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should u leave a gap???

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Posted 6/27/2011 2:37 PM (GMT 0)
OK  I'm confused confused    I have an end ileo

I've read you should leave an 1/8 inch gap around the stoma and I've read you should make it as snug as possible.  Which is it?  When I leave a gap, it seems a little stool gets in there under the wafer and irritates my skin.  When I make it snug, it seems I leak more!  As if when the wafer turtlenecks and expands, it may be pushing up and removing the seal.  I have 1/8 inch of dead skin below my stoma and the last time it was cut snug, when I pulled off the bag it pulled the dead skin off too and was bleeding a lot!  I'm really afraid of an open hole below the stoma!  I have more dead skin still on the right / underside and I'm afraid of ripping that off too.  I guess it needs to come off eventually??

I know the stoma can swell which is the reason to leave a gap but it seems that's just asking for irritation?!  Can I do this without seals / paste or do I need to purchase that extra stuff to protect my skin?

thanks for any advice, I'm new to this!

Posted 6/27/2011 2:39 PM (GMT 0)
oh, and a side note, is it bad to tug on the top of the bag to get the stool to slide down away from my stoma?
Posted 6/27/2011 2:55 PM (GMT 0)
I don't leave a gap on purpose because that doesn't make sense to me. But there usually is but the paste fills it in. I'm not sure what you mean about the dead skin, is I like when your skin peels and there is good skin underneath?
Posted 6/27/2011 3:35 PM (GMT 0)
it's like where they stitched my skin to the stoma, the skin died and when the skin was ripped off, it was just a gap and blood.
Posted 6/27/2011 4:17 PM (GMT 0)
Have you had a nurse look at your skin?

I think the point of leaving the 1/8 inch gap is that the stoma changes size when it moves things through.... I can see this when I am in the shower w/out a bag on. My nurse said I was cutting mine too close when I was having leaking problems, and cutting it a little bigger helped. She also told me my stoma was oval -- I had never tried measuring from different angles and I
couldn't see it in the mirror. It's been better since (also w/the convex wafer)

I would imagine that different people are different in terms of how much their stomas expand etc.

I always wear an Eakin seal to protect that ring of skin near the stoma. I haven't had the kind of skin problems you're describing, though -- just has been very red when I didn't wear the eakin, but it cleared up after wearing it.
Posted 6/27/2011 6:45 PM (GMT 0)
I think the reason there are so many differing opinions on the size of the gap is that everyone's stoma sizes and stoma behaviors are vastly different. I need to leave a gap as my stoma expands and contracts A LOT. Sometimes when I was cutting a new pattern, it would be perfect only to be 1/8 inch too tight by the time I was ready to put my wafer on just because my stoma had expanded (and was ready to output... ugh!) in a matter of minutes. The times I have cut mine too small, I know because my stoma turned a dark reddish purple color in some spots. Now I just cut it with 1/8 gap and use the Eakin to fill in the space with a material that protects the skin but is more forgiving movement-wise.

My stoma is an oval with a few irregular spots... almost like and oval-ish blob:) It took me a while to make the perfect pattern (my stoma shrunk over a period of three months after surgery) for cutting my wafers. Now I have a pattern that accounts for the irregular shape of my stoma very well. I just put it on the back of my new wafer, trace it, and then cut. I then test it over my stoma and make minor adjustments in case I didn't cut it exactly right the first time.

The Adapt rings, though they worked much better than the Coloplast strips, didn't work as well for me as the Eakins. With the Adapts, my stoma would punch them back as it expanded and contracted and then I could see the skin again. The Eakins get sort of gooey and really stick to the skin next to my stoma well. They are a little harder to remove, but that is the same thing that makes them work so well for me.

As far as the wound next to your stoma, you might want to get it checked out again if it isn't clearing up. As I mentioned in the other post, is it a case of your stoma separating from your skin a bit (mucocutaneous separation)? For me it looked like I could see the edge of my skin where it was cut, and then there was a 1/8 inch wide gap that was about 1/8 inch deep and then my stoma. It also looked like the stitches had ripped through my skin along the edge that was affected. It is a fairly common complication, many times caused by poor healing due to prednisone. A trip to your stoma nurse could help get this sorted out. They have some cotton-like dressings made out of an algae material that can be put in the gap to aid in healing. This could be something that would take a lot longer to heal on its own without this special dressing. I know it is a pain to go back in, but it would probably be worth it. Maybe they can show you how to use the rings and strips too:)
Posted 6/27/2011 6:50 PM (GMT 0)
thanks all! Im going to suck it up and go see my WOC nurse tomorrow.
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