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Sudden leakage issues with ostomy

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Posted 1/5/2018 3:11 AM (GMT 0)
I’ve had an ilestomy for eight months, since step one of a three-step j-pouch surgery plan. Overall, managing the ostomy has been really low maintenance. I usually change it twice a week and haven’t had any leaking or skin issues. However, in the past few weeks, something has changed. I’ve had three times where the seal has ruptured and everything has come bursting out ... always in public, too, which adds to the fun! I thought I narrowed the issue down to the jeans I was wearing. I thought the waistband was too tight and flattening the ostomy too much, causing bulging pressure and eventually bursting. So no more jeans. But now I’ve had two or three leaking issues in the past week. I’ll get a horrible itchy sensation, and when I change my pouch, I’ll find that feces has leaked past the barrier ring to cause the itching.
So, my question is, what has changed? Or what do I need to do to stop this from happening?
I use the Coloplast Brava protective seal ring, and the Coloplast Sensura Mio two-piece. I cut the water opening myself, and at first I thought a smaller opening might help, but it doesn’t seem to be solving the problem.
I use a skin barrier wipe and an adhesive remover wipe. The skin is a little red, but not angry red, and not weepy.
Any ideas?
Posted 1/5/2018 4:40 AM (GMT 0)
Kanva,

Is your stoma above skin level? Is your output thick? Have you increased your liquid intake? What kinds of foods are you eating?

I have a colostomy. So a little different...but the Mio gives me issues whenever my output is not mostly liquid. I even tried the convex on the mio and that didn't help much. I switched to the brown wide opening click it and so have both the flat and convex. I also use the moldable Convatec flat wafers. I don't like any of them as much as the mio...but the mio seems to give me lots of problems.

Hang in there!

Clo
Posted 1/5/2018 5:32 AM (GMT 0)
I agree with trying the convex waffer.

Have you tried the Bravo protective sheets? They really helped when I had my loop ileo and I had skin issues.
Posted 1/5/2018 3:22 PM (GMT 0)
Hi Kanva,
Has your ostomy changed much in appearance? Has it become retracted where it has sunken in more and has become more flush with the skin?? These changes can cause the output to get under the wafer and cause blow outs and leaking. I know about this as that was my situation.


If this is what is happening, I too would recommend using a convex wafer.
I use the Coloplast Sensura Mio 1 piece SOFT convex item# 16705. This is Soft and doesn't put excessive pressure around your ostomy. I have used the LIGHT convex.....but the SOFT convex I find is better for me.

You use the 2 piece.....would you consider trying the 1 piece?
The one piece has an inspection window so you can see what is going on with your ostomy by lifting up the flap to the window.
My ostomy nurse made a wonderful suggestion which helps immensely in using the 1 piece system.

You can do this in advance and at the same time cut your wafer to size. I usually do about 5 at a time so the day of my ostomy change I don't have to fuss with these extra steps.

Ok.....here goes....
Take the inspection window and lift the flap.
At this point you can visualize your cut out for your ostomy.
Take your scissors and make 2 linear cuts..one on each side of the hole for your stoma.
You will then have a flap you can temporarily tape up with some HYPAFIX tape ( a small piece ).
You now can apply your wafer and be able to visualize its placement around your stoma.

Once on, I remove the tape. The inspection window is back down. I find I don't need the inspection window so I then apply Zino Pink tape over the whole area which also covers and seals the 2 slits.

Another recommendation made by my ostomy nurse was to use Paste.
I know a lot of people HATE the paste.....but I will tell you it is working for me.
I use adapt paste ( hollister) or convatec Stomahesive paste. The convatec paste does get a little less tacky after say 15-20 seconds or so .Some find it easier to use.
I will however say I am doing great with the Adapt paste.

Anyway apply the paste around the hole on the wafer before applying to you skin/ostomy.
The paste actually conforms and fills in any depressions or divits around your ostomy......so no leaks!

If none of these suggestions help, seek out an ostomy nurse in your area. They are always soooo helpful as every patients needs are different.

Sorry for such a long post. I sincerely hope it will help.
Posted 1/5/2018 3:23 PM (GMT 0)
Got time to read through this? This routine has been working for me for a long long time:

OSTOMY APPLIANCE
STANDING POSITION IN FRONT OF SINK
CHECK LIST
- Hand mirror - Skin prep?
- Pouch - Blow dryer
- Wafer - Stoma powder?
- Sure seal - Tincture of Benzoin
- Q tips - Rubbing alcohol
- Few folds of toilet tissue - Warm, wet face cloth
- Paper towel - M-9 deodorant drops
- Zip lock bag - Few squares of gauze
- Ball point pen - Ostomy belt
Choose a time of day when the stoma is inactive. For me it’s the first thing in the morning.
I lay all of the above items out just like an operating-room nurse would do in the hospital. I don’t want to be hunting around for anything.
Prepare wafer. I cut hole to desired size. Remove release paper and heat gummy side for THREE seconds with blow dryer.
Prepare Sure Seal. Remove the release film on ONE side of seal and heat for THREE seconds with blow dryer.
Mate the wafer with the Sure Seal.
With forefinger, pull enough Sure Seal through the wafer hole to form a “turtle neck”.
Now place wafer aside.
Place a fold of toilet tissue on the leading edge of the sink and lean on it with my abdomen just in case there are any spills. I don’t step back from this leaning position until I am ready to apply my pouch.
Remove old wafer and pouch from abdomen and place in sink.
Place hand mirror in sink and adjust for viewing.
Clean skin around stoma with dry toilet tissue.
Continue to clean skin around stoma with alcohol until all residue is removed. BLOW DRY SKIN.
Keep your eyes on the mirror. No drips are allowed. If there is a drip of any kind dab with gauze. BLOW DRY! BLOW DRY!
Using a Q-tip apply a coating of Tincture of Benzoin to surrounding skin. BLOW DRY.
Keep watching the mirror for drips.
Apply a second coating of Tincture of Benzoin to skin. BLOW DRY.
Now heat the wafer and pouch that you’ve already prepared with blow dryer. THREE seconds is enough.
Place wafer over stoma and remove release paper.
Use M-9 if available.
Close end of pouch and done! 7 days guaranteed. It’s important for the wafer to stay in position for at least 5-6 days to allow the skin to heal and to allow the adhesive to break down naturally.
RAW SKIN is another matter. I would not use alcohol on raw skin because of the burning sensation. In the case of raw skin I would use a skin prep such as non-sting Nephew & Son. Somehow, someway, it is important to get the skin squeaky clean.
And then, I would continue with the directions using the Tincture of Benzoin. If skin is raw the Benzoin will sting, but it’s worth the few minutes of discomfort.
The Benzoin is anti-septic and provides a very sticky base for the wafer.
Posted 1/5/2018 6:27 PM (GMT 0)
This is all helpful information... Thanks for the suggestions!
Twingirl No changes in stoma size or position, and it's not flush with the skin. No big changes in output or consistency. I haven't ever tried sure seals or paste or protective sheets ... I don't want to use more product than I need, but maybe it would be worth a try. I do have a window into the pouch, but not seeing anything amiss.
I mold the protective seal ring into a snake shape and then stick it to the wafer so that it goes right up to the edge of the cutout. Should it be going around the edge?
The one thing I can think of that has changed is the weather ... It's gotten significantly colder. So Tom, maybe using a hair dryer to warm things would help.
Seeing an ostomy nurse is a great idea, but it's a 30 minute drive for me, so it's hard to fit into my work schedule.
In three weeks, I will have step two surgery, and I assume things will change again.
Posted 1/6/2018 12:27 AM (GMT 0)
Maybe a suggestion for the use of the protective ring would be to apply it to the wafer so yes it is up to the edge...but also maybe flatten it down so more surface area is in contact with the actual wafer and therefore more surface area would be in contact with your skin.....maybe producing a better seal. Hope that makes some sense.

Kanva, good luck as you take the next step to your j pouch. There are quite a number of people on this forum who have had great success with this surgery.
After this step 2, what is the time frame for your third and final step?
Posted 1/6/2018 3:23 PM (GMT 0)
We use the same products (coloplast protective seal rings and 2/piece Mio) I started having some leaks under the barrier a few weeks back. Two things helped. I found the protective seal ring wasn't always adhering to my skin as well as it used to. I used a microwaveable heating pad and just warming it up for 30 seconds so it was warm not hot. Then after I was done changing I would apply that with light pressure on top of my shirt and pouch. This stopped the leaks but I still didn't think my wear time was as long as it used to be.

I went back to the Convatec stomahesive paste and I'm having good wear time again and no leaks. I noticed my leaks were always the same spot so I take a pea size dollop of paste and plop it on that spot right on my skin. Then do a flat ring of paste around the opening of the wafer. Let it dry for 10-15 seconds then applied. I read that the stomahesive is meant to set up a bit before applicayion , not be applied when it is gooey. I have good luck with it.
Posted 1/8/2018 4:09 AM (GMT 0)
Kanva--
I've had A LOT of leaks, like more than a dozen in the last 12 weeks. So obviously, I'm not an expert. I have super thick output and that is definitely part of my problem. No advice, I just wanted to say hello!
Posted 1/12/2018 4:48 PM (GMT 0)
Plucky! So good to hear from you! I've thought about you in the past months, but life has been busy and I haven't been on the forum much. It sounds like you did surgery? I hope so much that you are feeling better.
Cupcakespinkgal: I found my way to the Mio setup through you after surgery, and it really had been great until recently. I tried heating briefly with a blowdryer this morning, and we'll see if that helps.
I tried a Hollister setup last week, just to see if something different would work. It kind of did - no dramatic leaks - but I realized how much better I like the Mio stuff. The Hollister stuff felt like it was made for a giant - the wafer covered almost half of my abdomen, and the bags hung way down on my leg. And I felt like there was less odor control.
I'm not sure whether the convex wafer helped - there was still some oozing under the ring, but it didn't explode. I thought it was interesting that with the convex shape, output actually pooled up in around my stoma for a while before making it into the bag. That didn't seem particularly helpful for my situation. Today I went back to my normal Mio setup and am keeping my fingers crossed. I have to go out of town this weekend, so I'm nervous about it. I'll take a bunch of supplies and hope for the best. I also have a sample of the convex Mio to try, but I got pre-cut for 1 inch, and I think my stoma is just ever-so-slightly smaller -I've always cut my own.
Honestly, I still don't think my stoma has changed shape much. My working theory is that sometimes I get pretty thick output, and my stoma contracts more than normal to expel it. When it does that, it strains on the edge of the ring and breaks the seal.
Twingirl: My second sugery was supposed to happen in October, but I got a partial blood clot and had to delay until now. I wish so much I could have had it then, because with this big of a gap (number 1 was in May), I am much less ready to deal with a hospital again. I got so out of the habit/system that I'm really dreading it. I want to get all the surgeries done and over with as soon as possible, though, so I'm ready in that sense. I hope to do the third surgery as soon as they will let me, whether that's 3 or 5 months after.
Posted 1/12/2018 6:39 PM (GMT 0)
I had that issue with the convex too. Everything stays up at the top, but it was the only thing that would stop leaks for me. I think they say if your stoma is less than .75 inch, you tend to need the convex. You've had the ileo for longer than me, so I am sure you know all the trick, but do you ever pull up above the stoma to try to get it to point straighter? mine used to sometimes point down and it would not get a great seal, especially with the loop. Wait till you see how the loop is, I hated mine, but it was just 8 weeks between step 2 and 3 for me. I hope you can do it after 8 weeks once you complete the 2nd step. Keep me updated smile

Have you tried the moldable wafers from convatec? They come in convex and flat. I always ended up wearing hollister with my ostomy. They didn't make a mio convex at the time, and for some reason the hollister convex wafers were a slam-dunk for me. I didn't need any additional supplies really. Just wafer, pouch, adhesive remover. With my loop, I wore the convatec convex moldable a lot in a one-piece. Crazy huh? I changed it so often there was no benefit in trying to swap pouches.
Posted 1/13/2018 9:30 PM (GMT 0)
NSSG: You are not making me excited for the loop! ;)
I went back to the old Mio two-piece system, and it’s worked ok ... at two days with no leaks. I tried using a hair dryer to warm it a bit and really concentrated on holding the pouch in place for a minute or so. I’m also getting a bit compulsive about rubbing my stoma surreptitiously, trying to move any output down and gently pull my stoma up.
I can’t wait to get step three behind me, although I know there will be challenges there too.
Timing of this all sucks, because my sister was just diagnosed with bad cancer. I don’t want to be recovering same time she’s really sick, but I think I just have to barrel ahead. They think she will only be able to fight it off for 1-5 years, so the sooner I’m back to normal, the better.
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