Aqx99 wrote:1/8th is the typical measurement, though there are exceptions. My ostomy nurse has me cut my hole much larger because of how my stoma lies flush with the skin. My output was going straight under the wafer when it was cut close, so she has me cut a 2 inch circle out and protect my exposed skin with paste. Everything is trial and error when it comes to your ostomy set up. Every single stoma is different and has different needs to make the pouch work.
MissMolly wrote:Mike:
Do not be overly concerned of providing a strict 1/8 th inch allowance around the stoma.
Remember that stomas move in the course of a day. Aromas move in and out (retract and protract) in length, in concert with normal intestinal motility. Stomas also expand and contract in width, as bloodflow and interstitial fluids ebbs and flows.
Keep a flexible mindset when making your template. I keep to a 1/4 inch leeway when cutting my wafer. I use Cavilon Skin Protectant as part of my paristomal skin care routine, protecting the exposed paristomal skin from the caustic digestive enzymes. Ann (aqx99) has shared that she uses a dab of ostomy paste as a sauve on the exposed paristomal skin to minimize skin irritation.
A wafer trimmed too close has its own risks. The edges of the water can cut into the stoma and cause bleeding and trauma. A highly active aroma can be restricted by a wafer that is trimmed too close.
You may want to explore moldable wafers - offered by ConvaTech and Hollister. Moldable waters employ extended hydrocolloid material that encircles the aroma like a turtleneck. Moldable wafers are especially effective with stomas that protrude 3/4 inch to one inch. The moldable wafer has the advantage of no exposed paristomal skin - and, by extension, low incidence of skin irritation.
I endorse your decision to change your wafer more frequently. Changing the wafer every 3 days will give you opportunity to inspect the skin more frequently and to take a “naked” shower (a shower without wearing an Ostomy wafer, freely airing the skin). Removing a wafer in and of itself does not increase skin irritation. Take care to push the skin away from the wafer using your finger tips. Avoid pulling the wafer away from the skin. Pulling the wafer can irritate the skin by wisking away the outer epithelial layer of skin.
Many individuals with permanent ileostomies wear an elastic tube garment to hold the ostomy pouch close to the body when engaging in sports. Women’s maternity belly tubes are comparable. A valuable resource for undergarments designed specifically for individuals with an ostomy is a company named “Comfizz.” Comfizz is a family-owned company in England that has earned NIH recognition for their quality and product designs.
I have worn their camisole top and boy shorts for several years and highly recommend them.
http://www.comfizz.com
Best wishes,
Karen
NHMike wrote:Aqx99 wrote:1/8th is the typical measurement, though there are exceptions. My ostomy nurse has me cut my hole much larger because of how my stoma lies flush with the skin. My output was going straight under the wafer when it was cut close, so she has me cut a 2 inch circle out and protect my exposed skin with paste. Everything is trial and error when it comes to your ostomy set up. Every single stoma is different and has different needs to make the pouch work.
The flange on mine is 2 1/4 inches so a 2-inch circle wouldn't leave much of the wafer sticky part to attach to the skin. My stoma is currently an oval about 1.5 inches wide and 3/4 inch high and it was cut relatively close - 1/8 inches last time. So I'll give this one a try. The tracing looks like a walnut right now. I'm also planning to go to three days per change to decrease the amount of irritation. Changing the bag is a pain but it's a good feeling after a change.
MissMolly wrote:Mike:
Do not be overly concerned of providing a strict 1/8 th inch allowance around the stoma.
Remember that stomas move in the course of a day. Aromas move in and out (retract and protract) in length, in concert with normal intestinal motility. Stomas also expand and contract in width, as bloodflow and interstitial fluids ebbs and flows.
Keep a flexible mindset when making your template. I keep to a 1/4 inch leeway when cutting my wafer. I use Cavilon Skin Protectant as part of my paristomal skin care routine, protecting the exposed paristomal skin from the caustic digestive enzymes. Ann (aqx99) has shared that she uses a dab of ostomy paste as a sauve on the exposed paristomal skin to minimize skin irritation.
A wafer trimmed too close has its own risks. The edges of the water can cut into the stoma and cause bleeding and trauma. A highly active aroma can be restricted by a wafer that is trimmed too close.
You may want to explore moldable wafers - offered by ConvaTech and Hollister. Moldable waters employ extended hydrocolloid material that encircles the aroma like a turtleneck. Moldable wafers are especially effective with stomas that protrude 3/4 inch to one inch. The moldable wafer has the advantage of no exposed paristomal skin - and, by extension, low incidence of skin irritation.
I endorse your decision to change your wafer more frequently. Changing the wafer every 3 days will give you opportunity to inspect the skin more frequently and to take a “naked” shower (a shower without wearing an Ostomy wafer, freely airing the skin). Removing a wafer in and of itself does not increase skin irritation. Take care to push the skin away from the wafer using your finger tips. Avoid pulling the wafer away from the skin. Pulling the wafer can irritate the skin by wisking away the outer epithelial layer of skin.
Many individuals with permanent ileostomies wear an elastic tube garment to hold the ostomy pouch close to the body when engaging in sports. Women’s maternity belly tubes are comparable. A valuable resource for undergarments designed specifically for individuals with an ostomy is a company named “Comfizz.” Comfizz is a family-owned company in England that has earned NIH recognition for their quality and product designs.
I have worn their camisole top and boy shorts for several years and highly recommend them.
http://www.comfizz.com
Best wishes,
Karen
Aqx99 wrote:NHMike wrote:Aqx99 wrote:1/8th is the typical measurement, though there are exceptions. My ostomy nurse has me cut my hole much larger because of how my stoma lies flush with the skin. My output was going straight under the wafer when it was cut close, so she has me cut a 2 inch circle out and protect my exposed skin with paste. Everything is trial and error when it comes to your ostomy set up. Every single stoma is different and has different needs to make the pouch work.
The flange on mine is 2 1/4 inches so a 2-inch circle wouldn't leave much of the wafer sticky part to attach to the skin. My stoma is currently an oval about 1.5 inches wide and 3/4 inch high and it was cut relatively close - 1/8 inches last time. So I'll give this one a try. The tracing looks like a walnut right now. I'm also planning to go to three days per change to decrease the amount of irritation. Changing the bag is a pain but it's a good feeling after a change.
Mine is also 2 1/4, but it sticks just fine. I change it every 4 days. I also use an Eakin ring to help seal up where I have creases in my belly that allow output to pool under the wafer. If you are having leaking, I suggest examining your wafer after taking it off to see if you can find where the leak is getting through. You should not have irritation under the wafer at all, it should be normal skin.
NHMike wrote:I haven't had leakage problems - just irritation.
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