Help! How to get a good seal...?

I was almost in tears today from frustration....

I've never had a full-on leak, but it seems no matter what I do, output seems to seep under the edge of the flange, causing irritation, ulceration, bleeding (and pain!) around my stoma. I didn't even shower this time around because once I saw the open sores, I knew the water would sting like a mother.

I have a loop ileo, so I know those are a little tougher to work with as they tend to retract a bit more....

I've tried paste, regular convex wafers, and moldable convex wafers. I've heard of Eaken rings, but don't think it's worth it to try to order any since my take-down is less than a month away... by the time they got here I wouldn't have much time to use them. Though I could try to find a medical supply store to see what's available locally.

Lately I've been trying to get a tighter and tighter fit around my stoma to try to prevent the seepage, but I'm worried that I'm damaging my stoma, and it doesn't seem to be working anyway. I've heard from some people we're supposed to leave a gap between edge of wafer and stoma (which doesn't make sense to me since that would leave exposed skin?), and others say a tight, turtleneck fit. What works best to prevent output from seeping under?

The consistency of my output varies a lot within 24-hours from super thick sludge to super runny. I know it would be helpful to try and adjust my diet to maintain a thicker, less liquidy output, but I'm not sure which foods cause what, and that's not always reliable anyway. I've already started drinking less water with my food. Maybe I should make sure to take Metamucil twice a day to try to keep it more formed.

One of the most frustrating parts is not being able to see or tell when it starts seeping. This last round it still LOOKED like a tight fit, but I felt some itching and pain, so when I changed my bag of course there was seepage and more ulceration. I think I'm going to have to just start changing every other day, which I've been trying to avoid since removing that fresh of a wafer causes a lot of irritation to my skin when I pull the firm adhesive ring off.

I have ordered Friar's and am waiting for it to arrive in the mail. Hoping it will solve my problem.

*sigh* Thanks. Maybe I just needed to vent.

If Larasmom's suggestion doesn't work you need to see a wound nurse asap. They can help!!!! If you touch the stoma it will always bleed a little - it's nothing to worry about.

Would convexity help at all?? Plus the moldable type wafer???

Not familiar with loop ileos so not sure if those suggestions are any good. Obviously cutting the hole to be the right size is important and making sure the wafer is adhering to very dry surface for the best adhesion. It's hard when the skin has issues as that makes it even tougher to contend with.

I do hope it straightens out soon for you.

Thanks for the advice, everyone. I will try calling in for some samples of some Eakin rings tomorrow.

UC wife - I am using convex moldable wafers already. They were recommended by my stoma nurse since I have a loop ileo that doesn't stick out very far.

Everyone else - do you agree that's what I should be using? It actually seems to be helping and hurting at the same time - the convexity is good to try to keep my stoma pushed through the hole, but since I still spend a good amount of my day lounging around, output just pools up and sits in the little "dish" around my stoma created by the convexity of the wafer.

My stoma is so little now (right around 7/8"), that I don't even really fold the molded part back hardly at all anymore since the ones I have start at 7/8".

ddd45 - I know you're quite experienced with stomas, so I'll take your word for it on the gap issue. I have heard of that powder/wipe technique before but I guess didn't realize exactly what it was for. I will try that on my next change while I'm waiting for supplies.

Other than that, I'll just start changing more frequently.

*Whew* Wish me luck. Looking forward to my take-down so I can be done with this stoma/bag business!

okay, here is my input as i am too dealing with a tiny loop ileo until my surgery about the same time as yours.
i have had to switch to convex wafers. i use a 1 piece and i love it! *i used to be a 2 piece girl, but i've been converted.
i found the same thing happening to me.
no matter what i do, i rarely have thick output. it's most liquid all day and night.
i sit and lounge as well and yes it pools there, but if you stand up every now and then and lean over and move it down to the bottom you should be fine.
i also have a red ring around my stoma from ulceration and raw skin. worse just under it. my loop ileo has the hole pointing down like right next to my belly. almost like its a hose resting on my skin pointing down where as my end ileo pointed straight out and away from my body.
stupid loop!
my stoma nurse and all the ostomy peeps over here on the gold coast (i know because i talk to them a lot since i am on the gold coast ostomy association committee) say that the best thing to do is STOP USING ANYTHING BUT THE APPLIANCE.
let me repeat that in case you missed it (i know everyone will disagree) but stop using anything but your appliance. i thought i had to use rings and seals and paste but i still had leakage and raw skin. nothing was working. so, a third time....
no rings, no paste, no powder, no wipes, no barriers, no nothing *except adhesive remover (because i change every day). i did this and my skin cleared up so fast it was incredible and i had bad raw skin too (even bleeding)!

the other thing i have to do with my loop ileo is CHANGE EVERY DAY.
no matter what, i change it every morning.
my skin is doing so much better now. no stinging. no itching. no irritation. still looks a bit red like a ring around my stoma but i can tell its better and that is just red skin nothing raw and open.
if i go 2 days, nope, im all messed up and skin is open and weeping and it hurts.
if i stay on track of changing every day im good to go.
the only thing i use is an adhesive remover to take off the wafer, then i wipe my stoma and skin with a wet chux cloth and then i fan my skin dry with the wafer, remove the backing and stick it on.
takes all of 3-4 minutes total.
the hole i cut is maybe 1mm bigger than my stoma. thats it.

we are in the same place with our stomas etc... so maybe give it a go and see how you do?

My husband's skin is fine and has been....the only thing he does before putting on the actual wafer is....be sure the skin is totally dry and he sprays on the Smith and Nephew Skin Barrier spray all around the stoma (uses a plastic cap over the stoma when he sprays) dries the skin on cool with a blow dryer and then slaps on the wafer.

He had a leak surprisingly start a week or so ago...changed immediately and there already was a little red at the bottom of the wafer. He applied the stomahesive powder for 2 changes and it is gone.

He has a perm ileostomy but when he cuts the opening to be a little larger than the precut size of the wafer it is fairly snug with just a little extra not much so when the stoma does its job it is not too tight or restrictive but not so much extra that you see skin.

"Dancing Stoma" made me chuckle and gave me a humorous visual...lol...

if you haven't named her, she should have some famous dancer's name I think. (Are you young enough to remember the song "Little Egypt"?

here's a link FYI....lol

http://www.youtube.com/watch?v=3rRmrOTB1qU

Post Edited (Another UC wife) : 11/14/2012 4:39:23 PM (GMT-7)

Oh wow...a dancing stoma. Never would have thought about that. I have noticed that my stoma will sometimes move in an out a little, but it sounds like your moves around alot! Good luck with the new system!

And thanks for clarifying the 1/8 inch question.

I have never used any adhesive remover... only alcohol swabs to get the tape up, but nothing on the hard ring where the problem has been happening. The only thing I ever use around my stoma (aside from water) is barrier wipes and powder. And yes, I always make sure everything is really dry before attaching the wafer.

Well I changed it out today (two days after this original post), and it already looked better just because I hit it up sooner. (Used to go more like four days in between changes.) Still waiting on supplies to arrive, so still had to use the moldable wafer, but I didn't make it quite so tight this time, and I tried to use the powder/barrier layering technique a little just because I know that the moldable won't hold a good seal for me and wanted to have some other layer of protection in place for if/when output seeps under. Will let you know how the eakin rings work out when they arrive...

Might also try kazygirl's "naked appliance" method (which is what I started with when I came home from the hospital, by the way). I think I started having issues when I switched to the modables, so once I go back to pre-cut I may be able to get away with using nothing but the appliance, as long as no skin is exposed. We'll see...

Yes, also looking forward to trying out the Friar's, if it ever arrives! Took like a week just to get the notice saying it had been shipped... now I have to wait for it to get here from Canada.