My low profile stoma in a belly fold solution UPDATED

[Shamrock4806]

Overview

This method has been over two years in development. I am now achieving close to a 100% success rate with a consistent 3–4 day wafer wear time, even with a hinged stoma located in a belly fold, and 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.

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.


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Diet Timing and Output Control

Wait until the stoma has quieted by observing the pouch and ensuring output has slowed.

Eat small, nutritious, non–diarrhea-causing meals throughout the day.

Eat more during the morning and early afternoon when the bag is fresh.

Eat less later in the day or when a bag change may be needed soon, allowing the system to clear.

Newly digested food can take approximately 4–5 hours to pass through.

Meals of 4 oz or less, spaced about every four hours, works well. Gives more lull times for a bag change without it spewing.

Diet balance that works best for me:

High protein

Medium carbohydrates

Low fat

Lower fluid intake (but still urinating normally)

No artificial ingredients, salty, fatty, fried, overly spicy, type foods, no alcohol or hardly any caffeine. Rather plain meals like TV dinners often work very well for me. Hard boiled eggs, Greek yogurt, whey isolate protein powder mixed in with lactose free protein, low fat enriched milk works great.

No solid fruits or vegetables, only juices, sauces or soups. Low fiber.


Mornings are generally the best time for a bag change, before breakfast.



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Products Used

Brand: Coloplast
Bag: Sensura Mio convex drainable one-piece, 2" wide

Accessories:

Brava No-Sting Paste

Brava Skin Protectant Spray or PREP Dabbler Bottle

Stoma powder

Extra-large moon-shaped barrier strips


Tools & Supplies:

Ostomy scissors

Plastic trash bags

Plastic or metal butter knife (for paste removal)

Toilet paper


Additional Items:

Oil-free eye makeup remover (shake before use)

Cocoa butter–based lotion (for skin and scar tissue)

Two toilet paper tubes nested together (for even wafer application pressure)



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Wafer Preparation

1. Roll the tail of the pouch (blue side up) and secure it with Velcro.


2. Enlarge the wafer opening:

Cut vertically to the “30” mark.

Cut horizontally to the line between 30 and 40 (approx. 35).

Round the oval back to 30 and then 35 to complete the shape.

3. Save the cut-out piece.

4. Slightly bend the wafer bubble horizontally to increase flexibility.

5. Remove the backing.

6. Cut the saved cut-out in half lengthwise.

Place sticky side up around the wafer hole.

Stack remaining additional piece halved at the 3 and 9 o’clock positions to fill the belly fold.

7. Apply one continuous bead of paste around the wafer hole, approximately ¼" away.

8. Set aside.

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Removal of Old Appliance

1. 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

2. Dispose of the old pouch in a sealed plastic bag.

3. Dry wipe stoma clean of output, use no water.

4. Clean the mucus fistula opening (if present) using a coffee stir stick. (I have a double-barrel ileostomy.)

5. Use the flat side of the butter knife to remove thick paste.

6. Wipe residue off with toilet paper.

7. Use eye makeup remover soaked on toilet paper to thoroughly dissolve remaining paste.

8. Gently remove any stubborn residue with a soft fingernail if needed.

9. Massage scar tissue with eye makeup remover to soften and increase flexibility.

10. Ensure all paste residue is completely removed. Important.

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Showering

1. Wash the area with plain, non-moisturizing Ivory-type soap and water using a washcloth. 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 and will affect adhesion.

3. The skin should feel “squeaky clean.” when rubbed with fingers.

4. Do not apply other shampoo, conditioner, moisturizing soaps or anything from putting on or running over the area. Skin must be absolutely clean and clear of anything. No need for healing creams etc., the skin will heal itself 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. Rinse with clean water only.

6. Occasionally use a plastic scrubby to gently exfoliate the skin if needed to remove dead skin.


7. Towel dry, then blow-dry to:

Fully dry the skin

Warm it for better adhesion

8. Dab around the stoma with dry toilet paper until completely dry, especially in creases

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Setup Area

Place a towel or plastic bag under you while laying down in case of unexpected output.

If output occurs:

Rinse away digestive enzymes with plain water.

Do not use spit—it contains salts and will burn.


Dry thoroughly.

Drying at this stage is critical.

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Skin Preparation

1. Perform a finger test:

Rub around the stoma and then rub fingers together.

Any moisture or greasiness must be corrected.

2. Address any leak wounds:

Apply a single grain-high layer of stoma powder.

Stretch skin to reach creases.

Remove excess powder from healthy skin with damp toilet paper.

Dry thoroughly.

3. Powder should form a secure crust that does not rub off.

4. Fan-dry for one minute.


5. Fungal note:

Use antifungal powder only if there is clear fungal itching.

Lock it down with skin protectant.

Do not use routinely—adhesion is reduced.


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Barrier and Paste Application

1. Apply either:

One light coat of skin protectant spray, or

PREP Dabbler on wound areas
(Never both—they do not bond together.)

2. Allow to dry for 60 seconds.

3. Apply a half-bead of paste directly around the stoma, pressing into the crease.

4. If using a ring, apply it skin-side now.

5. Align the pouch exit downward over genital area.

6. Seat the wafer starting from the bottom, pressing upward and left.

7. Press around the stoma to spread paste.

8. Use the toilet paper tube to apply even pressure for 3 minutes.

9. Allow ~¼–⅓" paste ooze—this deflects early output.

10. Press all wafer adhesive for an additional 60 seconds.

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Barrier Strip Application

1. Apply one barrier strip across the bottom:

Exhale slightly while applying for tension.

Hold for 60 seconds.

2. Apply two extra-large barrier strips around the hard wafer edge:

First centered at the belly button

Stretch outward on each side

Overlap slightly

3. Allow the wafer adhesive to partially fill the belly button divot.

4. Cover remaining area with the barrier strip to minimize trapped air. Air pockets under the adhesive causes mold, itching and undermines the barrier adhesive due to humidity buildup. Avoid any trapped air. Stick adhesive down inside belly button or other depressions.

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Post-Application Care

Rest quietly for several hours if possible.

Avoid high-fiber foods that cause pancaking.

Favor softer output consistency.

I do not use a belt:

It caused wafer distortion and granulomas.

Barrier strips provide better stability without movement. Stretched out to either side before applying provides downward pressure.


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Mucus Fistula Care

Fold toilet paper into quarters.

Apply a dab of cocoa butter.

Secure with one piece of waterproof tape.

Replace daily or twice depending upon output.

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Exposed Scar Care

Apply cocoa butter sparingly.

Cover with half an extra-large barrier strip.

Over time, scar tissue softens and improves significantly, eventually disappearing.


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Emptying and Rinsing

Empty when pouch is ~⅓ full.

Rinse with plain water.

Add 1–2 drops peppermint oil to rinse bottle if desired.

Optional: toothpaste for odor control of future sticky output so one isn't choking on the smell.

Do not use soap to rinse with.

Do not apply pressure to the pouch—this forces paste out.


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Warning Signs

Persistent pain, itching, or discomfort means the pouch should be changed.

Feeling cold during rinsing indicates a leak—change immediately.

Pure water is best to rinse. However toothpaste seems fine as an afterwards odor control.

Edited to revise and cleaned up using ChatGPT

[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 off 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 thick paste also flexes some and keeps the seal.

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.

[Shamrock4806]

My latest improvements (included in the original post) are as follows:

1: I now put a bead ring of paste skin side down right around the stoma BEFORE putting the water (with it's three beads of paste) on. What this does is places the most pressure possible right around and up tight around the stoma. I ensue the skin side paste is sticking which I have been missing with the paste on the water pre prepared method

2: I've also no longer using toilet paper in my belly button, it was drying the scar out causing irritation. Just cocoa butter lotion and a piece of thin costed cardboard to protect the scar from the adhesive sticking to it.

Little tweaks but makes a big difference.

[Shamrock4806]

Have been having paste separation from the skin and blow outs on the belly button belly fold side.

I was using too much paste.

So reducing that and putting a ring of paste right around the stoma plus some built up in the below fold on that side ensures it's well adhered to be skin.

I've also started stretching the barrier strips by placing them center first over the belt hooks then stretching out to either side creating downward pressure.

Hopefully this will resolve the blowout issues. But most times it's because I ate something that stayed solid and pancaked the wafer. My output needs to remain very liquid or like pea soup consistency. Any chunks block and start pushing output through the paste.

Although my stoma hole is on my left, I try to direct it towards the right or down, away from that weaker left side.

Haven't been doing very well on the wear times, every two days now to occur with a shower seems to be my new routine.

Hardly any leak burns, very small ones.

[Shamrock4806]

Okay figured out what I was doing slightly wrong.

What. I was doing was placing a second barrier strip in top of the first one to try to hold the wafer down better since I don't use a belt.

So now the first barrier strips go center down first over the belt hooks and stretched out to either side before bonding to the skin. Since I have a belly fold this seems to do better especially on my left side where it has been blowing out.

Then I put another one along the bottom while exhaled to press the bottom down firmly as well.

I put one on top of the bag itself on the left side to keep it from tilting to the right when output flows and pulling things up.

So it's important with a blue fold to maintain downward pressure within the belly fold so the wafer doesn't separate and pull the paste off from around the stoma.

Usually a belt does this but sleeping and movement was moving the wafer around, so using barrier strips like tape seems to work great.

[Shamrock4806]

Another adjustment since my stoma hole is on my belly button side where my belly fold is, so it's been a weak point and thicker output has been pushing the paste.

So now I put a ring of paste, skin side down right up tight against the stoma, then fill the belly fold on my left some with paste then cover it with a half a barrier strip. Three rings of paste on the wafer as well but just a 1/8 away from the wafer hole as I already have a ring around the stoma. I marry the two and press it down for 60 seconds.

So hopefully this will prevent the paste from being pushed away from the stoma on that weak side.

[Shamrock4806]

Okay a new modification,

I use the oil free eye makeup remover to remove residue fine film of paste and moisturize the skin. Then wash three times the wafer area with plain ivory type soap to remove the surface layer of the eye makeup remover.

After any crusting, then I squeeze one ring of paste right into that crack going around the stoma. Then on the wafer two rings of paste but slightly away from the wafer hole edge.

This has the benefit of two things, one that I can test right away if the paste is sticking to the skin or not and two makes it easier to line up when the wafer is applied. I now use a toilet paper tube to hold the water down around the stoma for 60 seconds.

Also I have some scar tissue under the wafer that the adhesive was grabbing. I learned using a piece of thin cardboard was not ideal. So now in the hot shower I massage the area so eventually it becomes more pliable and less sensitive. Also I put a thick bead of paste right there so the wafer adhesive can't grab it. Much how I cushion my graneomola on the other side. Why I like paste so much, it's so versatile.

The key thing I've learned is keeping my weight down, when I lost weight my stoma became more pronounced and a lot easier to seal than when it was an "innie" so now I monitor my weight that it stays at 200 pounds, because before it was 210-214 and the belly fold became worse.

Now I no longer "stack" wafer cutout pieces and just use one ring of them around the outer edge of the convex wafer bubble. My graneomola has shrunk so much I can barely feel it anymore, so this keeps the wafer slightly off of it.

Also I only use water to rinse the bag, anything I tried using before would cause the stoma to retract and this caused leaks.

So I update my first post with my latest improvements so it can help others who experiencing similar issues.

[Shamrock4806]

Okay, the circle of wafer cutout pieces around the edge of the convex bubble wasn't working as well as it should.

Apparently thin paste, about the thickness of a credit card, is supposedly the best method and I've been using paste as belly fold filler.

So now I'm putting 1/2" double stacked wafer cutout pieces in the belly fold on each side, then one on each side and no place else. The graneomola I'm trying to protect is in the belly fold on my right, next to the stoma, so I just put the wafer cutout pieces slightly behind it.

Hopefully this will reduce the height of the paste to the skin and prevent micro channels from forming better.

It really looks like something that's molded to fit would be so much better, then just a slight smear of paste.

ChatGPT has been considerably helpful, especially since I can't find or afford a seriously competent ostomy care nurse.

[Shamrock4806]

Definitely a lot better seal, I can feel the improvement.

I was using way too much paste, I've revised my original post.

ChatGPT has been a great help.

[Shamrock4806]

Okay ChatGPT said the reason why my wafer cutout pieces wasn't working was because they were placed on the outter edge of the convex bubble, that instead should be around the wafer hole edge.

So my latest improvements are as follows:

When preparing the wafer, using the wafer cutout piece, create a crescent shaped piece about .5 mm in thickness. Then the remaining cutout piece cut into eights the other way.

Three 1/8 pieces on one side belly fold, then three on the other side. With one more stacked on the middle one. I of course have a graneomola near one side so I set those just slightly behind it.

Then the crescent piece is used to fill the top and bottom empty space along the wafer edge.

What's been happening is because it's a cut to fit, the center of the wafer near the hole is flexible so when I'm bending it's lifting up and causing micro channels to form which cause leaks.

So now hopefully with less flexibility of the wafer hole area it shouldn't move as much and stay on place.

Also it advised me to hold the toilet paper tube on the stoma area for 3 minutes instead of 1 minute like I was doing. So we will see how these new improvements will do.

[Shamrock4806]

Okay holding the water down with the toilet paper tube for 3 minutes definitely works a heck of a lot better. So does putting the wafer cutout pieces trimmed around the wafer hole reduces it from flexing.

Another problem I was having was pocketing caused by my chest scar and belly button being covered by adhesive which I learned hot air would cause sweating and humidity buildup which was working it's way under the paste undermining it.

So now I've altered how I put the wafer adhesive down, right into the belly button hole on the right and barrier strip on the left with it just covering the other. Thus minimizing air pocketing under the adhesive.

I also noticed my chest scar under the wafer has almost disappeared after two years, but my exposed scar has not, so now I put a 1/2 extra large barrier strip over that part also.

I no longer put a barrier strip on the outside left of the bag to keep it from lifting, apparently it's not needed and could have been causing my pocketing issue. I just make sure the wafer adhesive is down good

So we will see how this goes, I've updated the original post to reflect these new changes.