Well I guess I should post my low profile stoma in a belly fold solution

[Shamrock4806]

It's been about two years in the making but now I'm having near 100% success rate and a steady 2.5-3 day wafer wear time which is likely the best one can do under these most difficult types of stomas.

So read, however realize that it's personalized for me and my body contour, stoma shape (oval) and some tweaking may be required to adjust to ones own situation. But it should give a valuable head start to those with this type of stoma etc. It's quite detailed and thorough so hang in there.



Wait until stoma has quieted down by watching bag contents until it slows down filling up. Small nutritious non diarrhea causing meals over the course of the day with more food during the morning and early afternoon on a good bag and less during the later hours or if a bag change is going to be needed soon so the system clears out. Hunger causes bile to be produced so not feeling hungry on a empty system equates to a quiet stoma. Less food at night also reduces bathroom visits and accidents.

Products used:

Brand: Coloplast
Bag type: Sensura Mio 2" wide convex drain able one piece.
Brava No-Sting paste, oil free eye makeup remover, spray skin protectant, stoma powder and extra large barrier strips

Other items:

Plastic bags for waste, a plastic or metal butter knife to scrape paste off the skin, toilet paper to clean, small pieces of thin cardboard about 1" square to cover belly button.

Prep.

With the blue side up, roll the end of the wafer bag and lock with Velcro. Then cut a larger oval hole in wafer through small hole to 30 vertically, then across to the left side line between 30 and 40 (35). Then around to 30 line again and then to the 35 line again and then complete the oval. Save the cutout piece.

Slightly bend the wafer bubble a little so it's flexible. Apply one drop of skin lotion through the wafer hole onto the inside of the bag and smear around. Remove the backing. Apply three 1/4" pieces of the wafer cutouts stacked, behind the peristomal graneoulma sticky side out, belly fold area right side about 1/4 " from the wafer hole edge. Repeat on other side but only two stacks. Place single stacked u-shaped thinner width cutout pieces around the circumference of the convex bubble away from the hole edge a bit (1/4") to act as a paste slide resistor. Squeeze three bead rings of paste round wafer hole. Set aside. See photos above for details.




Removal:

Remove old wafer by using oil free eye makeup remover along the top and squirting the crack while peeling down..plastic bag and seal for trash disposal. Use butter knife to cut hairs if needed.

Remove covering over mucus fistula and clean hole with coffee stir stick if needed.

Use a flat butter knife to remove thick paste and wipe off using toilet paper. Clean area or knife off with toilet paper. Used toilet paper into the toilet. Use oil free eye makeup remover on toilet paper to soak around stoma to remove all paste residue. Use a little eye makeup remover to moisturize scar tissue pre shower.


Shower:


Wash the area with a light amount of plain soap (not moisturized) and water with a washcloth to remove slight greasy feeling of the oil free eye makeup remover. Skin should be squeaky clean afterwards.

Towel dry, then blow dry the area, then use dry toilet paper to dab around using a fresh piece each time to soak up any moisture.


Preparation station on bed:

Have a towel underneath in case of a sudden unexpected large discharge..

If any output gets on the skin, repeat washing and drying until it stops or just keep rinsing into toilet or use shower if a lot. Small amounts on skin can be wiped up with toilet paper and plain water used to wipe off digestive enzymes away, do not use spit, it contains salts and will burn. Not wiping the enzymes away with water will cause a leak burn later as it eats into the skin and trapped under the adhesive. Dry well again. Drying is extremely important at this stage.

Finger test; drag finger around stoma and rub fingers together looking for any trace of moisture or greasy feeling, address until skin is absolutely dry to the touch.

Once very dry determine if there are any leaks wounds that are not drying and feel wet to the touch. These get one grain high stoma powder. Remove stoma powder with damp toilet paper from healthy skin. Dry well. Make sure nothing comes off damp areas like clumped stoma powder. Finger test the wounds are very dry and nothing removed by rubbing. Extremely important at this stage. A slight wet will cause the adhesive not to bond and will leak later which everything is wasted.

Note: If any areas are experiencing fungal infections then rub in anti fungal powder (in lieu of stoma powder) and dust dry, then coat area with skin protectant.

Optional: Spay the entire adhesive area under the wafer with one light coat of skin protectant..this will also lock down the stoma powder if applied (required) Wait 30 seconds to dry. Not needed if no stoma or fungal powder used. Paste will stick to plain skin also.

Line up the bottom of the prepared wafer hole to go over the stoma and gently press down. Pressing around the stoma through the wafer to get the paste to spread and stick. Starting from the bottom up. Ensure oozed out paste does NOT cover the stoma hole nor the entire wafer hole as seen though the bag. About a 1/4 to 1/3 inch oozed out is good.

Belly button gets a ball of toilet paper soaked with oil free eye makeup remover and a small piece of thin cardboard to cover the belly button/scar after the wafer is applied and before that adhesive area pressed down. It will be covered by the extra large barrier strips. Test by pressing so there is no irritation. Press the wafer adhesive all around and onto the skin and hold it until it bonds.

Apply 2 extra large barrier strips all around the hard wafer edge (first one center on belly button) and over the hooks, press and hold to bond. Both barrier strips should meet each other and lap over slightly.

Place another 1 barrier strips on top of the previous one around the bottom ensuring they are over the hard wafer part. Provides better downward pressure as it's been leaking down there. Exhale when doing this to make sure it's tight.

Cut a extra large barrier strip in half and apply over the belt hooks while exhaled, this provides more downward pressure. No need for a belt now.

Do NOT use a belt as it pulls on the right side and warps the wafer. Causes graneoulmas on top of the stoma and on the right side. Dam belt has caused me plenty of problems because it moves the wafer around so much.

For the mucus fistula, one piece of toilet paper folded into a quarter size, water proof tape in place to hold. One piece of tape will do.

Massage some eye makeup remover into exposed scar tissue to make it soft.

Dump bag every time it's about 1/3 full. Gently rinse bag with water every time, use no soap. Diet control and frequent rinsing to keep bag looking cleaner longer. Add dollop of toothpaste (odor control) to the cleaned out bag and close up with some air inside. Roll up air towards stoma. Squish toothpaste down and spread inside bag.

Do not touch or place any pressure on the bag as that will cause the paste to squish out and the wafer will irritate the graneoulmas. Soap during rinsing will irritate and cause the stoma to retract causing a leak.

Feel any pain that lasts more then just temporarily (like always wanting to rub it) the bag needs to be changed as soon as the stoma is quiet. If when rinsing if cold is felt means there may be a leak, change as soon as possible.

There should be absolutely no pain or irritation whatsoever until s small leak starts forming then it will start itching. Absolute heaven finally after all this time.

[Shamrock4806]

I should note the reason for the stacked 1/4" wafer cutout pieces is to provide something to stop the wafer from squishing all the paste out also to double as a wall of sorts to prevent blowouts through the belly fold sides where the paste is thicker and weaker there.

That and the extra barrier strips placing downward pressure keeps the wafer at the exact height of the skin, keeping the wafer stable and thus not causing the paste to move or ooze exposing skin to output.

That combined with better paste skin adhesion using the oil free eye makeup remover, soap and water wash has helped tremendously to solve my difficulty and causes very few if any leaks to occur.

As an added note I can pretty much bend over some and sit on long car rides without leaking or detaching occurring because of the extra large barrier strips holding things down and forcing the wafer to bend some as my torso bends some.

The original design of the convex is to be used with an ostomy belt and force the area around the stoma to remain flat which unfortunately doesn't work well in a belly fold. So I was always very stiff all the time and couldn't sit at all less the wafer would detach.

The otosmy belt would move the wafer around and squish out all the paste as well. Now with this design the wafer remains perfectly positioned and the paste can remain that way also. Both will flex some as my body bends some.

[Shamrock4806]

Another key to understanding adhesive adhesion is the two layers of the human skin in regards to adhesion. The top layer and the under layer.

The larger under layer of the skin needs to be healthy and moisturized however the top thin layer where adhesion occurs needs to be dry and not as much moisturized so bonding is highly successful.

The oil free makeup remover not only removes the paste residue but moisturizes the skin and the plain soap and water wash cleans just the top level of the skin for the adhesives to work properly.