Come on over to the United Ostomy Association of America support forum for assistance from its ranks of stoma-sporting members. www.uoaa.org
A few ideas to get you through the immediate crisis of leaks:
1. Ostomy nurses are not all knowledgeable. You will find a number of individuals with ostomies who, when recounting their early days with a stoma, report disheartening experiences with WOCNs. Self-study and learning/sharing from others with an ostomy is the road to success.
Each of the main ostomy manufacturers (Hollister, ConvaTech, Coloplast) have 1-800 telephone numbers with trained customer service representatives. Do not hesitate to give a call to the supplier of the brand your mother is using. The 1-800 numbers are available on the UOAA forum.
2. A loop ileostomy (which your mother likey has) is the most diffcult of the ostomy types to pouch successfully. The larger/dual stoma and the placement of the stoma higher up the tract of small intestine contribute. The fecal output is high in digestive enzymes and highly liquid in consistency, which adds to a tendency for wafer leaks.
Be certain that the peristomal skin (skin around the aroma) is clean and dry before applying the wafer.
Do NOT use any soaps or body wash with added aloe or lanolin or essential oils. Preferred soaps: Neutrogenia soap for sensitive skin; Ivory bar soap; Cetaphal brand bar soap; any glycerin bar soap; Johnson & Johnson Basis bar soap.
Do NOT use any premoistened “baby wipes” or other hand wipes.
If you want a premoistened towellet, there are wipes designed specifically for ostomies. Ex. Safe ‘N Simple peristomal adhesive remover wipes, about $6 per package of 30 wipes (available from your ostomy product supplier as well as available on Amazon).
Warm the wafer before applying to the skin. A wafer is composed of pectin and a hydrocolloid matrix. It has no adhesive stickiness of its own. A wafer bonds to the skin by a reaction mediated by heat/body heat. Pre-warming a wafer aides in securing an air-tight seal. Use a hand held blow dryer on a medium setting, allowing the warm air to pass over the wafer for 30-45 seconds.
After applying the wafer to the skin place your hand over the wafer and hold in place firmly for 2-3 minutes. Use your fingertips to apply pressure to the wafer and to smooth its surface of any wrinkles or air bubbles.
4. Beware of ostomy/stoma paste
Ostomy paste is the single greatest misnomer that causes undue confusion and distress to new oatomates.
Ostomy paste is NOT a glue. It has NO adhesive qualities. Ostomy paste is not an adhesive material as its name implies.
Most people do NOT need to use ostomy paste. And yet almost every WOCN provides it to new patients and encourages it use.
What is the purpose of ostomy paste? It is meant to fill small divots or small creases in the skin to make a level skin surface. It is meant to fill small indentations in the skin. Ostomy paste is analogous to putty used to fill crevices between tiles in creating a kitchen counter or backsplash.
If you have been ostomy paste thinking that it is Elmer’s glue this is likely the source of your leaks. If you are making a ring of paste on the wafer, thinking that you are making a ring of glue . . . Stop and desist. A ring of paste, in this instance, is like a ring of cake frosting. Highly liquid and highly corrosive loop ileoatomy output will easily migrate through the ring of paste, undermining the wafer, and lead to distressing leaks.
What to use? Almost all loop ileoatomies will need to use what is called an “adaptic barrier ring” to prevent wafer leaks.
An adaptic barrier ring is a donut shaped sphere of silicone or hydrocolloid/elastic fiber matrix. It is placed around the stoma (or on top of the cut-out opening for the stoma on the wafer) and serves in function analogous to a gasket on a water facet.
Each of the main ostomy product manufacturers make their own proprietary line of barrier rings. The Top Pick, along most ostomates, is the ConvaTech Cohesive Ring Seals (regular or slim). Coloplast makes the Brava Adaptic Barrier ring.
You will want to become familiar with an adaptic barrier ring. Fortunately, YouTube has any number of videos that explain barrier rings and how to use them.
4. Finding the best ostomy wafer/pouch system is an individual process
The wafer/pouch system that your mother was provided with in the hospital may not be the best/optimal system for her. Hospitals contract with only one ostomy manufacturer, allowing them cost savings. However, every person has unique ostomy pouch needs based on the topography of his/her abdomen, skin characteristics, shape and length of stoma, incision line, etc. Each of the ostomy product manufacturers have unique differences in the design and composition of wafers, pouches, and accessory supplies.
It is beneficial to call the manufacturers and request product samples to find the best pouching system for each person. This is time well invested, even if the stoma is temporary.
5. Use of an ostomy belt or belly binder
An ostomy belt is a 1/2” wide length of elastic that attaches to clips to both sides of an ostomy wafer. It holds the wafer close to the body, minimizing friction and movement that can loosen the wafer/skin bond and cause leaks.
A belly binder or belly band is analogous to a maternity belly band. It is a 7”-10” wide elastic band that fits around the abdomen. Its mild inward compression helps to hold the wafer/Pouch close to the body and minimize movement that might contribute to leaks.
5. Body type
A “fluffy abdomen” with folds of adipose tissue will be more
challenging to pouch than a flat abdomen.
A fluffy abdomen will often do best with a thin/low profile wafer as compare to a convex wafer. Thin/low profile wafers include the Coloplast Mio wafer and CyMed MicroSkin wafer. The Coloplast Mio Flex is a new addition specific for those with rounded/protruding abdomens or prominent hernias.
Here again, talking to the customer representatives at any of the ostomy manufactures can be hekpful. These people know their stuff.
OK . . . A few ideas to help you trouble-shoot. My sense is that the source of the leaks is from over-generous use of ostomy paste (thinking that the paste is a glue-like adhesive, which it is not). Or that you Mother is using a wafer that has convexity and rigid.
The members of the UOAA will also be able to problem-solve with you.
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.