Wondering what I'm doing wrong

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blueglass
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Date Joined Dec 2010
Total Posts : 3332
   Posted 3/25/2011 7:46 AM (GMT -6)   
I'm four weeks out of surgery now, and I just started having trouble with pouches leaking after one day. I've been using the coloplast one piece sensura pouches.

about a week ago I started having some issues with itching. My stoma nurse said that that brand leaves residue, which can cause itching, so I should get adhesive remover to take it off. A few days later, I also had a big red ring around the stoma, thicker around the bottom..... so all at once I've started using stoma powder, and first paste and then eakin seals, after I ordered them, as well as adhesive remover, and I've been using the cavilon skin prep all along.

The good news is that my skin is looking better, which feels amazing to me, because I didn't really believe it was possible to heal with the bag on all the time.

The bad news is that I've had leaks the last two days after only one day on. The leaks are from the wafer. The first one was clearly because I didn't wash off the adhesive remover well enough (I forgot the soap and water instruction), but yesterday's was not from that, and I don't know if I did the eakin seal wrong, the stoma powder, or what.....

Yesterday I didn't use the stoma powder, since all the remaining redness was under the eakin seal. I also tried a sample of a hollister bag.

The itching does feel lessened, although now I am hyper aware of the pouch all the time, afraid I'll spring a leak, and it does feel like it hurts a little.

Just wondering if anyone has any thoughts on what is most likely the problem. I am, of course, also asking my stoma nurse.

thanks

Blueheron
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Date Joined Feb 2010
Total Posts : 720
   Posted 3/25/2011 8:51 AM (GMT -6)   
Sorry you are having trouble. I too sometimes get a narrow ring of irritation around my stoma, especially right under my stoma where it flops over (my stoma is 1.25 inches tall so it kinda does that instead of sticking straight up). My output seems to erode Adapt Rings and Eakin Seals fairly quickly (though the Eakins hold up a bit better). I can't go more than four days without changing. Still, my irritation is pretty minor and heals quickly with stoma powder. What I have found works is to put stoma powder just in the exact places I need it. For instance, I will only put it on the exact 1/16 of on inch irritated strip around my stoma. I lay a dry washcloth over the rest of the area so the powder doesn't inadvertently sprinkle onto places I don't want it, which could interfere with the pouch sticking. I make sure to dab skin prep over the powderad area so it becomes crusty. All this sometimes takes me a while, but I try not to worry about it... figure it is worth happy skin:) I also blow dry everything right before I put the Eakin ring on to dry any of the mucus of my stoma that may have gotten the area wet. I also put the Eakin ring really tightly against my stoma. To help do this, I actually tear the ring in one spot so I can sort of hook it around the stoma for a snug fit (instead of putting it over the stoma like you would put a shirt over your head). Then I just rejoin the tear after it is around my stoma. I find the Eakin stays drier this way because it doesn't slide over the wet stoma.

Because my stoma seems to output constantly no matter what time of day I change, I tear 1 inch strips of paper towel and wrap them around my stoma a bit like a turbin. This catches all the output and if the paper toweling fills up, I take it off and wrap on a new one. Then I can work at the bottom of the stoma without worrying about stool dripping down.

I am using Coloplast Sensura right now as well and though a little adhesive remains sometimes, I don't use adhesive remover wipes. I also don't use soap. My nurse in the hospital recommended just using a wash cloth and warm water and not to worry too much about adhesive residue (other than picking off the Eakin gunk the best I can). I have had good luck with this, though I have not become sensitive to the adhesive so I may be lucky that way. I find that I have slight sheen of adhesive residue all the time when I take off the wafer, but that it never builds up to be a problem.

Sometimes barrier prep wipes can also prevent things from sticking. I still use them sparingly in irritated spots, but try not to put them under the entire wafer. Perhaps you used to much skin barrier prep?
-Officially diagnosed with UC in 2006, though had symptoms since 1999.
-Had mild/moderate symptoms continuously until severe flare in autumn 2010 which required 2-week hospital stay
-Took Asacol, Rowasa, Canasa and Prednisone to manage flares but meds stopped working
-Tried 1 infusion of Remicade but had excruciating joint pain and discontinued
-Had permanent ileostomy surgery 11/8/2010

2b ColonFree
Veteran Member


Date Joined Nov 2008
Total Posts : 2603
   Posted 3/25/2011 9:52 AM (GMT -6)   
i also had lots of leaks at first. but it got better with time. i think i had the leaks b/c i had a loop ileostomy and they put that rod (bridge thing) under the loop stoma for the first 10 days-2weeks, so i suppose that what caused the leaks. but maybe also b/c in the first few mons the stoma keeps shrinking and changing it's shape and all that, maybe that's what causes the leaks in the first period post op..? just a thought. i'm sure you'll get things under control soon.
Hodaya
06/05/2007 - STARR procedure
colonic inertia w/pelvic floor dysfunction
08/16/2009 - total colectomy w/ileorectal anastomosis
07/08/2010 - loop ileostomy

blueglass
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Date Joined Dec 2010
Total Posts : 3332
   Posted 3/25/2011 10:31 AM (GMT -6)   
Thanks for your replies. Wow, Blueheron, your routine is elaborate, but glad it works for you, and it's helpful to know that it's worth it to be more careful. I think the skin prep might be the problem for now.... I didn't realize that could interfere w/the wafer sticking. One of the visiting nurses ordered me some spray skin prep and another suggested two layers of stoma powder with prep (these are not stoma nurses).... and then I put prep on the rest of the area too..... I'm thinking that with the spray I might have used more than with the wipes.

My stoma doesn't seem to be shrinking a lot yet, but it could certainly be changing shape.

I think I'll try to be more sparing with the skin prep and see how that helps....

polishdan
Veteran Member


Date Joined Mar 2010
Total Posts : 1595
   Posted 3/25/2011 1:20 PM (GMT -6)   
Powders and skin preps reduce wear time. I use Friars Balsam Compound. It helps open skin to heal. It dries sticky and the wafer sticks to it. After changing to a different type wafer I was having some itching. The Friars fixed that too.

Dan

Christine1946
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Date Joined Aug 2008
Total Posts : 5975
   Posted 3/25/2011 2:28 PM (GMT -6)   
     I don't use any seal, just the Coloplast Sensura one piece.  I did notice a little bit of redness surrounding the bottom of my stoma, but it doesn't bother me.  I use the adhesive remover wipes, then wash with antibacterial soap, rinse with clear water and dry.  Then I apply stoma powder, let it sit about 30 sec, wipe with a tissue and apply the bag.

blueglass
Veteran Member


Date Joined Dec 2010
Total Posts : 3332
   Posted 3/25/2011 2:40 PM (GMT -6)   
Christine, so you don't put anything over the stoma powder (i.e. skin prep)?

My stoma nurse says agrees w/Hodaya and says it's likely from the stoma shrinking....she says I should get some bags with convex wafers.

Dan, I will look into Friar's balsam.... had never heard of that (except from your previous posts)

thanks

elddiReMsihT
Regular Member


Date Joined Nov 2010
Total Posts : 111
   Posted 3/25/2011 3:00 PM (GMT -6)   
I've had ridiculous skin problem that I still haven't solved, so I don't know how much I can help. But, the best advice I ever received was to stick patches of the different products you're using somewhere else on your body for a few days and see if you get a reaction to anything. You may be allergic to something you're using. I found out I had a raging allergy to some barrier wipes I was using, so obviously I have stopped using them now!!
Also, are you getting your appliance dry after you shower? You can get fungal infections underneath the wafer if it stays moist all the time. I had trouble drying mine with a hair blower so now I wrap up in Glad Press 'n Seal before my showers, or else I just shower right before I want to do a pouch change.
If it gets severe, you can do what I do and use an adhesiveless system for a while. I leave the plastic backing on the wafer so that the adhesive isn't actually touching my skin. I put a ring of paste on, and a very tight belt... and that's it. It's obviously not the most secure system in the world, but it's allowing my skin to heal up before I try the next thing. I hope you don't reach that point though!
Also, I saw a dermatologist and got a prescription for a steroid cream to put on the irritated skin; that is helping a lot.
Diagnosed with UC in 2007
Flare in 2007 causing anemia requiring blood transfusions, eventually controlled by asacol and 6-MP.
Flared again in 2009 as 6-MP lost effectiveness, went on TPN and received more blood. Started Remicade, which induced remission.
Flared 2010; Remicade no longer effective.
Had 1st surgery of 3 step j-pouch at CC on 1/19/11. 2nd slated for April, and j-pouch in July!

polishdan
Veteran Member


Date Joined Mar 2010
Total Posts : 1595
   Posted 3/25/2011 5:48 PM (GMT -6)   
bluegrass
The full name is Friars Balsam Compound Bemzoin Tincture.
www.rougier.com
phone 866 470 6886

Dan

Blueheron
Veteran Member


Date Joined Feb 2010
Total Posts : 720
   Posted 3/25/2011 8:12 PM (GMT -6)   
I just thought of one other thing that can help your wafer stick. I often place a heating pad on a very low temp (don't want to melt the bag) over my pouch when I am all done with the change. I don't always do this... but if I am just going to be sitting around anyway I do. I think it does help it stick a bit better. I notice the edges don't peel up as much in the following days when I have used the heating pad.
-Officially diagnosed with UC in 2006, though had symptoms since 1999.
-Had mild/moderate symptoms continuously until severe flare in autumn 2010 which required 2-week hospital stay
-Took Asacol, Rowasa, Canasa and Prednisone to manage flares but meds stopped working
-Tried 1 infusion of Remicade but had excruciating joint pain and discontinued
-Had permanent ileostomy surgery 11/8/2010

stripey
Veteran Member


Date Joined Feb 2011
Total Posts : 1059
   Posted 3/25/2011 8:27 PM (GMT -6)   
I use an adhesive remover wipe, then clean area with non fragranced baby wipes, dry and use cavilon barrier wipe just around edge of stoma apply thin ring of stomadhesive paste around edge of stoma then stick bag on. Never had problems with skin irritation for last 18 years and don't have problems with bag sticking and wear time reduced. Usually change wafer once a week. I also make sure I cut wafer very close to stoma size so less chance of leakage from underneath.
Crohn's dx 1989, loop ileo 1992, end ileo 1992. Arthritis developed 1990 Stoma abcess 1995. Azathioprine started 1995. Panprocolorectomy 1999. Stillbirth 2000, antiphospholipid syndrome dx 2000. Flare up 2004, stoma abcess and strictoplasty 2004. Low blood pressure dx with impaired kidney function 2006, fludrocortisone pres. flare up 2010, steroids, Humira, codeine.

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 3/26/2011 6:23 AM (GMT -6)   
blueglass~hang in there...you'll get it all figured out yeah

You've gotten some great suggestions! I am a believer in 'less is more' so I don't use a lot of product...I really only use stoma powder.

It really sounds like it is the way your stoma is changing/works that could be causing the problems. Do you have a loop, end or end loop ileo? The end is definitely easier...I have an end loop ileo now and it has been the most difficult to figure out devil If you can, watch how your stoma moves...it may give you some ideas!

You are also far enough along that the changing should be almost finished. Have you been measuring it? If you have a loop, make sure you are not completely covering the lower hole...that does still function and the mucous could be weakening the area.

I hope things settle down...let us know how it goes!
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!

summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 3/26/2011 9:38 PM (GMT -6)   
this is what i do, im getting about 6 days, i could get longer, but i don't want to push it, lol.
I take the bag partway off, while cleaning around it with a small square of a towel i cut up, with the bottom of the bag hanging into the trashbag, that way if it leaks it goes in the bag, i clean the top half, then take the bag off and cover the stoma with a towel square and clean the bottom, then, i lay down flat, and put my wafer on, i only use paste, right around the edge. after i put it on, i put the bag on, then stand up and readjust the bag the way i want it, i turn the hair dryer on and use it for a minute or so to warm up the wafer then press it down some more. then i put on a sure seal, then im done! takes about 5-8 minutes depending on how ocd i get about putting the bag on, lol. sometimes i pop it on and off like 10 times, literally.
i think a sure seal would help you, that will keep the wafer from getting wet, and help with the irration. your wafer may also be cut too large, i cut mine a tiny bit smaller than it actually needs to be, mine has quit changing since it's almost 4 years, but for the first 6 months it can change size.
and also, the powders and skin preps def lessen wear time! when i first started i was using the skin preps and everytime i got the thing wet, it came right off!
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!

blueglass
Veteran Member


Date Joined Dec 2010
Total Posts : 3332
   Posted 3/27/2011 8:56 AM (GMT -6)   
Thanks so much for all the great suggestions, many of which I'd never thought of (esp applying heat to the wafer after it's on). Yesterday I did see that my stoma had shrunk, this was the first time .... and as my nurse said, it got shorter too (I am healing on the slow side due to all the pred and other meds, although I'm off pred now! Yay!).

The skin looked pretty good, and so I tried using just the eakin ring and no skin prep or powder or adhesive remover.... seems to be sticking better, we'll see. I ordered a sample of a bag with a convex wafer, so I can see how that goes too.

I also noticed that the English measurements on the back of the colopast wafer are off a bit..... the rings go up by 5 mm, and also 1/4 inch, but 1/4 inch is more like 6 1/3 mm (why some are skipped). I hadn't been tracing the ring, was using the measurements to cut things...... so, now I'm going metric with that....

I'm pretty sure I used too much powder before and that was part of the issue ... as well as not removing the adhesive remover.

Thanks again..... you are awesomely specific....

blueglass
Veteran Member


Date Joined Dec 2010
Total Posts : 3332
   Posted 3/27/2011 10:01 AM (GMT -6)   
Oh, it's an end ileo, forgot to say that.

2b ColonFree
Veteran Member


Date Joined Nov 2008
Total Posts : 2603
   Posted 3/27/2011 2:25 PM (GMT -6)   
glad things are working better for you. soon enough you'll find the perfect combination that fits you best.
Hodaya
06/05/2007 - STARR procedure
colonic inertia w/pelvic floor dysfunction
08/16/2009 - total colectomy w/ileorectal anastomosis
07/08/2010 - loop ileostomy
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