UOAA Discussion Board

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

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, spray skin protectant, stoma powder and extra large barrier strips moon shaped

Other items:

Plastic bags for waste, a plastic or metal butter knife to scrape paste off the skin, toilet paper to clean.

Oil free eye makeup remover from the cosmetics isle of supermarkets and drug stores.

Cocoa Butter based skin lotion for scar tissue.

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.

Bend the wafer bubble horizontally slightly a bit so it's flexible. . Remove the backing. Cut a .5 mm crescent shape piece from the cutout piece. Cut the remaining wafer cutout piece into 1/8 sections the other way. Apply three pieces of the wafer cutouts, behind the peristomal granuloma next to the wafer hole, sticky side out, belly fold area right side. Repeat on other side but to the edge of the wafer hole. Then stack one more on the middle one on each side. Apply crescent pieces on the top and bottom edge of the wafer hole. Squeeze one bead ring of paste round wafer hole 1/4" away from it. 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 side to remove thick paste and wipe off using toilet paper. Clean area and knife off with toilet paper. Use NO water, it will mess things up. Used toilet paper into the toilet. Use oil free eye makeup remover on toilet paper to soak generously around stoma to remove all paste residue. May need to use fingernail to gently remove residue paste off skin. Use a eye makeup remover to soak and moisturize scar tissue, massage it some so it becomes flexible and under wafer area pre shower, this has also reduced a lot of the scar issue pain under the wafer I was having.


Shower:


Wash the area with a light amount of plain soap (not moisturized like Ivory) and water with a washcloth to remove slight greasy feeling of the oil free eye makeup remover. Repeat soap wash 3 times works great. Skin should be squeaky clean afterwards when rubbed with fingers. Keep other shower products from running on top of the cleaned area, like shampoo, conditioners and moisturizer soap. Only clear water should be on the skin under the wafer area. Rarely use plastic scrubby to gently exfoliate the skin around the stoma.

Towel dry, then blow dry the area which also warms the skin for better adhesion, then use dry toilet paper to dab around stoma using a fresh piece each time to soak up any moisture. Ensure the crack is clean and dry.


Preparation station on bed:

Have a towel underneath in case of a sudden unexpected large discharge. Usually just a plastic bag (which I also dump trash from ostomy products) placed under and on the right side where excessive output tends to flow if stoma goes volcanic on me which is exceedingly rare occurrence but it has surprised me a few times. So this way the plastic bag will catch the output before it hits the bed.

If any output gets on the skin, repeat water washing and drying until it stops or just keep rinsing into toilet or use shower. 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. Dry for one minute with paper fan.

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 to form a crust. Target the crack around the stoma by stretching the skin. Remove stoma powder with damp toilet paper from healthy area skin. Dry well. Make sure nothing comes off damp areas like clumped or loose stoma powder. A secure thin coating of stoma powder on the wounds is essential just like a crust. Finger test the wounds are very dry and nothing removed by light rubbing. Extremely important at this stage. A slight wet or loose powder will cause the adhesive not to bond and will leak later which everything is wasted. Paper fan dry for one minute.

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

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 60 seconds to dry. Optional and not needed if no stoma or fungal powder used. Paste will stick to plain skin also.

Put a half bead of paste right around the stoma skin side, targeting the crack to force it in there. Make sure it sticks. Press it down a little using the tube as it comes out.

Line up the bag exit centered over genital area. 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 and left. Use a toilet paper roll to press evenly around the stoma for 180 seconds (3 minutes). Try not to cover wafer hole with oozed out paste. About a 1/4 to 1/3 inch oozed out is good. It will deflect output until the paste on the peristomal skin has had time to fully bond to the skin. Press all wafer adhesive down for 60 seconds including into the chest scar and belly button, minimum air pocketing is vital.

Stretch 1 barrier strip 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. Basically this barrier strip is acting like tape to push the bottom part of the wafer down against the skin. Hold for 60 seconds.

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


Then another on the left centered on the belly button so it's covering the other half of the bellybutton and just catching the edge of the wafer adhesive, this keeps the adhesive down into the belly button hole and reduces air and humidity which has been itching later.

Rest still and hopefully with no output for a few hours seems to make the adhesive bond better. Why I tend to put the bag on before bedtime.

I do NOT use a belt as it pulls on the right side and warps the wafer. Caused granuloma 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. Precision, exact height and elimination of any movement unless it's bending when I bend ensures the paste and water flex as well.

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. Use a dab of cocoa butter too.

Cover exposed scar tissue with 1/2 extra large barrier strip. Over time this will heal the scar and make it virtually disappear like it did under the wafer already.

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 granuloma. Soap used 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 or an itch) 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.

Edited to revise.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.