UOAA Discussion Board

I had a stroke in June of 2005 and as a result I only have use of my right hand and was looking for some help and suggestions on the easiest way to take care of my Ileostomy

Hi Kulipop
It looks like you had your stroke many years ago. Is the ileostomy new? I would assume that since the stroke was over 20 years ago that you have adapted to your limitations over the years. I'm an occupational therapist, and my advice would to find one in your area and get an assessment/evaluation done to determine the best approaches to help you be as independent as possible. A therapist that you can sit and converse with would be able to help you figure out the best techniques for your individual abilities. Some generic advice is that I could offer is to get pre-cut flanges/pouches. I know that Byram offers these for their Hollister products, but I'm not sure about other providers/companies. They do charge for the pre-cuts, but that is something that typically requires the use of both hands and would help with your current skill level. It would be helpful if you could provide some details on what aspects that you are struggling with that we might be able to brainstorm through on line. Hope that helps some.

David

If your ileostomy is oval or has an unusual shape (not round), then cut-to-fit wafers are typically the preferred option still unfortunately. Because if it doesn't fit almost snug all around, leaks occur much more frequently. Plus sometimes the stoma changes shape a little and you need to be able to adjust right away for that occurring which precut wafers don't have that option.

Perhaps using some sort of vise clamp mounted to a small table to be able to cut your wafer to your exact size?

Also I highly suggest, after removing a spent wafer and scaping off any residue barrier adhesive, is to use oil free eye makeup remover (cosmetics isle) to soak the skin around the stoma and clean off the remaining (often invisible) film and nourish the skin, use no water or anything else until you do this. Then once clean wash the area three times with water and a plain soap like Ivory. Ensure the skin and your fingers, is absolutely squeaky clean by rubbing, this the clue that's it's as clean as it's going to get. Keep your fingers squeaky clean until your wafer is fully applied, like don't touch your face etc. where more skin oils can get on your fingers then ruin adhesion.

Dry well of course and apply no other items under the wafer except stoma powder (a thin crust in wounds if needed) and Coloplast PREP dabber bottle skin prep as it creates a rougher surface for adhesive to bond well too.

When you apply your wafer, any barrier adhesive goes down first, rings will be difficult with only one hand, but a no sting paste would be easier one handed.

After the wafer is applied use a toilet paper tube to press through the wafer around the stoma for a good 5 minutes of steady, even pressure using the palm of your hand. Wait about a couple hours without moving afterwards has been my best experience, gives time for the paste to set up. I can actually feel the difference now, it's very slight though.

What this will all do is create an extremely secure barrier adhesive bond to the skin and with light rinsing with a hand held bidet, you can get extremely long bag wear days. Less bag changes means less effort and if you need assistance anyways, less times they will have to do it for you.

I now get anywhere from 6-10 days out of my one piece and I have a belly fold, a grameolula and a chest scar divot to deal with as well, but I've adapted to all those and I'm positive you will overcome your challenges as well.

There is another possibility, there is a company that is experimenting with more longer lasting wafers that are 3D printed to match your body contour held in place with medical grade silicon much like a prosthetic so all you have to do is use the bag portion which might be easier for you.

https://www.odapt.org/

I wish you well and hang in there.

Oh I should add using a two piece would likely be much easier than trying to rinse out a one piece.

Coloplast SenSura Mio Click Maxi Drainable Pouch

What's nice about this is although the locking mechanism is a little harder, it's much safer than the Hollister because in my experience those come apart much more frequently.

Also the Coloplast uses Velcro for the drain-able portion which can be opened and closed with one hand verses the Hollister clips which often fall into the toilet using two hands.

The next challenge would be designing some sort of weighted holder to hold the pouch steady while cutting the wafer hole, but be able to rotate it so you can cut again etc. not a problem if you have a round stoma, just get precut wafers.

So the rinsing routine would be to remove the soiled bag, place in a container, wipe and use a clean bag then wash the soiled bag and hang it up to dry.

You might want to explore a hand held bidet a plumber or handyman can put on your toilet, then attach a pointed plastic cone to the front of it that after dumping you pry open the end of the pouch, keep it somehow from closing and stick the cone inside and rinse the bag out. Although nurses can tell you you can avoid rinsing, the bag will stink up the neighborhood if contents are left to rot further in there, so I rinse every time usually unless it's very watery output.

Biggest obstacle is making sure your diet is completely under control so you can time when there's a stoma output lull period as you will likely need more time. Precutting your wafer before removing the old one is advised. You could even put the paste around the wafer hole first also, not skin first.

Thing with skin first barrier adhesive application is you can test if it's sticking well to the skin before wasting a wafer, remove and fix the barrier adhesive only and try again instead of cutting another wafer while your stoma is exposed to mess up your world.

However if you have your technique and routine down pact then putting the paste on the wafer first is the quicker option.

I'll keep thinking it out for you.


Good luck.

Okay!

I designed you a hardware store holder for your otosmy wafer that any competent handyman can put together for you.

A four or six inch PVC pipe long enough to fit between your legs and hold securely

On top of that is a round (maybe square) board of 3/4" plywood with a four inch hole cut in its center. It's secured to the top of the pipe with an round insert connected to the board underneath.

There are two thin metal bar clamps that have bolts and butterfly nuts, they swing over the sides of the wafer and then tighten down to hold it firmly in place.

The thin bar clamps (just thin rounded edge metal bars with holes in them, like used in fencing) should be long enough to extend past the wafer in case later they wear out (bent a little) and you have to use two butterfly bolts. But you could also flip the bar clamps over too.

The object is you start cutting, you release the pipe between your legs and rotate it, secure it with your legs and cut some more and so forth

Cheap and easy.