Help! Blowouts while sleeping!

Hi,

So I have a temp ileostomy (2 mos. into it now); most of the time I can cope. I wake up at least once per night and have to empty the bag and have not slept 8 hours in a row since coming home from the hospital. Usually nothing bad happens.

But sometimes -- I wake up in the middle of the night with thick output clogging up the flange area around the stoma, which makes everything blow out the sides of the surrounding tape. Yesterday morning I woke up at 4 am, not much output, went back to bed and at 7 am I woke up with a blowout. This morning I got up at 2 am and there was hardly anything in the bag, not worth emptying. Went back to bed, then woke up at about 3:30 with a blowout. Two nights in a row! Luckily this morning my DH got up and helped me, and I had to just end up taking a shower and us getting ready for work an hour early (our alarm goes off at 4:30).

Here's some stuff my dietitian suggested, can you all verify this or tell me anything different? Eat more carbs in the beginning of the day. Eat only protein and fats at the end of the day. The reason is to get the bulky output done with (the carbs) and the protein and fats take longer to digest so I guess that would not have much output at all overnight. And, eat dinner pretty early (maybe even 3:00 pm), with no evening snacks, so everything gets out of me in time for bed. Also the doc said to take walks after dinner because everything moves faster with exercise. I walk at lunchtime with my DH already, but guess that's too early?

I can't really point to anything specific that I'd eaten that makes this happen, but *it seems* like if I ate a lot of potatoes for dinner, or ate lots of chips (crisps) during the afternoon (yeah I know, shouldn't do that anyway) it's happened. Last night I had a half of a chicken enchilada which I guess had lots of fiber (tortilla) and probably beans.  But I have eaten bean soup for dinner without any problems.

I'm thinking also that maybe I don't drink enough liquids so that the output is too thick? Except that I thought the thin output would mean that you are dehydrated?

And, it doesn't seem like it would be an issue with the hardware setup I'm using. I have the two-piece thingy with a cut to fit wafer (so far until I try the pre-sized one), a small amount of powder for a raw spot which isn't very severe, either some Adapt paste around the hole in the wafer or one of those Adapt rings sized the same as the hole. Nothing special at all.

Ugh!!! Help please...

Oh, so far I haven't heard of a bigger bag, at least I haven't seen one from Hollister. Where do you get them? But it's not the bag itself that is blowing out, it is from around the sides of the wafer. I will sometimes get a lot of gas at night too; it seems like the bag is full but most of it is gas. But what happens is, the output gets stuck in the round flange space around the stoma, it won't fall down into the bag. It seems like the output is fairly "solid" so it doesn't move. It sticks inside the flange, and I guess because it gets stuck there and can't go anywhere then it starts leaking down through the space between the stoma and my skin and then out through the sides. I have made sure that the hole in the wafer is pretty close to the stoma without touching it, and making sure that the paste or barrier ring is either touching or very close to the stoma all the way round. Just to try to minimize the space that leaks could happen in. One thing I do when I'm awake, is check around the stoma from time to time, just checking the little rubber knobs that are around the hole of the wafer from the outside of the bag. If I can feel them then I know there's nothing building up in there. I couldn't feel them last night, and being sleepy and lazy, I just thought, OK, I'll just change the bag in the morning. Well, yeah, I changed the bag in the morning all right, and a whole lot more!

I "finally" can sleep on my side (thankfully!!! I was soooo uncomfortable sleeping on my back until the surgery healed!) and thought if I slept on my right side, it would let the bag hang downward so stuff could fall down in the bag. But unfortunately that hasn't worked very well!

Juice or ~wine~ speeds up the transit time huh? Hmmmm, might have to try the last choice haha! How long does it take to get the output if you drink either one of those?

My ostomy was always quite liquid, so I didn't experience that - but apparently "pancaking" is quite common, and yes, drinking grape juice, wine, or Apple juice can help thin it so it falls to the bottom of your bag better. (Oh, and don't forget that you can swivel two-piece bags to go down your right hip if you do choose to sleep on your back.)
My only other experience to share is to maybe try the moldable wafers. I haven't heard of anyone who tried them who went back to cut-to-size. You just roll the waxy stuff back and it unroll till it fits your stoma like a turtleneck. In my opinion, much easier and more secure. Just some thoughts. Good luck!

Well, it just *almost* happened again, this afternoon!!! I was coming home from work, had to stop at the store, and when I got home and changed clothes I could see that the output was heading toward the outside edge of the wafer, just ready to break through in a minute! I got all my equipment ready and took off the wafer. Again, the output was all stuck up around the inside of the flange, not having had a chance to travel down into the bag. And it was breakfast (I could tell) which I'd eaten about 8 hours before. Lunch has yet to appear I guess. Here's something else I've realized. I have one of those Stoma Guard belts (a plastic bridge over the stoma so you can wear fitting pants without squashing things) which I've been wearing to work. I sit all day at work (IT professional) and sitting for 45 more minutes driving home is NOT doing me any good. The 90 degree angle of my leg to the bottom of the stoma guard keeps all the crap stuck up around the wafer. It does work well if I'm standing up all the time like going out shopping etc. So this is in addition to it happening when I'm sleeping! So OK. Guess I'll be wearing leggings for the next four months. Ugh.

I'll check out the Hollister version of the Brava Strip tape that goes around the flange. I have some Flextend wafer samples which I will try, they're supposed to hold up longer. I have tried the Adapt rings which you can get up right close to the stoma so I could make a turtleneck out of one of those and try that. Sounds good.

I got some cranberry juice and wine at the store. I'm trying to drink more liquids during the day, and have tea at night sometimes too. Tonight it's gonna be a glass of wine (and a chocolate dessert, haha). I'll check out the grape juice also. It's gonna be too late to eat before 6 this evening though.

Also when I took off the wafer the stoma was bleeding somewhat. I know it's very common to have a little spot or so but this was a little more.

And -- If your output is thick that's supposed to be good, meaning you're not dehydrated, right? Well, how can I stay hydrated enough and not have the output be thick?

Phew. Got through last night without a problem. One thing I meant to mention is -- the blowout three nights ago was actually with a bag with a gas filter. So it didn't seem like gas would have been "forcing" the blowout. In fact I thought (probably erroneously) that actually having gas would sort of blow the output away from the flange area and down toward the bag more. Anyway so last night, I had a hot dog, a few fries (chips), the dessert, a glass of wine, and one of those flavored vitamin water drinks. I think that I may have not been drinking enough of any liquid lately especially in the evening. I woke up at 10:30 (went to bed around 7:45 - 8:00, I was tired!) and just small liquidy output. Again at 2:30 and the same. But my stomach was really hurting (gas?) so I got up and drank some cranberry juice with the hope that the juice would force some output, including gas. Still had pain this morning, but more output, so I'm pretty sure there was no obstruction. I can't say that drinking the wine helped with transit time or not. But drinking that plus the vitamin water specifically in the evening, may have thinned things up overnight. It's so hard to tell!

Also about the Stoma Guard belt -- I think I'll be OK with wearing it; it's just that you really have to monitor it to make sure everything is falling down like it's supposed to. My drive home plus time in the store didn't allow me to check things so that was pretty much my bad.

Yes I was wondering about a convex wafer or insert or barrier ring, whatever... thought that since there's an indentation all the way around where the stoma comes out, that might be a place where the output would collect and if a convex thing would flatten out the area, that might help?

It was just something I read that said if you have a lot of watery output you're probably getting dehydrated... and not sure where I heard that the thicker output would mean that you're not dehydrated. But of course, it seems like if it's too thick you do need more water! So much information that it gets confusing after a while... :(

I think from the sound of your output being that thick that you are not drinking enough. True you ideally don't want output like water but the aim should be sort of porridge like, thickish but able to move on it's own down the bag. My go to drink if I need to make output thinner (not usually my issue as have short bowel syndrome and need 10mg immodium four times a day) is tomato juice.

The mouldable collar flanges as mentioned are superb. I use convatec ones and have for ages and wouldn't change back to normal ones.

As for the stoma guard. Never used them. I wear tight skinny jeans and have a tight leather and suede skirt and they don't impede the output or squash the stoma. As long as the jeans have some stretch in them, very rare to find tight jeans without it nowadays, you should be okay as long as you get your output a bit runnier.

I'm happy to hear that adjusting your diet is working for you. This is all very frustrating, and yes all trial and error.

Those side bags, I can't remember if anyone here wears those. I've seen their advertisements, and can't seem to wrap my brain around emptying sideways. They do seem cool, if you are into athletics and swimming, they would seem transparent.

Although I believe that water would compromise the seal, there are so many members here that swim daily, live in very humid climates, shower daily, and they get a weeks wear.

With that said, and along with not having leaks due to our diet, having the right appliance could be the answer. You are also 2 months out, things are still changing and it takes some months for their body to adjust. Whether bulky stool or dh, which they would take imodium or lomotil.

Once I switched to my regime that I has been successful for me for the last 4 years, this has not been a problem. Once, I changed my appliance the night before, had thick stool in the morning, and with that compiled with the bag's filter, it leaked. The filters for some, they believe, contributes to this pancaking issue. Expelling gas directly over the stoma, causing the bag to get stuck, affluent can't move, and it pushes under. I use a convex wafer, used to combine a dollop of paste in my divots, apply the Eakin seal and wafer. I experimented without the paste, and the Eakin seal was sustainable. For me, I must wear a ostomy belt. Without it, I get 4 days. With it, I get 7/8 days. I've stopped tweaking my diet in the evening, but sometimes the gas in the bag ballooning wakes me up and I have to expel. But no leaks. The Eakin seal/belt/convexity combo provides me a tight seal, whether my output is liquid or solid as a rock.

As the other member suggested, try pushing your affluent down. Sitting for long periods, the cars seat belt, tight clothing, can weaken your seal, used to for me. My problem is my stoma placement. It is not placed correctly, it is directly next to my naval. My clothing had been a problem ever since because too low cuts off the bag and it balloons on the top, and waisted clothing presses right there. I need super high waisted, which is not the style and hard to find because we're not in the 80's anymore.

One suggestion I have for you, in addition to the appliances and set up above, is a product called SureSeal. It is like tagaderm. It is a 1 piece bandage/tape with a whole in the middle for placement around the adhesive paper of the wafer. It's hard to apply in it's 1 piece, so I cut it in half. This stuff is fort knocks because your protecting the paper. It's used for swimming because it's waterproof, exercising, daily use...and for containing a leak. It has saved many, many people. One ostomate here, referred this product to so many from members here and from her support group, she laughs and states she should get proceeds from her referral. Call/email for samples and or purchase on his website. It was developed by an ostomate, here in Illinois. It took me a long time to get my free samples (2), so I would suggest buying some. This could be a real game changer for you!!

I shower every day and also swim and use hot tub regularly and get a week from one flange. I don't use a hairdryer to dry the seal afterwards as think this weakens the seal if you keep heating and cooling it when it is wet. Instead, I wrap a towel around the bag and wafer after I get out of shower/bath and this takes away majority of water. We don't have sure seal in UK. I know because when I saw it mentioned few years ago and tried to get it but not available over here, which is a shame.

Not sure how the turtle neck cutting of the barrier ring will work as the convatec flanges are able to stretch and move with the stoma but worth a go and unless hollister have changed their products then I don't think they do a similar version but check out their website. You could always just get convatec to send you some samples to try. I just went onto their website and picked what I wanted to try and they sent me about 5 flanges and bags to try. I have stuck with convatec for nearly 23 years, occasionally will have a look around and see what else is out there but never found anything nearly as comfortable for me.

The twisting bags are ones where they have a clip that you tighten to set it in place and loosen it so you can spin it round on the flange.

Glad you are finding something that is helping. My jeans aren't very stretchy but just normal skinny ones and the skinny type always have elastene/lycra in them.

Here's a video of the convatec moldable. For me, they were really great. And I think it's quite different from building up a turtleneck with a seal.
See what you think...
http://youtu.be/b8k3Iex-it0
(If that link doesn't work, you can just google convatec moldable, the video comes up early. Oh, and I understand Hollister has a version as well.

Good morning y'all! Another nice night without a blowout...except that wasn't too hard to do since I hardly slept at all. :(

I'm happy to get so many useful replies! Thank you for all of this!

So... you all have mentioned a few products that I haven't heard of yet. Which I will Google and probably add to my arsenal! But here's what else I'm trying this week: I don't know if any of you have heard of this, it's called Enzymatic Rain. It's a spray liquid that kills odors, cleans the stoma area, and emulsifies output. So the last couple of days (and nights) I've been pouring about a teaspoonful into the bag after I empty it and smush it around in the bag to distribute it. That way if I do have a thicker output it'll break it down and liquify it, sort of beating things to the punch. (I've been trying the Adapt lubricant/deodorant packets also but I don't think it emulsifies output.) That's in addition to a glass of wine, extra liquids in the evening, and more water & coffee during the day, plus not snacking a lot on bulk-producing carbs.

Yes, I do monitor the flange regularly -- I've been running my fingers around the inside of the flange just through the top of the bag and if I can't feel the little rubber knobs that are around the hole in the wafer, I'll sort of push the stuff down to the bottom of the flange and into the bag. But I can't do that while I'm sleeping, haha!

The wafers with the built-in barrier ring that a few of you have mentioned, are available from Hollister. But the customer rep that I spoke to said that in my case I'd probably want to keep using a stiff wafer, pre-cut to size, because they hold up a bit better than the ones that have the built-in softer barrier ring. I have just used the first of the Flextend wafer samples but yeah they are the ones you have to trim. Once I get through these, the last of my present stock of wafers, I will definitely get something else! Oh, and also, I have a few bag samples that have the filter and you're right, I think they create a "dangerous" vacuum seal!!! So I put a piece of tape over the filter and that allowed the gas to build up. I don't get much gas during the daytime, just at night. But if that helps that's OK with me! I've had a blowout with a gas filter bag (one of the times last weekend) before I thought of the tape, and I pretty much figured out what you said about how that hinders the flow.

So today I'm trying an experiment. First off I showered without Press&Sealing over the bag. I towel dried it all but used the cool setting on the hair dryer (just a couple of short fast waves of the warm setting to get things started) to get it dried "enough". Also, I'm wearing some tight pants (as usual) which are "kind of" stretchy but no stoma guard belt. I figured that since I'm awake and monitoring things like I usually do, plus the fact that the output is pretty liquid for the most part during the day, I should be good to go. And I have extra supplies at work just in case (which happened my first day back to work after recovery!!! How awful is that!!!). And I have begun to wear the ostomy belt. I haven't tried it at night yet but I will. Wow!!! So much I never wanted to know about ostomies!!! I know you all are saying the same thing... but hey! Good thing they invented them!

Swordswoman, how did it go wearing the trousers without the stoma guard - any problems?

fdsmith, just checking - are you saying you're fed up with your stoma or the fact that some people give their stomas names?

Glad you are having some success. I use bags that the separate clip as can't stand the ones that have it built in. To stop the bag hanging down,bear with me - you have to use imagination, I fold the end of the bag with the clip into top of my knickers. I wear the bikini brief ones or shorts type ones. Due to placement of stoma the top edge of the knickers sits just below the bottom of the flange. Then I take the clip end of the bag and fold it towards my body and slide clip so it is just being held up by knickers. So the clip is same place as bottom of flange and then bag is sort of folded in half hanging down outside of knickers. This means there is less weight on flange as it has two places of support and also bag isn't hanging down my leg which is a pain when you sit down. This way all in much smaller area. Yes it means I empty bag more often but as I have a high output stoma anyway I tend to empty every 60-90 mins when I'm at work so it never gets too full.

Glad I'm not only one who does it! I was lucky in that the stoma has always been well positioned even when it has been moved 3 times, my previous surgeon always made sure it was in sensible place in relation to waist bands and clothing. Only thing I can't wear a really low slung jeans as they cut bag in two and find them really uncomfortable.