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Leaking Ileostomy

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Posted 4/18/2011 4:52 PM (GMT -7)
I recently have a temporary ileostomy and have had over 42 attempts to seal without any successes in over 2 weeks.  My ileostomy is no more than two inches away from my hysterectomy open incision.  The staples were removed too soon.  So it is almost impossible to get a good seal and the longest one I have had is 22 hours.  I have tried several types of bags and attempted various types of ileostomy seals to no avail.  Any ideas anyone?  I am tired of being housebound unable to do or go anywhere.  Any ideas would be appreciated. 
Posted 4/18/2011 6:41 PM (GMT -7)
Thats harsh..sorry to hear. maybe try cutting away material from wafer so it's not in contact with hysterectomy incision...it will look short, but a short good seal is better than a larger one that doesn't seat good.
Make sure your skin is good and dry before you put wafer on, and stay flat longer than you think necessary to allow barrier to adhere to your skin. keep bending and twisting to a minimum for a little longer too.
Can't think of anymore 'tricks of the trade' I've used over my 20+ years with my ostomy...but I'll keep warm and positive thoughts headed your way :)
Posted 4/18/2011 6:55 PM (GMT -7)
Is there any chance of using a wound vac on your open incision? I had complications with my abdominal incision after ileostomy surgery and it had to be healed open from the bottom up. It was a huge wound (13 cm long by 3 cm wide and about 1.5 cm deep) with a lot of drainage... which would have made appliance adherence very difficult. I ended up with a wound vac which, though a pain to wear and haul around, sucked the drainage out and helped the wound heal in six weeks. The nice thing about it was that it was a closed system. A sponge with a tube is put into the wound then a sheet of plastic is put over the whole area to maintain suction. I then put my appliance overlapping this plastic so no wound drainage ever got under my wafer. Everything stayed nice and dry (sorry... a little hard to describe in writing). Wound vacs are expensive, but worth it. Not sure if they can be used with all incision wounds, but it might be worth asking about since you are having so much difficulty.
Posted 4/19/2011 5:49 AM (GMT -7)
My suggestion is to cut all but about a 1/2" of wafer on that side...I cut mine off with each change because my scar interferes with my seal...AND use a belt.

When I am healing from surgery I put a piece of thick gauze over the part of my incision the belt touches just for the added comfort. My stoma is close, too, and the first few weeks are tough, but not impossible. Did they put steri-strips over the incision? If they did you can cover them with a small piece of gauze so the appliance doesn't stick to them.

The wound vac is a great option for quicker healing but might not help your appliance since they are so close:( Do you have an ostomy nurse? If you don't you can find one in your area at www.WOCN.org.
Posted 4/19/2011 7:06 AM (GMT -7)
I have a scar from a right hemicolectomy surgery I had years ago before my ileostomy and my stoma is positioned about an inch below that scar and in the beginning I also had some problems due to that scar and tried different seals and applying heat to the wafer for about a minute after application and that helped. However I have also tried a product called coloplast protective sheets product number is 3210 they are a thin adhesive sheet that you can cut a piece in the centre of the sheet to fit over your stoma then place it on your skin then apply your wafer and honestly it sticks so well you will be amazed and I have never had a leak while wearing that, I also use those when I want to go swimming for added security. Good Luck and I hope that works for you
Doreen
Posted 4/19/2011 11:55 AM (GMT -7)
Thank you so much for your replies.  I have Home Health Care, but the Ostomy nurse at the hospital is the one who rubbed my skin around the stoma to where it weaps because it is so damaged, nothing can stick to it.  No matter how much glue we use.  She took off the glue one day using a dry hospital washcloth, and needless to say, even with a morphine pump, I cried like I did when I was a baby.  The skin around the stoma is almost back to normal, but I will talk with my insurance company regarding an Ostomy nurse.  The HHC have sent several nurses, and none have been successful for more than 20 hours.  I do limit movement and such, but thanks for all your ideas and I will see what I can do.  I like the idea of the wound vac, and will mention to my doctor when I go tomorrow.

My wound is 12cm x 4.5cm x2cm.  It seems strange to have it open like that.  I thought that was strange, but it sounds like someone else had something similiar.  How long did it take to close?  They are doing mine with dry aborbent stuff inside it and pulling it shut.  No strips are being used, just the sterile lengthwise adhesive over the pulled together wound.  Is that normal?

Posted 4/19/2011 12:44 PM (GMT -7)
I was really desperate early on and called the local hospital and made an appointment with the ostomy nurse. She was wonderful. My insurance paid it--$500, I was shocked it was that much and that they paid all of it.
Posted 4/22/2011 10:06 AM (GMT -7)
Hi...hope that lately things have gotten better! In July I had a total colectomy with ileorectal anastamosis. The anastamosis opened and the leakage caused serious complications, ended up in ICU, had an ileostomy performed. Due to a blood clot, the medication made my incision bleed and remain open. While in hospital, I had a wound vac for 2 weeks. Monday, Wednesday, Friday dressings were changed. I had daily ostomy leakage, and fortunately only a little got under the wound vac tape. I was disappointed with the ostomy appliances given, the wound care nurse was ruff and my skin was suffering, as I physiologically. Because of all this, she was adamant transferring me to a nursing home for a month. I disapproved. Upon discharge, I was so weak and malnurished, could barely stand. I didn't know what was worse, the wound or ostomy. Because of wound drainage, and no proper appliances, wound & stoma so close and scar dips, and not knowledgeable on application, my ostomy was leaking every few hours and then also had to do my own wound care. How I forced myself to do all this every few hours, as I could barely stand, in retrospect I still shake my head. This lasted for 2 weeks until a ostomy nurse finally came. By then I was physically stronger, but so desperate...should of spoken sooner, demanded help!! She referred a convex mold to me, I ran to the ostomy medical store instead of waiting for my insured order to be mailed and it worked! 9 days on! Regarding the wound in the first 2 weeks, I was using for about 6 days wet/dry dressings, 2x a day. Then the nurse brought Aquacel...a calcium/alginate dressing that speeds up healing time and doesn't produce leakage. The dressing turns to gel with wound drainage, so that solved that issue. Changed 1x a day, can go to every other day, but then a stench is given because it is an alginate product. Speeds healing time too. 2 weeks home, the wound vac came. I was doing well with the Aquacel, controling wound leakage, felt I had more control than I would with the vac incase of ostomy leads, so denied the wound vac and nurse was discharged. Again, hope your doing better :-)
Posted 4/23/2011 6:45 AM (GMT -7)
Petlover4, your wound sounds a very similar size to mine. The first time I saw my wound I almost passed out. It looked surreal... I could see my ab muscles in the bottom and it looked like a shark took a bite out of my stomach. I actually cannot believe they do not have you on a wound vac for something that big. Yes, the dressing system you are using is fine and will work... it will just take longer and the drainage gets under your wafer more easily as I mentioned in my other post. I had your dressing system for a while when my incision had only opened a little bit. Later though, I developed an abscess and had to have the whole thing cleaned out and opened the whole length of my incision again. That is when my surgeon recommended the wound vac. For bigger wounds like ours, the wound vac really speeds up healing as it gets rid of that yellow drainage stuff better so it doesn't just sit in the wound until you change the gauze and then also encourages blood flow to the wound due to the suction. I had my wound vac on for 6 weeks and then a silver aliginate dressing on for about 1.5 weeks to finish things up. One bad thing about the wound vac is that it was very painful for me, especially when the sponge dressing was changed (which a nurse came to do 3 times a week). However, my surgeon gave me some lidocaine to put in the sponge before it was pulled out, which helped immensely. I also took some pain meds during the day. However, I was told this pain was very unusual- most people only get it the first week or so. I just had some sensitive nerves. The pain was totally worth it though, as my incision healed beautifully and looks like a pretty normal incision scar now. I was amazed that it didn't end up to be a super wide scar judging by how wide the wound was at first. First the wound filled in the granulated tissue, and then it started to get narrower and narrower... almost like it was zipping itself up. Absolutely incredible! I think the wound vac helped with that too. I would definitely ask about it... especially with all the trouble you are having. It is expensive. My insurance covered 80% of the bill for the vac and the nurse visits, so it still cost me a fair amount. Again... money well spent though for less problems during the healing time and a nicer scar.
Posted 4/23/2011 7:43 AM (GMT -7)
I had a wound vac my last surgery in 2006. For me it was painless and healed much quicker than this wound. This wound on me is also close to my stoma and I have to wear small wafers or trim the larger ones back to provide room for the dressing. I think I have a handle on it now but when my wafers were failing within a day or so, the wound would fill up with stool which meant a long shower to get it clean. Now my wound is about healed except for an area a 2" stitch was found hanging out and later cut off.
Dave D
Posted 4/23/2011 4:26 PM (GMT -7)
I had a total colectomy and my wound sounds like it is very similar to yours. They are putting in the wound vac tomorrow. It should speed up the healing and decrease scarring. The wound is so close to the stoma that no on has been able to prevent contamination from the stoma sneaking into the wound for more than about 20 hours.
I wish us both good luck!
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