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Skin irritation under flange

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Posted 1/28/2013 8:09 AM (GMT 0)
Hello all. I had my surgery in November 2012, and I was given Hollister products and Eakin seals in the hospital. I've continued to use them mostly out of convenience. However, in recent weeks I've noticed increasing problems with adhesion and leakage, which has resulted in a series of emergency changes. I find with emergency changes, I can't pay the kind of attention I need to to the skin surrounding the stoma (i.e. the stoma is more active than I'd like so while I'm doing the change I'm battling all kinds of spurting and drooling), so probably there is adhesive residue and all kinds of nasty things remaining. I'm as diligent as I can be, but frankly when I'm doing emergency changes every couple of days, I get frustrated and pissed off with the whole procedure.

Anyway, today with my latest leak (after applying a brand new works yesterday) I came up with a pretty serious skin irritation. I saw the stoma nurse yesterday and he suggested I try an adhesive wipe, which I did after my SECOND change yesterday (holy crap what a day), and I think that wipe was a really bad idea.

So, my question is, what do I do about this? It seems to be a vicious cycle: I come up leaking so I change it in emergency fashion, then the skin seems to be resisting the adhesive and now it's got like a painful diaper rash, but I don't know how to treat that and make it go away so the thing will adhere properly and not leak, therefore not causing leak-rash. Argh! I'm so frustrated. The only thing keeping me sane right now is the thought that a) I feel so much better than I did before my surgery and b) this is NOT forever. However, in the here and now, I need a solution. Your wisdom and suggestions are welcome! Thank you.
Posted 1/28/2013 3:59 PM (GMT 0)
Unfortunately, there is no simple answer. It is all trial and error. Some questions and suggestions:

1. Have you measured your stoma recently to see if there has been a change?
2. Try eating marshmallows (2-3 large) before a change. This helps to stop the output temporarily.
3. You may need to switch products. Call all the companies and get samples of everything. Explain the trouble you are having and they will recommend products to help. Coloplast, Convatec and Hollister are the big ones.
4. A skin barrier like the 3M one can also help.
5. Perhaps you need a convex flange? Is your belly flat-ish and does your stoma protrude well? If not, you may need convex.

I know how frustrating it can be. I went through tons of products before I found a good system, and now I have a new stoma and am battling all over again.
Posted 1/31/2013 4:31 AM (GMT 0)
kc70 - I second what mom2panda said..also, bumping this up others can chime in...

Also, woudln't worry too much about adhesive left on the skin..i get that all the time...but, you definitely want to clean and dry the skin..no soaps with moisturizers..I use dial soap with NO moisturizers (the liquid soap in a bottle).

Also, as mom2p said, double check your stoma size...

Also, if your wafer "cut-to-fit" or "pre-cut?"

Keep us posted!
Posted 1/31/2013 2:36 PM (GMT 0)
You need to see a better stoma nurse. Having adhesive left on doesn't ever seem to cause leakage. It seems your system needs improvement. good ideas above - including remeasuring your stoma, convex appliance, etc.

If you are having skin irritation that MUST be dealt with. Or it will just keep getting worse. For now, temporarily I would suggest you clean as others have suggested, apply stoma powder over where the skin is irritated, blow it off, dab on a barrier wipe just where the powder is, and repeat that process three times. This will give you a crusty like surface over your irritated skin. Then carry on with putting everything else on.

Also.. if you have had to make an emergency change.. such as if you are not at home. When you get home, do a full proper change.
If you are at home and the stoma is being active.. use about 1/4piece of paper towel or a washcloth and keep that thing covered while you are cleaning your skin, etc.. Have your wafers pre-cut and everything lined up ready to go so you can change quickly.
good luck.
Posted 1/31/2013 3:50 PM (GMT 0)
I echo the above suggestions...the only improvement I would add is we much prefer the spray pump Smith and Nephew skin barrier prep...especially if you need to apply powder..the spray goes over the powder instead of trying to dab on the pads and taking powder off in the process

Silly us...when he had a skin irritation we dabbed on the skin prep then the powder not understanding and realizing we were providing a barrier to the powder being able to help and work on the skin itself.

You do need to apply a very thin amount of powder and have the excess kind of blown off then the skin prep.

An extra pair of hands will help if possible to assist you lying down...hubby uses a clear plastic top from my mousse to contain any possible discharge from the stoma when he gets out of the shower when ready to apply a new wafer. When I assisted hubby with skin irritations like that we would have a big bath towel on the underside of him on the bed, a wet and dry washcloth handy.

Some people who have had a tough skin problem will also use the duoderm(?) applied to clean skin to promote healing and place the wafer over that? Not sure how to do that but someone may chime in.

Sorry you are experiencing this as this situation is frustrating for sure and needs to be cleared up for the wafer to properly adhere.
Posted 1/31/2013 4:03 PM (GMT 0)
Hi all, thanks for your replies.

As of today, it seems things are better. My latest change is holding, the skin isn't nearly as irritated. I did the crusting technique last time I changed, and that seems to have helped quite a bit. I've done it before, but only for very minor irritation right next to the stoma. It didn't occur to me to use the crusting on a larger patch of irritation.

ddd45: To give my stoma nurse the benefit of the doubt: he was only trying to help, I think. There wasn't much he could give me so he made a couple of suggestions. Unfortunately they didn't work! Also, I haven't yet had to make a change outside of home or my boyfriend's house (knock on wood!), so I've been able to have a supply of paper and so on available.

Anyway I think things are improving. My stoma size is pretty static, and the pre-cut flanges are fitting fine. It is also protruding pretty well.

Again, thanks for the responses! This whole thing is such a big adjustment. Two steps forward, one step back.
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