difficulty with pouch leaking, using eakin seal

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frustrated1000
New Member


Date Joined Mar 2012
Total Posts : 7
   Posted 3/31/2012 5:32 PM (GMT -6)   
I am the care giver for a wheelchair bound patient with new colostomy placed in December. We are seriously struggling with getting a pouch to stay on longer than a day. we have had 1 stay on for 21/2 days using convatec active life one piece bag and eakin seal. There are multiple problems with this situation. her stoma was placed way to low on her abdomen so that the bags fold and pull loose because she is sitting all the time and has an abdominal fold. Also her stoma is almost flush with her skin. We have tried every convex bag that I could find and all have a hard plastic ring to them so that they do not work they just aid in pulling the wafer off. I really thought we had it figured out with the new system of using eakin seal and active life bag but the past two bags have failed with leaking under the wafer and coming off. another issue is her belly button falls under the wafer so I have been using the eakin seal in her belly button and a ring around her stoma. still not working. we are extremely frustrated and don't know what else to do. there is also an area of skin irritations where the top layer of skin is off right next to her stoma. what I did the first time was use powder and glue wipes to build up a barrier prior to placing the seal because the wound is weapy and moist so having trouble getting eakin seal to stick. then after that I went with just the seal around the stoma and filling the belly button area with seal. I'm using the small ring and making it more thin around the stoma area and attempting to make it more of a flat surface to stick to. I have been warming it and following all instructions concerning use. I'm cutting around the edge of the seal to make a piece for the belly button. another problem is wrinkling of the wafer after she sits up and moves around due to her body shape and stoma placement.

my questions are
is the seal supposed to be thicker around the stoma,

is it ok to use barrier slash glue wipes in areas where the seal is not,
is it ok to layer the powder under the seal.

I am a nurse and have had experience with ostomies prior to this situation but have never had this much trouble finding a solution to these issues. I am begging for help from people who have had similar issue or have any suggestions. thanks in advance

polishdan
Veteran Member


Date Joined Mar 2010
Total Posts : 1472
   Posted 3/31/2012 6:52 PM (GMT -6)   
Sounds like the first thing to do is have the stoma relocated properly. What you describe has no chance of sticking. If you have no confidence in the surgeon, find another.

Dan

blueglass
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Date Joined Dec 2010
Total Posts : 3073
   Posted 3/31/2012 7:26 PM (GMT -6)   
Sorry you're having such a tough time. Have you talked to a stoma nurse about the situation? They often have bags of tricks .... many of us have had the experience of having problems that visiting nurses w/some ostomy experience couldn't solve, but then having WOCN's know what to do.... they would have a better sense about whether surgery is necessary.

I would be wary of powder under the seal though .... powder makes the wafer not stick as well.

I wonder if something on the outside might help some -- sure seals and/or an ostomy belt?

Have you tried the eakin thins? Wondering if that would make a difference?

But it sounds to me like you need to find someone who is an expert on difficult pouching situations. Hope you figure something out.
49 years old, female. Sick for way too long with Crohn's (or possibly UC) Proctocolectomy and permanent ileostomy in Feb 2011. Surgery for lingering perineal wound on Sept 26. Other than the wound, been feeling healthier than I have in years.

frustrated1000
New Member


Date Joined Mar 2012
Total Posts : 7
   Posted 3/31/2012 9:18 PM (GMT -6)   
thanks for the advice. I have been working with a wound ostomy nurse at convatec. Just no one available on the weekend and I also find that people that have experienced similar situations have a lot to offer so hoping someone out there can help.

80sChick
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Date Joined Oct 2009
Total Posts : 1053
   Posted 3/31/2012 10:14 PM (GMT -6)   
A few thoughts:

1. I agree with Dan; you need to see about having the stoma relocated, and first marked by a stoma nurse who evaluates the patient while he/she is sitting in the wheelchair so it's obvious where the skin folds are. I know that sounds crazy but it may be necessary.

2. In the meantime, yes, you can use powder anywhere under the barrier, as long as you use barrier wipes (you can also do that anywhere under the wafer) over the powder. I'd just do the one layer; too much will cause it to not stick.

3. I would also say to use a belt in the meantime, as well as the convex wafer.

4. Bottom line, you need to have the patient SEEN by a stoma nurse soon and get their take on things before the skin breaks down more.

Keep us posted and good luck. We know how frustrating it can be.
Stephanie, 30 (!!) years old

March 2000-Diagnosed Crohn's Colitis
(Tried every drug imaginable, but lived 10 years with daily diarrhea)
March 18, 2010-Total Proctocolectomy and Permanent Ileostomy! :)
(Now med free, 4 subsequent procedures to correct blockages at stoma site)

Stoma named Zoe...She's my best bud!! :)

allbluezoo
Regular Member


Date Joined Feb 2012
Total Posts : 446
   Posted 3/31/2012 11:11 PM (GMT -6)   
I agree with the relocation, a belt and convexity. I used a Coloplast 1 piece covex that has a flexible barrier AND belt loops. Item 14404

Subzeromambo
Veteran Member


Date Joined Sep 2009
Total Posts : 1143
   Posted 4/1/2012 3:26 AM (GMT -6)   
I had similar problems with my new ileo. Any time I used the wipes and Eakin rings, it was a disaster.
After working with three nurses from different organizations, we found the following to be reliable. Clean area with soap and water. Rinse with a wet wash cloth. Dry with a hair dryer set on warm. Squirt Convatec Stomahesive powder protector lightly around the base of the stoma. Blow away excess with the hair dryer. I develop blisters very easily so I also put on a very light, almost non-existent layer of Mitrazol powder around not on the stoma. Spray the area with 3m Cavilon no sting barrier film, avoid spraying the stoma. Fill the abdominal crease and the navel fold with a small bead of Convatec Stomahesive paste. After cutting barrier to fit stoma, squeeze bead of the Stomahesive paste around the inside of the ring where it will be touching skin. The paste is a substitute for the Eakins ring. Put the barrier firmly around the stoma after the alcohol smell diminshes (about 15 seconds). Don't worry if a little paste turtlenecks around the stoma. If it is more than a little just wipe it off. Click the bag onto the barrier. Use a heating pad or your hand to press the barrier against the skin. This helps the barrier gel adhere strongly to the skin. I use a hollister 2-piece drainable Velcro seal pouch. I change the bag every three to four days and the barrier every seven days.
Diagnosed 1987 with lower left ulcerative colitis. Hospitalized often. Mega toxic pan colitis Dec. 1999. Perforated colon and total colectomy April 2011. First j-pouch surgery March 8. Five other damaged organs removed at that time.

Post Edited (Subzeromambo) : 4/1/2012 2:40:01 AM (GMT-6)


Subzeromambo
Veteran Member


Date Joined Sep 2009
Total Posts : 1143
   Posted 4/1/2012 3:35 AM (GMT -6)   
The above sounds complicated but it doesn't take more than a few minutes. I do not wear a belt but I do like the ostomy secret wraps. The wraps have a pocket for the bag so it doesn't get pulled or tangled in clothing. The wraps also help to contain the mess if there is a leak.
Good luck! And thank you for being such a conscientious caregiver.
Szm

frustrated1000
New Member


Date Joined Mar 2012
Total Posts : 7
   Posted 4/1/2012 10:57 AM (GMT -6)   
Thanks for the tips but relocating her soma is not an option. Too many abdominal surgeries and scar tissue. Her skin is surprisingly in good shape besides one small sore area at top party above soma.

summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 4/1/2012 3:26 PM (GMT -6)   
Can she lay down flat when you put the bag on? I found I could get a better seal when all the skin was flat.
I think that the powder and wipes will make it worse they can compromise the seal.
Have you tried a sure seal over it?
UC for 8 years, before finally kicking its butt and having a permanent ileostomy April 17 2007!
-I have gone to find myself, if i get back before i return, keep me here-
No matter what kind of day you are having, take five minutes to sing loudly and dance like a fool!

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3067
   Posted 4/1/2012 5:43 PM (GMT -6)   
I am a fan of less is more...skin prep can often shorten wear time.

You should be able to trim off the area off the wafer that interferes by her bellybutton. I have to remove about 1/2" from mine and it doesn't affect my wear time.

Have you tried the ... the name escapes me right now... it's the 'other' Eakin. If one doesn't work for a patient the other usually does. Someone will know the name, I am sure, and post it!

I recently discovered that not all convexity wafers are the same...I need it for a stoma that can become flush but the wafer I was using wasn't very flexible and was actually pulling away when my stoma pulled in. I switched to a light convexity that had a more flexible wafer and it stays on a lot better.

I'd also suggest trying a Sure Seal (www.alpglobal.com) they'll send a couple samples with good instructions.

Is irrigation an option? If her stool is formed enough it might work.
formally known as OHIO76 ~ honoring my daughter's passion!
Crohn’s dx 1989
some terrible years before my temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!

blueglass
Veteran Member


Date Joined Dec 2010
Total Posts : 3073
   Posted 4/1/2012 6:25 PM (GMT -6)   
I think EQ Mom meant the adapt ring, right?

Irrigation is a great idea if that's possible.
49 years old, female. Sick for way too long with Crohn's (or possibly UC) Proctocolectomy and permanent ileostomy in Feb 2011. Surgery for lingering perineal wound on Sept 26. Other than the wound, been feeling healthier than I have in years.

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3067
   Posted 4/1/2012 6:56 PM (GMT -6)   
Yes, thank you!!

Maureen4RU
Regular Member


Date Joined Dec 2007
Total Posts : 42
   Posted 4/2/2012 11:32 AM (GMT -6)   
I had the first part of j-pouch surgery on March 1st and had a terrible time getting a bag to last more than a day without leaking. My problem was that I have a scar from hernia surgery right above my belly button and it was impossible to get the wafer to stick where the scar was. After several visits with my ostomy nurse we discovered that using a moldable wafer with an eakin seal and also wearing an ostomy belt (very tightly) completely fixed things. I haven't had a leak in almost 3 weeks and my bags are lasting 5 days at a time. Good luck!!
-Diagnosed with Ulcerative Colitis in September 2001.
-Been in a bad flare since December 2009 - been on Prednisone four times.
-Had two colonoscopies since May 2010.
-Most recent colonoscopy (August 26, 2010) revealed that I have Crohn's Disease.
-Current medications: Humira, Vitamin D, Vitamin B12, Levothyroxine, Melatonin, Yaz

frustrated1000
New Member


Date Joined Mar 2012
Total Posts : 7
   Posted 4/3/2012 5:49 PM (GMT -6)   
I am confused about how irrigation would help. Are you talking about irrigating to stoma or the bag? Thanks for all your input.

frustrated1000
New Member


Date Joined Mar 2012
Total Posts : 7
   Posted 4/3/2012 5:50 PM (GMT -6)   
Also we have tried the belt and it did not work and rubbed sores on her.

blueglass
Veteran Member


Date Joined Dec 2010
Total Posts : 3073
   Posted 4/10/2012 5:52 PM (GMT -6)   
Irrigation is something that some people w/a colostomy can do if there's enough colon left. I don't know a lot about the details (not an option for me, as I have no colon at all), but from what I've heard it takes about an hour every day or two or so.... people get themselves on a schedule. It's kind of like an enema to clean out the colon... then the rest of the day, you don't need a bag at all, just a little cap on the end of the stoma.

I think that some people w/colostomies hate the idea of having to irrigate regularly and others find it liberating to not have to wear the bag.

Here's an article about it http://www.ostomy.org/ostomy_info/pubs/Phoenix_Irrigation.pdf
49 years old, female. Sick for way too long with Crohn's (or possibly UC) Proctocolectomy and permanent ileostomy in Feb 2011. Surgery for lingering perineal wound on Sept 26. Other than the wound, been feeling healthier than I have in years.

frustrated1000
New Member


Date Joined Mar 2012
Total Posts : 7
   Posted 5/14/2012 6:19 PM (GMT -6)   
Okay so it has been awhile since I have posted. We had been after much counsel with ostomy nurse and research, using eaken seal under wafer just around stoma, cutting side of wafer tape to keep it out of belly button area, and using bead of paste to area next to belly button to reinforce that area. We have still been having to change it every other day due to leaking. I am still not quite sure if it is due to break down of seal or seeping under seal. I would remove the bag and sometimes all that would be seen is ring of stool right around stoma where seal would be. I had started taking it off every other day because of the ring of stool to keep it from breaking down skin. Now sometimes we don't even make it to every other day. We are now trying, after much research by team mom, trying new method of placing seal on the wafer and working it all over wafer and turtlenecking it up into opening. We will keep yall posted. open to input about the new process or old. Still trying to find long term solution. Thanks everyone.

Another UC wife
Veteran Member


Date Joined Jun 2007
Total Posts : 2111
   Posted 5/16/2012 7:50 AM (GMT -6)   
Excellent advice above to try and hopefully something in there will be the answer. What a shame that the stoma had to be placed and located where it is. I have to assume the surgeon had no other option...I certainly hope that is the case. I definitely agreed with Dan until I saw your response that relocation is not an option.

Hopefully this trial and error process....(make notes to refer to of each variation you try and which appliance etc) ...will keep you focused on what to try next for successful results. Good Luck!!!!
Wife of 64 yr old male suffered with UC & in May 06 had a severe flare & hospitalized 6 days...various prednisone treatments leading to steroid dependence and osteopenia, 12 asacol, 200 mg Imuran, failed remicade infusions Jan-May 2010 Dependence on pain meds. Made decision 6/10 to have surgery which was on 12/17/10 (total proctocolectomy & ileostomy - unable to have the j-pouch) & now pain free

B'Dereh
Veteran Member


Date Joined Jun 2011
Total Posts : 1912
   Posted 5/16/2012 4:00 PM (GMT -6)   
That's what I did: I put the eakin ring on the wafer and made the turtle neck up and around the opening. The system worked quite well for me
UC Dx and then 7 years of no symtoms. But when they started, they didn't let up, ASA stopped working, pred stopped working, and azathioprin did nothing. The threat of much more radical drugs, plus the fact that a stricture was about to shut down my colon, led to my decision for a total colectomy in April 2011, 2nd step December 2011 and ... TAKE-DOWN WAS ON MARCH 19, 2012.

Toritoo
Regular Member


Date Joined Apr 2008
Total Posts : 184
   Posted 5/19/2012 7:09 PM (GMT -6)   
Dear frustrated1000,
I can totally relate to your problem getting the bags to last longer than 24 hours is like winning a battle but not the war. We are dealing with our Mother and her ileostomy she had done in January and it's just been a nightmare. Not even the 3 different stoma nurses we saw and had put a bag on her from lasted 24 hours. Then we got the eakin seal which I thought was the answer to all our prayers but after the first bag the stoma nurse put on we're back to every 24 hours. I've been offered a lot of help from my post, What can we do? So many people gave me so many different options and we're trying them all. Good luck with your problem and know that the people here are the most sympathetic and helpful people I know concerning these issues. Trial and error is all I can do at this time but I'm still hopefull. Hang in there and good luck.
toritoo

frustrated1000
New Member


Date Joined Mar 2012
Total Posts : 7
   Posted 5/20/2012 9:29 AM (GMT -6)   
Thanks for the encouragement. I feel your pain. I know we will find the answer with trial and error and prayer. That is all that has gotten us through to this far without pulling our hair out. I'm very blessed to be working with her mother and we are a team. My patient, friend, is so patient with this entire process. She is amazing. we are the ones having our frustrated and want to throw in the towel moments. Thanks for all the advice. the first 2 attempts with the turtle neck have not worked but got some more advice from an ostomy nurse. Convatec is so great. it is amazing that you get to speak to a certified ostomy nurse when you call them. She said to try two seals to turtle neck and make it more convex. part of the problem is the seals are breaking down too quickly so going to try this next change. keep up the advice and thanks everyone.

allbluezoo
Regular Member


Date Joined Feb 2012
Total Posts : 446
   Posted 5/20/2012 1:46 PM (GMT -6)   
I needed convexity but using the seals and/or the adapt barrier rings from Hollister didn't do enough for me.

kazygirl
Veteran Member


Date Joined Sep 2007
Total Posts : 955
   Posted 5/20/2012 7:11 PM (GMT -6)   
just a quick note on the eakin rings/seals.... i use those too and at first i was freaking out because they puffed up and were full of poo goo and seemed to be breaking down. but i got some advice from another person using them here and they said just ignore it. i leave my wafer on for about 4 or so days and the eakin ring looks completely broken down, but my skin underneath is perfect. no irritation or redness. so i think that is just how the rings work. they look broken down, but are not.
steph ~ gold coast, australia ~ 36
UC since 2003 :: lots of blood & pain, hard to manage flares, never more than 2 months remission at a time.
emergency life saving surgery in march 2012 :: total colectomy & ileostomy

felt great to throw away ALL my meds!
reversal planned for aug 2012 :: 2 more surgeries required to complete j-pouch
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