extends an inch, so no issue there.
All the area around the stoma is perfectly flat and even, so no issue there.
I have met with several ostomy nurses, and they all say that I should come to this forum to find a solution.
Button
Posts: 3616
Joined: 2017-10-10 22:14:15

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by Button »

Flux:
I have thin, watery ileostomy output. I have a flush stoma, no “spout,” as there was insufficient small bowel available to pull up and through to make a longer/conventional ileostomy stoma.

I found convex wafers more of a problem for me then helpful. I am a petite little gal, more child-sized then adult-sized, and the rigid plastic convex design would “pop off” as my body would move.

I ditched convexity and gravitated to a flat wafer . . . and found success.

The CyMed Microskin barrier has been a favorite of mine. The TegaDerm MicroSkin film adheres with a high degree of intimacy to my skin. It is like a second skin. The MicroSkin, for me, is my “bomb-proof” ostomy pouching option. I do not use the available convex rings that CyMed offers. I use a flat CyMed wafer, one-piece design.

I also use the Coloplast Mio (flat wafer, no convexity, one-piece design). The Coloplast Mio wafer has elastic polymers that enable the wafer to be dynamic and move as the body moves. Thankfully, I rarely experience a leak.

Nu-Hope does show the bond-free/wafer free pouching systems on its website.

Older ostomy systems used karia as the primary wafer material. These wafer remain available, although limited.

The fecal output with a loop ileostomy is watery-liquid in consistency with a high level of digestive enzymes and an alkaline ph. The urine output with a urostomy is high volume,
constant, alkaline ph, and lots of accompanied mucus. These ostomates find workable pouching solutions. Perhaps joining a local ostomy support group would put you in touch with fellow ostomates where you could effectively trouble-shoot to find workable options for you.
Karen
Intestine perforation, sepsis, ileostomy, 2012
Addison’s disease + endocrine failure
Palliative Care
egerfin
Posts: 3
Joined: 2019-04-26 07:07:57

Re: Please Help! All the barriers and rings I've tried dissolve after a few hours!!!

Post by egerfin »

If you have a well budded stoma and it sounds like you do, there is a brand from England called Salts that could help. The product actually has a thin plastic sleeve (collar) that you place over the stoma that directs the output into the pouch ( https://www.salts.co.uk/en-gb/products/ ... oma-collar). These products are amazing but the company has had a hard time breaking into the US market. It may be worthwhile requesting samples and speaking to a rep.
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