UOAA Discussion Board

Hello.

My wife had an Ileostomy. The stoma is alongside a wound from surgery. The wound is healing nicely, and thus the area around the stoma changes a bit, but that is getting better. However, because of circumstances, I've been thrown into the care arena with very little guidance. We were given some Hollister one piece bags and Eakins rings. The rings are the 4" diameter ones. There have been many leaks. The stoma is near a crease in the belly, so that poses challenges too. Experimenting with stoma paste is hit and miss.

I trim about a 1/4" off the OD of the ring as that seems to allow more of the adhesive tape around the bag to adhere. However, I see there are also 2" OD rings. I'm not sure, but would that be a better approach?

Also, I'm shopping online for bags and rings. I find there are cheaper alternatives for rings. For example I found a company called Heagi. Has anyone any experience with such products?

The record we've had for a bag is 4 days. One time a nurse came in to change the bag after a leak and I could tell he was not experienced with that. So, I shared all the things that I observed in bag changing. That was the first 4 day record. I shared what he did with the next nurse what he did and that bag lasted 4 days. The next leak, I got tired of waiting on the nurse in the middle of the night, so I jumped in and changed it. I did exactly what I helped that first nurse did and it lasted about 4 hours!!! That is frustrating.

I've been told that every stoma situation is unique. But any information is appreciated.

Thank you.
Greg

Hello Greg

Welcome to the boards.

It is indeed a lengthy trial and error process to figure out what works, however I see your case is similar to mine and I can tell you what works for me so far.

Okay there is some unevenness that rings are not the best fit, you also have a belly grove like me.

So this is what I do.

I use a one piece 1/8" convex which isn't flat but has a curve in the bottom, it's designed to be used with an otosmy belt to put downward pressure around the stoma to get it to pop out some into the pouch. If the stoma is near or flush to the skin surface, you'll need this type of pouch, not the flat ones, those leak like crazy especially when one sits up.

I first make sure all bleeding has stopped and the stoma has quieted down some from producing output. This means usually the best time to replace the bag is after a fast with something like applesauce to stop the bile and dry output up long enough to put a fresh bag on. Good time to take a hot shower. Be sure to thoroughly blow dry the area around the stoma so things will stick.

If the bag replacement is because of a leak, the stoma may still be active and a handheld bidet on the toilet or a long shower may be in order (use a chair or a bench) to wash the output away until it subsidies. Do a last wash around stoma using a moisturizing soap like Dove, do not use a drying soap or it causes itches under the adhesive later. If in the hospital they usually have a sucker machine that can be used for fluid waste but solids need to be wiped up using gauze as the stoma is very fragile. At home use soft toilet paper moistened and very gently wipe or it will bleed.

If you have skin fungus infection which could occur in the hospital because of can't take a shower and wash thoroughly with soap, you use anti fungal foot powder but it will cause the adhesive not to stick very well unfortunately.

If there is damaged skin around the stoma, it and only it gets a very lite dusting of stoma powder and excess brushed away, clear skin water wiped clean. Dry thoroughly. Next comes a coating of skin protectant which has to dry thoroughly also. Skin protectant is applied everywhere where adhesive sticks and especially around the stoma (not on it) and on top of stoma powder if used. (Called crusting) Dry very thoroughly so the skin is nearly chapped and rough if possible. Paste will stick very well to this.

Next a non-sting paste which has no alcohol you put a thin layer around the stoma out to about a half an inch and make sure it's sticking to the skin. You use a small flat stick or plastic something and press down and around, it should stick to the skin stronger than the stick. If not you remove it and discard, clean and dry the skin much better this time around untill you get a nice thin coating all around. Make sure it's close, but not touching the wet stoma. Keep the stoma area extremely dry, it will lubricate itself no problem. This sort of detail is possible with paste, not so much with a ring. One stretch of a ring too much and you have gaps. Gaps that can be filled in with more paste but harder with a ring as you have to press to get it closer, not always possible so you toss the ring and try again. It's too easy to get careless and sloppy with a ring.

Paste works great especially over uneven surfaces or dips in the skin where acid can get under and cause the skin to ooze liquid which makes adhesion come off etc. So this first thin layer needs to bind good to the skin around the stoma.

Measure and cut your hole to be just a hair bigger than your stoma. Bend sharpies inwards. Mine is 20mm x 30mm so it oval actually.

Next you take the convex or the flat wafer section and fold it in half lengthwise in the middle and crease it. )I take a small cigar torch to heat mine) You want to do this to better fit the belly grove. Bend it back and forth to get it to loosen up some. This way it will bend when sitting up and standing or laying flat.

Apply a second coating of paste for leveling and keep it slightly away from the stoma as when you press you don't want it oozing over and blocking.

The first coating of paste is protecting the skin, so this second level is just to handle the unevenness.

Next remove the backing on the bag wafer section (duh close the bottom first) and line up the bottom to the stoma, now crunch up to create the belly fold and stick it on and press down and hold so the adhesive and paste etc bonds. You should also press through the bag around the stoma to get things to stick between there as well. Hold for a few minutes so things stick. If the stoma is covered with paste remove, clean and try again.

Now you put on the otosmy belt and make sure it's tight but not painfully so.

It might be necessary to put extra adhesive strips around the outside of the bag (before the belt) for extra holding power and to avoid scars etc.

What I do to avoid the adhesive from sticking to scar tissue is rub a lite amount of petroleum jelly on it and then filling the belly button with tissue to soak up any moisture that gets in there. However the adhesive of the appliance may need to stick there why the extra adhesive strips are needed to bypass it and grab clear skin on the other side.

If the adhesive sticks to the scar tissue, it will itch. The healing scar will also pull the appliance and cause leaks too.

Now for the fistula stoma (the other stoma up top) if and when it stops producing output one can get away with simply covering with paper or low stick tape with a tiny bit of petroleum jelly to avoid drying it out damaging it.

It will spit out goo, so the tape should be just covering lightly to allow it to come out. It's clothes and such that could injure it so the tape is there to protect from that. There are stoma caps also but I don't see the need. The tape is disposable and cheap.

Stomas are very fragile, a very light and gentle touch or it will bleed like crazy and with the bottom stoma hamper your efforts to put on a bag with the blood wetting everything.

There is a diet to adhere to with a illeostmy, nothing hard! No nuts, or fiberous veggies or fruits (juices fine) or tough parts of meats. A clog is bad news and may require a hospital visit and pain.

Some food produce more (or less) liquid output and even diarrhea which could make putting on a bag very difficult if not impossible.

Read this

viewtopic.php?t=27653

FYI I use nearly all Coloplast products because their belt has four hooks instead of two and their grade is higher than others I've found. I strive not to replace the bag and my record is nine days so far. But it's usually 3-5 days depending upon how active I am in my sleep that might be causing my appliance to loosen. I'm still trying to figure that part out.

One thing to remember, the part of the skin right next to the stoma and that portion of the appliance adhesive is the most vital. This is where leaks occur the most, if not always. So if there is a good solid bond there then your good. What happens outside that is mostly containment. So with extra adhesive strips you put one on the left so it covers the area with the hooks and one on the right doing the same so they both meet at the bottom. At the top there can be a gap, a leak is not going up unless it's already filled down, but you'll know it long before then.

Note: the hospital staff use a lot of reverse phycology to get you to do things yourself. They know how to do it right, just choose not too to force your hand and get you to do it yourself which you will need to.

Have you looked at the sensura mio? They do make a post op as well as regular pouch.Made by Coloplast.

Gotta give it time.
In the beginning it's tough.
It takes time
Trial and error. We all go through it.
Especially if you just had the surgery
Things have to heal. Until then I had alot of leaks.
I'm eight years in. All has healed. It's much easier now than in the beginning
Simple thing to do.
What I do.
I use a two peice drainable convetec.
An adapt slim ring. I put the ring on. Place the wafer over it.
Get it all centered best you can. Snap the bag on.
Once I change I sit back in a recliner and put a heating pad on it for 20 minutes
Just to melt it all together and to my skin.
I set the heating pad on high. But be careful not to burn yourself.
Just a suggestion you may want to try..

Previous advice very good. My rule for ostomy equipment—less is more.

IMHO A 2 piece system is a good place to start, easier to center the eakin seal and wafer over the stoma, then add bag and belt. Be sure and stand up straight ( I stand at bathroom sink using a smallish stand mirror for a close view) pull belly up so area around stoma is as flat as possible . I apply Eakin seal to the convex wafer rather than to my skin.
I do not use any paste or skin prep .

An in-pouch liquid deodorant,like M9, is essential unless output is odorless. For me a belt is a must as well.
Try the small Eakin seal, warm it a minute or so under your arm or wherever, then pinch outer edge and apply by pressing firmly onto convex wafer. When applying wafer to skin hold down a minute or so before adding bag and belt. Avoid bending over for the first hour or so to keep stoma area as flat as possible.

Hope this is helpful,