Advanced Otosmy Adherence Secrets
Posted: 2026-05-12 01:03:38
Okay here's a list of advanced ostomy wafer/bag adherence secrets that I've learned the hard way. It's specifically for my illeostomy but many of the tricks apply equally to other ostomy types as we use the same products and techniques usually.
There's an important secret i learned about skin and the adhesives applied to it. The deeper skin below the surface needs to be properly nourished and healthy. If it's too dry or lacks oils it's going to cause problems. However the skin surface that makes contact with the adhesives needs to be absolutely clean, skin oil free and very dry.
Skin is porous so it's going to absorb whatever is first on the surface and sort of retains it below. Once filled it's difficult to adjust. Alcohol breaks down skin oils below the surface (if applied first) and drys out the skin causing it to itch later. If water hits skin first it's going to be absorbed below the surface and later weaken adhesion.
So it's important to keep in mind the order of what one applies to ones skin after wafer removal as to have just nourishing oils below the surface while the surface level is made to be absolutely clean, oil free and dry for maximum adhesion. I've found just plain soap, used 3 times, ideal to remove surface dirt and skin oils but only after first using a nourishing cleaning oil first to address the below skin needs.
So I've written these instructions of mine in a particular order to address keeping the skin in an ideal state for maximum adhesion.
Terminology used:
Wafer refers to the portion of the ostomy product that actually attaches to the skin. Wafers and bags can come as a one piece or two separate pieces that attach together. Bags are just the bag portion however people use "bag" to mean both depending.
Wafer cutout piece refers to the leftover hard wafer disk portion remaining after one cuts their wafer hole to match their stoma. Some use it as curved strips around the wafer hole to bring the wafer closer to the skin and reinforce the wafer hole as it can flex causing leaks. Advantage is it's solid and won't melt unlike rings or paste will (in thicker amounts).
Barrier adhesive (if required) is the sealant used right around the stoma protecting the skin and keeping output from escaping. It's most vitally important that this is securly attached to the skin well. Pastes and rings are barrier adhesives.
Wafer adhesive is referring to the extra non disk adhesive that keeps it attached to the skin. It's in this area that air pockets can occur like over scar divots and belly buttons. Or even if it's not pressed down firmly enough. It can grow mold if air pockets with underneath exist.
Barrier strips refers to extra adhesive tape like material used around and on top of the wafer adhesive to give it more holding strength. It's optional depending how well the wafer adhesive is holding. However it's useful for cutting into skin sealing portions under air pocket areas like in belly buttons, belly folds and scar divots. Sealed skin won't grow mold, at least not on the skin. It can be used to fill in air pockets also if stacked. It won't melt or shift like paste or rings used as filler can. So it's ideal for maximum holding strength. However it can't be used as a barrier adhesive because it's weak sideways and will swell if output hits it.
Skin Prep refers to fast drying liquid or spray products designed to seal and protect skin (and stoma powder if used) somewhat (doesn't last long if a leak occurs) mainly from adhesives effects and either provides a rougher or smoother surface so one can slightly adjust their adhesive strength. For instance of one has a really hard time removing their wafer because the adhesive is too strong, they can use spray skin protectant one or two times and this creates a smoother surface so next time it's easier to remove. For right around the stoma where the barrier adhesive is, very smooth isn't very good and can cause leaks to occur more often. A rougher surface skin protectant application (like Coloplast PREP dabber bottle) is much more effective, gives paste and rings something to grab.
So here we go:
1: Skin must be absolutely clean and very dry, I use fresh pieces of toilet paper dabbing to remove any trace of moisture during my process then hand fanning for one minute before applying anything. Dirt, oil, greasy feeling (skin oils) must be removed from the surface. But the below skin surface needs to be nourished. Skin also has to be healthy and not too dry or cracked. Tools that can help:
A: Optional: For seriously bloody scabs like what occurs soon after surgery: That purple stuff called Medline Marathon (expensive) first as a skin protectant/scab creator then apply a sting/alcohol free paste as a barrier adhesive to create a smooth surface to bond to the flat wafer. Avoid using rings on uneven surfaces, belly folds, scar divots, grameolula etc. paste is better as long as it's not too thick. If you need to fill more space you should be looking at a convex wafer and/or curved wafer cutout pieces to bring the harder wafer material closer to the skin.. Also scabs tend to flake off often causing leaks. So wafer changes will be required more often until one gets that skin healed up. The less output hitting the skin, the sooner those scabs heal and the longer wafer wear times will be. Allow the pain to continue only makes things worse. Rip the bag off and sit in the shower if necessary to rinse output away so it's no longer being attacked by the digestive enzymes until the stoma is quiet enough to prep for a new wafer. Bleeding must be stopped before doing anything.
B: For cleaning and nursing the skin below the surface and pores. Oil free eye makeup remover (Neutrogena) available in cosmetics section used first BEFORE any water touched the area or it won't work as well if at all. Ensure that after cleaning with it that the area is washed 3 times with regular plain ivory type soap (not moisturizer soap) as to remove it (and any skin oils) completely from the top of the skin where adhesion occurs. Sometimes a very gentle scrubby on healthy skin (not on wounds) can assist in removing stuck old adhesive material and exfoliating the skin. A trick is to ensure both the skin around the stoma AND ONES FINGERS are absolutely squeaky clean when rubbed and kept that way until the wafer is successfully applied as one will be touching adhesives. Always maintain this squeaky clean state on both until one finished applying the wafer etc. it's because oils, water and dirt transfer and lessen adhesive effects when those areas are touched or the adhesive is. Without healthy nourished skin below the surface problems arise later when wafer is on like intense itching from dry skin caused by using alcohol. You want the pores below nourished and the skin surface absolutely clean, oil free and very dry. Alcohol cleans the pores of skin oils, doesn't nourish the skin and why it later causes itching.
B1: Optional. For leaky wet wounds (not bleeding) that won't stay dry use stoma powder one grain high just on the wound, brush off any excess leaving a scab of sorts then cover with a skin prep and allow to dry for one minute. Repeat with another layer again if necessary, this is called "crusting". Skin must be dry and free of grease or debris to achieve a good bond. Never use medication, ointments etc. not otosmy approved to work under the wafer as they interfere with bonding and cause leaks. Stoma powder is rarely used once the skin has healed up enough because very light skin burns can take just the skin protectant. The secret is to be able to change the water at the slight hint of a leak + combination of diet/food quantity (illeostomy) so one knows the effects and timing of what they consume so if the wafer/bag needs changing the stoma is quiet and not hampering efforts. Usually 4 oz or less of non diarrhea causing meals spaced out every 5 hours or so over 24 hours seems to work for an illeostomy. Gives more lull periods in between for wafer changes should a leak occur. And don't eat or drink anything before a wafer change obviously.
B2: Optional. For itchy skin fungus instead of using stoma powder, use an anti fungal foot powder instead and cover with skin prep just the same way. Should only need to use it once. After it's cured go back to using stoma powder because it's specifically designed for that purpose and works better than fungal powder at bonding.
C: For skin prep Coloplast PREP dabber bottle works great to protect the skin and create a rough surface for later superior bonding. Apply only to absolutely dry skin. Economical. However it contains alcohol and can sting wounds for a very short period. Allow 60 seconds (twice as long as instructed) to dry it out thoroughly. Alcohol use can dry out the skin below the surface, causing it to itch, why using the oil free eye makeup remover first to nourish it.
D: For larger areas and when one wants to slightly reduce the adhesion of wafer or barrier strips, spray skin protectant works as it creates a smoother surface that reduces bonding adhesion with each light spray coat. Be careful not to overdo it or the wafer detaches too easily as it creates a very smooth layer. However it can't be applied where alcohol based skin protectants (like PREP) already applied as they don't bond with each other. Issues with shipping so it might have to be delivered via ground delivery services.
D1: Optional. For filling voids under the wafer adhesive (like what occurs with a convex) that holds the wafer disk to the skin (not the under the disk itself) use cut barrier strips first to seal the skin (not under where the barrier adhesive or convex wafer will go!) as they are weak sideways and will fail if output hits them. Only use barrier adhesives like a paste or a ring right around the stoma about 1/3 of an inch around or so. Barrier strips are useful for this because if they are covering the skin then itchy mold doesn't form underneath unless there is an air gap above it which causes a very humid area where mold loves to grow in. So the object is to fill that empty void under the wafer adhesive portion (only) with cut barrier strips and if necessary paste creating a flatter more airtight surface.
D2: Optional. For covering sensitive scar tissue first use a skin protectant, allow 60 seconds to dry, then cover with paste if needed (small areas like belly button) to fill air gaps etc. then another small barrier strip floating over it then another full barrier strip holding the wafer down like normal. Paste won't grab the scar tissue as severely as a wafer adhesive or barrier strip (or tape) will. However it can weaken the hold in that area so reinforcement is required to grab solid skin on either side to compensate.
D3: Optional. For grameolula protection avoid using anything hard on top (like rings or wafer) or grabbing it (like wafer or barrier strips/tapes).. Paste on and around it, like on sensitive scar tissue, acts as a sealer, an air gap filler without grabbing it or irritating it enough. If it's no longer being irritated it might decrease and disappear on it's own like what occurred in my case where the belt was causing the wafer to dig into the skin. Why I don't use belts anymore and use barrier strips and better barrier adhesive bonding techniques. However in some cases a stoma nurse or doctor will have to address a grameolula if everything you've tried hasn't worked.
E: Barrier adhesives, for unevenness and scabs, or if time is an issue, paste is ideal however it can't be thicker than 1/8" or it will simply run when one stands up. So do not use it as a large thickness filler use a thin ring or cut strips from wafer cutout hole or a combination with convex wafer + thin paste to bring the solid wafer material closer to the skin surface like to fill belly folds. Alcohol paste will sting wounds for quite some time and dry them out casing itching. Alcohol free (pectin based) will not. For perfectly flat skin and time to mess around, rings will work as they take more adjusting to cover the skin around the stoma and heating/pressure to work. Paste sticks well to the skin (as long as it's clean and very dry) right out of the tube and doesn't need to be touched unlike a ring.. I apply my paste first to the skin to test adhesion as it should stick to the skin when coming out of the tube, if not I've done something wrong and need to remove and redo things. I've found using a used toilet paper cardboard tube pressed through the applied wafer around the stoma for 5 minutes ideal for excellent bonding of either. Note that rings too thick will run also in high heat environments, why I use cut wafer pieces instead as they don't melt like in hot climates, showers etc.The thinner the paste or ring material used under the wafer disk the better because it melts and runs. However when I use paste, I apply a thick one bead right around the stoma, and after ensuring it sticks, center and apply the wafer then hold it down using a toilet paper tube or similar for a good 5 minutes of steady even pressure. What this does is two things, it bonds better to the skin and it forms a bubble like ring of oozed out paste around (but do not cover the stoma hole) the stoma as seen through the bag. This oozed out ring alongside the stoma then hardens and swells with contact with output and creates a tight waterproof collar that keeps digestive enzymes from attacking the paste where it meets the skin. The stoma can handle some enzyme irritation as it produces mucus and renews itself, the object is not to allow plain bile (eat regularly unless it's time for a bag change) or high detergent like salts in the bile (more than 10% fat in foods) to irritate the stoma for long periods of time. Rinsing the bag out after every dump helps as well as trying to remain more upright so output drops to the bottom of the bag away from the stoma. It's by this method I'm getting upwards of 6-8 days or more out of a single one piece illeostomy ostomy wafer. It uses a very limited diet also to produce consistent slurry output free of chunks or high fats while providing energy and nutrition. The object is to reduce volume and strength of the bile (without using medications) so it just oozes out without a whole lot of output volume or too little of it that it's bile salt rich which is a detergent for food and adhesives. Of course proper nutrition and hydration is maintained with my diet and ORS to achieve this and still feel normal and healthy.
F: Wafer types. One needs to do a body check with an otosmy supplier to use the right type of wafer for their stoma and body contour. Also accurately measure their stoma and cut the wafer hole shape just a tiny hair bigger so it's covering the skin around it but not tight against it as it can swell a bit and pinch or hurt. Biggest misconception is stomas are always round, the guides are round but the cutting may be irregular to fit properly around the stoma. The wafer is pressing the barrier adhesive to the skin and if not there then weakness forms there and leaks occur prematurely. Test fit the old cut wafer backing material on the bare stoma to see if any changes occur before cutting the new wafer. The backing material can also be used as a guide to find low spots where the wafer adhesive forms air gaps, to fill with either paste or cut pieces of barrier strips. Any air gaps cause mold to form and intense itching and will undermine barrier adhesives and cause premature leaks. When wafer is applied press firmly through with a toilet paper tube for 5 minutes to get things to heat up and bond well. However with scabs this might not be possible yet, press gently and hold instead. Unfortunately more wafer changes are required with serious scabs as they flake off and leak so it's a matter of resealing it again to beat the output destructive effects. You don't want it to bleed again and again. Any bleeding must be stopped before applying anything as it won't bond. Always check your stoma size before cutting every wafer as it can suddenly change on you. I use the wafer backing from the last change to see if anything has changed with my stoma.
G: Barrier strips chiefly provide extra wafer adhesive adhesion all around and act as a blowout catch less the barrier adhesive fails. Blowouts are usually caused by poor barrier adhesive bonding in my experience. Typically only small tiny leaks start to occur which itch signalling a wafer change is needed as soon as the stoma is quieted down enough. However for exposed scar tissue outside the wafer area they can be used also to cover the scar (first use skin protectant and a tiny bit of scar lotion just on the scar) to aid in its protection and gradual healing and disappearing, takes months or even years.
When placing full barrier strips for supportive purposes around a round wafer, I've found a bottom first (slightly stretched) then a top application supports the wafer hold better than a left/right configuration. However if the ends of the top or bottom strip ends over sensitive scar tissue or belly button then it will cause weakness issues there for some reason. So first float a small strip over that area (with paste underneath if necessary to fill) before applying a final bottom and top for support. Although they sell curved barrier strips with a belly button extension, the problem is the weakness caused by a left and right barrier strip application process. A bottom then the top full barrier strip holds the wafer much more securly in my experience. I get less bottom and top leaks that way. Bottom usually is the one most occurring. Left over the belly button scar divot / belly fold next, used to get plenty of blowouts there until I figured out what the problem was. (belly fold + scar divot that needed to be filled with a solid)
H: Optional. For those with a separate mucus fistula (a stoma that outputs only mucus) a simple folded piece of toilet paper into quarters and secured along the top with a wide piece of waterproof tape works. Tear off the soiled pieces without removing the tape even. Clean the fistula first if required using a rounded coffee stir stick as sometimes there's a stuck ball of the stuff in there that needs a little help getting out. I like this approach better as a stoma cap creates a bulge under shirts etc.
I: For an illeostomy a proper diet is important along with drinking a watered down flavored oral rehydration solution with sugar (no sugar free as it contains artificial ingredients which causes issues) all day so the intestines can soak it up. Diet had to be medium proteins, low fat under 10% RSA per serving, decent carbs. Eating things like rice and pasta can soak up and slow digestion allowing better absorbtion time. No solid or hard pieces or things that won't digest completely like solid vegetables or greens despite how well chewed. Puree instead. If fats needed like what happens with zero fat meals, a little olive oil or half an soft avocado can provide a healthy fat too, as long as it's under 10% RDA or it causes too much barrier adhesive destroying and stoma irritating bile to be produced. Breads will often cause gas so one piece of sourdough toasted usually works to reduce that. Greens like salads often get stuck and more water is discharged trying to flush it out of ones body. An otosmy nutritionist can help by giving a list of what foods cause various issues with an illeostomy. However trial and error using small amounts and recording the results will help one narrow down what their system will tolerate. However eat nothing hard, like nuts, candies or tough parts of meats or vegetables, even baked potatoes or baked beans can catch one with a hard part. A wafer and the skin constricts the exit hole so it won't pass larger objects like an anus will. So eating stuff that fully digests in stomach acid is best. Meats, breads, fully cooked rice, mashed potatoes (without chunks or skins) and pasta works as well as pureed fruits and vegetables or juices/soups in small quantities. Skins of most fruits and vegetables do not digest. Dehydration and malnutrition are serious problems with an illeostomy so ensure ones diet is proper and getting ones RDA. I find ricotta cheese, white meat turkey hotdogs, European pasta, canned white meat chicken and some sort of low fat sauce (lemon or turkey gravy in small quantities) ideal as consistent source of protein and carbs, while low in fat, a little olive oil on sourdough for fat if needed. Liquid juices of fruits or veggies as needed. This is so far the best illeostomy meals I've found that produces the nicest output without problems, ample wafer changing periods while giving energy. As long as it's maintained and under 4 oz per serving every four to 6 hours or so over the 24 hour day.
These tips are from my own personal experience with a rather difficult stoma in a belly fold combined with a grameolula and a scar divot. It's been a royal pain in my arse for over two years but I'm finally enjoying very long wafer wear days (a record 8 days on the last one) when typically it's an average of 3 days with this type of stoma.
In no way are these tips considered medical advice and just my personal experience of what works from countless hours of trial and error. I think it's important to share this experience with others so others can learn. It doesn't mean it's complete or will 100% work in your situation as everyone is different. So take it as that and seek professional care to double check before doing anything.
Good luck.
There's an important secret i learned about skin and the adhesives applied to it. The deeper skin below the surface needs to be properly nourished and healthy. If it's too dry or lacks oils it's going to cause problems. However the skin surface that makes contact with the adhesives needs to be absolutely clean, skin oil free and very dry.
Skin is porous so it's going to absorb whatever is first on the surface and sort of retains it below. Once filled it's difficult to adjust. Alcohol breaks down skin oils below the surface (if applied first) and drys out the skin causing it to itch later. If water hits skin first it's going to be absorbed below the surface and later weaken adhesion.
So it's important to keep in mind the order of what one applies to ones skin after wafer removal as to have just nourishing oils below the surface while the surface level is made to be absolutely clean, oil free and dry for maximum adhesion. I've found just plain soap, used 3 times, ideal to remove surface dirt and skin oils but only after first using a nourishing cleaning oil first to address the below skin needs.
So I've written these instructions of mine in a particular order to address keeping the skin in an ideal state for maximum adhesion.
Terminology used:
Wafer refers to the portion of the ostomy product that actually attaches to the skin. Wafers and bags can come as a one piece or two separate pieces that attach together. Bags are just the bag portion however people use "bag" to mean both depending.
Wafer cutout piece refers to the leftover hard wafer disk portion remaining after one cuts their wafer hole to match their stoma. Some use it as curved strips around the wafer hole to bring the wafer closer to the skin and reinforce the wafer hole as it can flex causing leaks. Advantage is it's solid and won't melt unlike rings or paste will (in thicker amounts).
Barrier adhesive (if required) is the sealant used right around the stoma protecting the skin and keeping output from escaping. It's most vitally important that this is securly attached to the skin well. Pastes and rings are barrier adhesives.
Wafer adhesive is referring to the extra non disk adhesive that keeps it attached to the skin. It's in this area that air pockets can occur like over scar divots and belly buttons. Or even if it's not pressed down firmly enough. It can grow mold if air pockets with underneath exist.
Barrier strips refers to extra adhesive tape like material used around and on top of the wafer adhesive to give it more holding strength. It's optional depending how well the wafer adhesive is holding. However it's useful for cutting into skin sealing portions under air pocket areas like in belly buttons, belly folds and scar divots. Sealed skin won't grow mold, at least not on the skin. It can be used to fill in air pockets also if stacked. It won't melt or shift like paste or rings used as filler can. So it's ideal for maximum holding strength. However it can't be used as a barrier adhesive because it's weak sideways and will swell if output hits it.
Skin Prep refers to fast drying liquid or spray products designed to seal and protect skin (and stoma powder if used) somewhat (doesn't last long if a leak occurs) mainly from adhesives effects and either provides a rougher or smoother surface so one can slightly adjust their adhesive strength. For instance of one has a really hard time removing their wafer because the adhesive is too strong, they can use spray skin protectant one or two times and this creates a smoother surface so next time it's easier to remove. For right around the stoma where the barrier adhesive is, very smooth isn't very good and can cause leaks to occur more often. A rougher surface skin protectant application (like Coloplast PREP dabber bottle) is much more effective, gives paste and rings something to grab.
So here we go:
1: Skin must be absolutely clean and very dry, I use fresh pieces of toilet paper dabbing to remove any trace of moisture during my process then hand fanning for one minute before applying anything. Dirt, oil, greasy feeling (skin oils) must be removed from the surface. But the below skin surface needs to be nourished. Skin also has to be healthy and not too dry or cracked. Tools that can help:
A: Optional: For seriously bloody scabs like what occurs soon after surgery: That purple stuff called Medline Marathon (expensive) first as a skin protectant/scab creator then apply a sting/alcohol free paste as a barrier adhesive to create a smooth surface to bond to the flat wafer. Avoid using rings on uneven surfaces, belly folds, scar divots, grameolula etc. paste is better as long as it's not too thick. If you need to fill more space you should be looking at a convex wafer and/or curved wafer cutout pieces to bring the harder wafer material closer to the skin.. Also scabs tend to flake off often causing leaks. So wafer changes will be required more often until one gets that skin healed up. The less output hitting the skin, the sooner those scabs heal and the longer wafer wear times will be. Allow the pain to continue only makes things worse. Rip the bag off and sit in the shower if necessary to rinse output away so it's no longer being attacked by the digestive enzymes until the stoma is quiet enough to prep for a new wafer. Bleeding must be stopped before doing anything.
B: For cleaning and nursing the skin below the surface and pores. Oil free eye makeup remover (Neutrogena) available in cosmetics section used first BEFORE any water touched the area or it won't work as well if at all. Ensure that after cleaning with it that the area is washed 3 times with regular plain ivory type soap (not moisturizer soap) as to remove it (and any skin oils) completely from the top of the skin where adhesion occurs. Sometimes a very gentle scrubby on healthy skin (not on wounds) can assist in removing stuck old adhesive material and exfoliating the skin. A trick is to ensure both the skin around the stoma AND ONES FINGERS are absolutely squeaky clean when rubbed and kept that way until the wafer is successfully applied as one will be touching adhesives. Always maintain this squeaky clean state on both until one finished applying the wafer etc. it's because oils, water and dirt transfer and lessen adhesive effects when those areas are touched or the adhesive is. Without healthy nourished skin below the surface problems arise later when wafer is on like intense itching from dry skin caused by using alcohol. You want the pores below nourished and the skin surface absolutely clean, oil free and very dry. Alcohol cleans the pores of skin oils, doesn't nourish the skin and why it later causes itching.
B1: Optional. For leaky wet wounds (not bleeding) that won't stay dry use stoma powder one grain high just on the wound, brush off any excess leaving a scab of sorts then cover with a skin prep and allow to dry for one minute. Repeat with another layer again if necessary, this is called "crusting". Skin must be dry and free of grease or debris to achieve a good bond. Never use medication, ointments etc. not otosmy approved to work under the wafer as they interfere with bonding and cause leaks. Stoma powder is rarely used once the skin has healed up enough because very light skin burns can take just the skin protectant. The secret is to be able to change the water at the slight hint of a leak + combination of diet/food quantity (illeostomy) so one knows the effects and timing of what they consume so if the wafer/bag needs changing the stoma is quiet and not hampering efforts. Usually 4 oz or less of non diarrhea causing meals spaced out every 5 hours or so over 24 hours seems to work for an illeostomy. Gives more lull periods in between for wafer changes should a leak occur. And don't eat or drink anything before a wafer change obviously.
B2: Optional. For itchy skin fungus instead of using stoma powder, use an anti fungal foot powder instead and cover with skin prep just the same way. Should only need to use it once. After it's cured go back to using stoma powder because it's specifically designed for that purpose and works better than fungal powder at bonding.
C: For skin prep Coloplast PREP dabber bottle works great to protect the skin and create a rough surface for later superior bonding. Apply only to absolutely dry skin. Economical. However it contains alcohol and can sting wounds for a very short period. Allow 60 seconds (twice as long as instructed) to dry it out thoroughly. Alcohol use can dry out the skin below the surface, causing it to itch, why using the oil free eye makeup remover first to nourish it.
D: For larger areas and when one wants to slightly reduce the adhesion of wafer or barrier strips, spray skin protectant works as it creates a smoother surface that reduces bonding adhesion with each light spray coat. Be careful not to overdo it or the wafer detaches too easily as it creates a very smooth layer. However it can't be applied where alcohol based skin protectants (like PREP) already applied as they don't bond with each other. Issues with shipping so it might have to be delivered via ground delivery services.
D1: Optional. For filling voids under the wafer adhesive (like what occurs with a convex) that holds the wafer disk to the skin (not the under the disk itself) use cut barrier strips first to seal the skin (not under where the barrier adhesive or convex wafer will go!) as they are weak sideways and will fail if output hits them. Only use barrier adhesives like a paste or a ring right around the stoma about 1/3 of an inch around or so. Barrier strips are useful for this because if they are covering the skin then itchy mold doesn't form underneath unless there is an air gap above it which causes a very humid area where mold loves to grow in. So the object is to fill that empty void under the wafer adhesive portion (only) with cut barrier strips and if necessary paste creating a flatter more airtight surface.
D2: Optional. For covering sensitive scar tissue first use a skin protectant, allow 60 seconds to dry, then cover with paste if needed (small areas like belly button) to fill air gaps etc. then another small barrier strip floating over it then another full barrier strip holding the wafer down like normal. Paste won't grab the scar tissue as severely as a wafer adhesive or barrier strip (or tape) will. However it can weaken the hold in that area so reinforcement is required to grab solid skin on either side to compensate.
D3: Optional. For grameolula protection avoid using anything hard on top (like rings or wafer) or grabbing it (like wafer or barrier strips/tapes).. Paste on and around it, like on sensitive scar tissue, acts as a sealer, an air gap filler without grabbing it or irritating it enough. If it's no longer being irritated it might decrease and disappear on it's own like what occurred in my case where the belt was causing the wafer to dig into the skin. Why I don't use belts anymore and use barrier strips and better barrier adhesive bonding techniques. However in some cases a stoma nurse or doctor will have to address a grameolula if everything you've tried hasn't worked.
E: Barrier adhesives, for unevenness and scabs, or if time is an issue, paste is ideal however it can't be thicker than 1/8" or it will simply run when one stands up. So do not use it as a large thickness filler use a thin ring or cut strips from wafer cutout hole or a combination with convex wafer + thin paste to bring the solid wafer material closer to the skin surface like to fill belly folds. Alcohol paste will sting wounds for quite some time and dry them out casing itching. Alcohol free (pectin based) will not. For perfectly flat skin and time to mess around, rings will work as they take more adjusting to cover the skin around the stoma and heating/pressure to work. Paste sticks well to the skin (as long as it's clean and very dry) right out of the tube and doesn't need to be touched unlike a ring.. I apply my paste first to the skin to test adhesion as it should stick to the skin when coming out of the tube, if not I've done something wrong and need to remove and redo things. I've found using a used toilet paper cardboard tube pressed through the applied wafer around the stoma for 5 minutes ideal for excellent bonding of either. Note that rings too thick will run also in high heat environments, why I use cut wafer pieces instead as they don't melt like in hot climates, showers etc.The thinner the paste or ring material used under the wafer disk the better because it melts and runs. However when I use paste, I apply a thick one bead right around the stoma, and after ensuring it sticks, center and apply the wafer then hold it down using a toilet paper tube or similar for a good 5 minutes of steady even pressure. What this does is two things, it bonds better to the skin and it forms a bubble like ring of oozed out paste around (but do not cover the stoma hole) the stoma as seen through the bag. This oozed out ring alongside the stoma then hardens and swells with contact with output and creates a tight waterproof collar that keeps digestive enzymes from attacking the paste where it meets the skin. The stoma can handle some enzyme irritation as it produces mucus and renews itself, the object is not to allow plain bile (eat regularly unless it's time for a bag change) or high detergent like salts in the bile (more than 10% fat in foods) to irritate the stoma for long periods of time. Rinsing the bag out after every dump helps as well as trying to remain more upright so output drops to the bottom of the bag away from the stoma. It's by this method I'm getting upwards of 6-8 days or more out of a single one piece illeostomy ostomy wafer. It uses a very limited diet also to produce consistent slurry output free of chunks or high fats while providing energy and nutrition. The object is to reduce volume and strength of the bile (without using medications) so it just oozes out without a whole lot of output volume or too little of it that it's bile salt rich which is a detergent for food and adhesives. Of course proper nutrition and hydration is maintained with my diet and ORS to achieve this and still feel normal and healthy.
F: Wafer types. One needs to do a body check with an otosmy supplier to use the right type of wafer for their stoma and body contour. Also accurately measure their stoma and cut the wafer hole shape just a tiny hair bigger so it's covering the skin around it but not tight against it as it can swell a bit and pinch or hurt. Biggest misconception is stomas are always round, the guides are round but the cutting may be irregular to fit properly around the stoma. The wafer is pressing the barrier adhesive to the skin and if not there then weakness forms there and leaks occur prematurely. Test fit the old cut wafer backing material on the bare stoma to see if any changes occur before cutting the new wafer. The backing material can also be used as a guide to find low spots where the wafer adhesive forms air gaps, to fill with either paste or cut pieces of barrier strips. Any air gaps cause mold to form and intense itching and will undermine barrier adhesives and cause premature leaks. When wafer is applied press firmly through with a toilet paper tube for 5 minutes to get things to heat up and bond well. However with scabs this might not be possible yet, press gently and hold instead. Unfortunately more wafer changes are required with serious scabs as they flake off and leak so it's a matter of resealing it again to beat the output destructive effects. You don't want it to bleed again and again. Any bleeding must be stopped before applying anything as it won't bond. Always check your stoma size before cutting every wafer as it can suddenly change on you. I use the wafer backing from the last change to see if anything has changed with my stoma.
G: Barrier strips chiefly provide extra wafer adhesive adhesion all around and act as a blowout catch less the barrier adhesive fails. Blowouts are usually caused by poor barrier adhesive bonding in my experience. Typically only small tiny leaks start to occur which itch signalling a wafer change is needed as soon as the stoma is quieted down enough. However for exposed scar tissue outside the wafer area they can be used also to cover the scar (first use skin protectant and a tiny bit of scar lotion just on the scar) to aid in its protection and gradual healing and disappearing, takes months or even years.
When placing full barrier strips for supportive purposes around a round wafer, I've found a bottom first (slightly stretched) then a top application supports the wafer hold better than a left/right configuration. However if the ends of the top or bottom strip ends over sensitive scar tissue or belly button then it will cause weakness issues there for some reason. So first float a small strip over that area (with paste underneath if necessary to fill) before applying a final bottom and top for support. Although they sell curved barrier strips with a belly button extension, the problem is the weakness caused by a left and right barrier strip application process. A bottom then the top full barrier strip holds the wafer much more securly in my experience. I get less bottom and top leaks that way. Bottom usually is the one most occurring. Left over the belly button scar divot / belly fold next, used to get plenty of blowouts there until I figured out what the problem was. (belly fold + scar divot that needed to be filled with a solid)
H: Optional. For those with a separate mucus fistula (a stoma that outputs only mucus) a simple folded piece of toilet paper into quarters and secured along the top with a wide piece of waterproof tape works. Tear off the soiled pieces without removing the tape even. Clean the fistula first if required using a rounded coffee stir stick as sometimes there's a stuck ball of the stuff in there that needs a little help getting out. I like this approach better as a stoma cap creates a bulge under shirts etc.
I: For an illeostomy a proper diet is important along with drinking a watered down flavored oral rehydration solution with sugar (no sugar free as it contains artificial ingredients which causes issues) all day so the intestines can soak it up. Diet had to be medium proteins, low fat under 10% RSA per serving, decent carbs. Eating things like rice and pasta can soak up and slow digestion allowing better absorbtion time. No solid or hard pieces or things that won't digest completely like solid vegetables or greens despite how well chewed. Puree instead. If fats needed like what happens with zero fat meals, a little olive oil or half an soft avocado can provide a healthy fat too, as long as it's under 10% RDA or it causes too much barrier adhesive destroying and stoma irritating bile to be produced. Breads will often cause gas so one piece of sourdough toasted usually works to reduce that. Greens like salads often get stuck and more water is discharged trying to flush it out of ones body. An otosmy nutritionist can help by giving a list of what foods cause various issues with an illeostomy. However trial and error using small amounts and recording the results will help one narrow down what their system will tolerate. However eat nothing hard, like nuts, candies or tough parts of meats or vegetables, even baked potatoes or baked beans can catch one with a hard part. A wafer and the skin constricts the exit hole so it won't pass larger objects like an anus will. So eating stuff that fully digests in stomach acid is best. Meats, breads, fully cooked rice, mashed potatoes (without chunks or skins) and pasta works as well as pureed fruits and vegetables or juices/soups in small quantities. Skins of most fruits and vegetables do not digest. Dehydration and malnutrition are serious problems with an illeostomy so ensure ones diet is proper and getting ones RDA. I find ricotta cheese, white meat turkey hotdogs, European pasta, canned white meat chicken and some sort of low fat sauce (lemon or turkey gravy in small quantities) ideal as consistent source of protein and carbs, while low in fat, a little olive oil on sourdough for fat if needed. Liquid juices of fruits or veggies as needed. This is so far the best illeostomy meals I've found that produces the nicest output without problems, ample wafer changing periods while giving energy. As long as it's maintained and under 4 oz per serving every four to 6 hours or so over the 24 hour day.
These tips are from my own personal experience with a rather difficult stoma in a belly fold combined with a grameolula and a scar divot. It's been a royal pain in my arse for over two years but I'm finally enjoying very long wafer wear days (a record 8 days on the last one) when typically it's an average of 3 days with this type of stoma.
In no way are these tips considered medical advice and just my personal experience of what works from countless hours of trial and error. I think it's important to share this experience with others so others can learn. It doesn't mean it's complete or will 100% work in your situation as everyone is different. So take it as that and seek professional care to double check before doing anything.
Good luck.
