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There are many things that can happen to the stoma and to the skin around the stoma that an ostomate can experience. A big compliant is leakage concerning the appliance. Sometimes the all three issues tie in with each other. If you have an ostomy and you have leakage problems the stool can get underneath the flange or wafer as it's also called, and sit on the skin and cause ailments with the stoma and surrounding area. Issues with an ostomy are very common and if they become apparent they must be dealt with right away or the problem can worsen.

If someone has had a stoma in the same place for a long time the skin becomes weaker from the usage of appliances and acids in the feces and urine and is easily susceptible to infection, redness, and can break down. I will list a series of the regular problems one might encounter and try to give the best advice on how to deal with them. It is better in the long run to eliminate troubles at the source then to let them linger.

Please be aware that the recommendations given should be used as a guide and not substituted for professional medical opinions. If you are in any doubts about the condition of your skin and stoma you should seek therapeutic advice as soon as possible.

Leakage Problems and Possible Solutions

Leakage can occur anytime and anywhere. It is one of the most frustrating things for an ostomate to deal with because when you have leakage it is embarrassing if you are not at home to deal with it and can disrupt your daily routine. Even when you are homebound it can be a pain.

There are many ways you can avoid leakage or stop it from happening.

Changing the Appliance

    1. When you change your bag and flange and clean the skin access the condition of it. Make sure the skin is healthy and there is no redness or any other probs.

    2. Do not use baby wipes or anything that will leave a residue on the area as it can cause leakage and maybe even irritate the skin. Just because they are good for babies does NOT mean they are good for stomas. Use a basic washcloth that wont leave lint or small pieces of fabric around the stoma. You can use soap but I would suggest a mild one such as Ivory and you probably don't even need to use a cleanser. If you do make sure you rinse it off very well as the new flange may not stick like it should.

    3. Ever hear of the old saying "less is more"? Using skin preps such as barrier wipes and adhesive wipes is OK, but if you have troubles with the flanges sticking right you should not use any kind of preps as they may cause them to not adhere they way they should. Try not to remove and old adhesive off the skin from the old flange either. People have stated that just using warm water and getting off the stool is the best thing to do and they get longer wear time.

    4. Make sure the skin is 100% dry. A new wafer does not like moisture and it can cause it to not stick properly.

    5. I have been told that warming up the adhesive part of the flange before applying can help. Use a hairdryer at a LOW setting for only a few seconds, and then put the wafer on. Also pressing on it after putting it on (make sure you don't press on the stoma) can help it adhere better.

    6. It is not a good idea to use lotions or creams. If you do use them make sure they are specifically designed for STOMA care and that is has completely absorbed into the skin. Do NOT use Vaseline or any kind of hand creams or lotions for dry skin, using them is a bad idea.

    7. Make sure if you cut the flange yourself to fit the stoma that no skin is really showing. If it is cut too big waste will get under the wafer and sit on the skin. Acids and enzymes in the feces will start to make the skin red and possibly break it down. If you use per-cut flanges make sure they are the right size for you and not too big or too small.

    8. Removing the bag and flange more then 3 times in 24 hours is asking for trouble. Excessive changing will not help matters and can create additional ones.
Using the Right Appliance and Supplies for your Stoma
Using the proper appliances for your needs is very important. Here are a few tips about choosing the right stuff.

If your stoma is flush (flat and does not stick out and is close to the skin) then using a convex insert with the flange or using a wafer that has convexity built into it is a good idea. It will help the stoma protrude more and the possibility of stool or urine getting under the flange and sitting on the skin is minimized.

Stoma paste is only good for chalking and fills in gaps and folds in the between the skin and flange. It is NOT made to make the appliance stick better. Also do not use it on red and raw sore skin or others skin problems as it contains a lot of alcohol so it can dry quickly and it will sting and hurt the damaged area. Try using Eakin Seals or Coloplast Strips around the stoma since they do not have alcohol in them or anything that will irritate. They also have healing properties in them. They may look too thick and bulky when you put them on but they absorb into the skin during wear time.

There is something else called a "Belt" that people swear by, even though they are not the most fashionable thing to look at. They are kind of like the belts you wear with pants. The attach to the bag and/or flange and if the adhesive comes off the wafer wont fall down your leg or come right off. They are not going to stop leaks totally though as the flange will not be secure. They should only be used for additional defensive purposes and not as a solution.

Stoma powder is good for weeping red skin. But should not be used in OPEN wounds. I use it a lot. A small bottle will last a long time, as not a lot is needed. It's a white substance and is not absorbed into the skin right away. When it's applied the excess should be removed so the wafer does not have trouble sticking. However it does not really interfere with adhesion.

Make sure you use the products that are made for the type of ostomy you have. For example, Urostomy supplies are not made for colostomies and ileostomy appliances are not made for urostomies and so on.

Wear time of an appliance is about 3-4 days. Some people can get 5 days, but a person should never have one on longer then that. You do not want to leave it on until it falls off or starts to leak. If you do leave it on too long you are just asking for troubles and anyone with an ostomy knows that leakage is the start of skin problems.

Additional Problems That May Cause Leakage
There are some other problems with waste and changes to the body that may cause some unpleasant troubles.

An ostomate might experience "pancaking". This happens when the feces is too thick and sticky there is no air in the bag and it clumps around the stoma and gets under the flange and lifts it off the skin. Try putting some baby oil (just a small amount) on the inside part of the bag that touches the stoma, this will keep the pouch from sticking to the stoma and will separate it. Also rapping up a few small sheets of toilet paper and putting them inside the pouch on the sides may help keep air in the bag. If you use a bag that has a filter built into it then use the covers that come with it and put them over the filter. This will help keep gas in the pouch so the stool can side down bag. None of these tips are full proof, but they might help a bit.

Diarrhea and watery feces can cause major problems as it can seep underneath a weak flange or pouch and getting out the sides or bottom and running down your belly. The consistency of the waste is related to diet. Try to figure out what foods or beverages cause this for you and try to avoid them or consume them in moderation. Once you know what foods make this happen you can eat whatever you want as long as you are prepared for it.

If you have lost or gained weight the layout of the stoma to change due to creases, folds, or indents in the skin around it and appliances struggle to adhere. There is no too much that can be done about it. However you might try to suck your tummy in when putting on the flange. This helps to prevent the wafer from creasing when you sit down.

Skin Ailments and Problems

The most common problem ostomists face is skin troubles and they are usually created from leakage and improper care. Below I will list some problems and provide possible solutions and/or advice.

If the skin is red, sore, and tender it means that stool has gotten under the flange and it is constantly sitting on the skin. Try using a convex flange or insert to make the stoma protrude more. Make sure you are cutting the hole on the flange the appropriate size and make sure per-cut wafers are the right diameter. Also use eakin seals or coloplast strips around the stoma and NOT paste. Another thing that might help is stoma powder. Applying it to the affected area will help soothe it.

An allergic reaction can occur from the products being used and the area affected is usually the place it is sitting on. It is a lot more common to be allergic to flanges and pastes then anything else. I have never known another ostomate to be sensitive to to eakin seals. The first step is to identify what is causing the reaction. You might want to do a patch test on the arm with certain supplies and adhesives. If the entire area around the stoma is red you are likely to be having a reaction to the flange. Try a different appliance from another manufacturer, as they are more then happy to give free samples. Also try using the powder on the red area for a little while until it heals.

If there are whitish skin growths around the base of the stoma, which are called Granuloma, then it would be best to visit your ET nurse. A medical professional should deal with this ailment. He/she will take the proper measures to get rid of it. This condition should not interfere with the flange sticking unless it's a severe case.

If there appears to be raised, red, moist, painful bumps then it might be a yeast infection. A visit to the ET nurse is in order to make sure its not something else and they will tell you how to treat it. They might advise on using an antifungal cream you can get over the counter at a pharmacy and using stoma powder after the agent is applied. The nurse might also tell you to change the type of flange you use depending on the severity of the infection and to also use a skin sealant.

Thinning and over hydration of skin around the stoma from prolonged excessive moisture. Skin may appear red, pink, white, or gray with raised bumps. This is more common with urostomies and ileostomies and/or high waste output stomas. Try using a convex flange or insert and that the hole being cut for the wafer is the right size and fits the stoma properly. A trip to the ET nurse is in order too for this type of condition if it is rigorous and further treatment may be necessary.

Appliances that do not fit right may cause cuts on the stoma, ulcerations and stripping of the skin. Once again make sure the hole for the wafer is cut to the right size and is not cutting into the stoma. Try experimenting with different products until you find one that is the most comfortable. Convexity might be a good choice, as the material will turtleneck the stoma and cushion it after it is applied. However it does not hug the stoma right away. Make sure you are not using preps or other accessories in excess and if you wear a belt with the appliance make sure it is not on too tight. A visit to the ET nurse might be in order.

Another condition called Pyoderma Gangrenosum is and ulcer characterized by a bluish hue and tenderness in the affected area. It is related to inflammatory bowel disease and rheumatoid arthritis. You will need to see the ET nurse and she/he will treat the ailment in the appropriate manner. Steroid injections in the affected area are the usual treatment. It might be necessary to change the products used until it heals, but the nurse will advise on that.

Other Problems with Ostomies
If blood is noticed in the pouch then the first to do is to determine whether it is coming from the stoma or the inside of the bowel. IF it is coming from the inside of the body then it is best that medical advice be sought as soon as possible. If it is coming from the stoma then it is not as big deal. Stomas are made out of blood vessels and muscle as it is part of the intestine and the slightest nick will cause it to bleed. However it will heal quite fast. If you are rough when cleaning you stoma during an appliance change it might bleed and it's nothing to worry about. It does not hurt, as there are no nerves in it. Remember not to cut the hole too small for the flange.

If a lot of odor is causing some grief then there are special deodorizers that can be used for ostomies. They can come in liquid or in a tablet that can be taken orally. They are made by the same suppliers that make the rest of the products that are used. If the deodorants are not helping you can go to the nurse or doctor to make sure it is not an infection causing the prolonged odor.

Prolapse of the stoma. This happens when the bowel weakens and comes out via the stoma. It is a very painful condition and can be serious. Professional medical advice is needed and if it becomes severe possible surgery is necessary if it cannot be corrected by any other means. In certain cases it can be fatal if left untreated. However in most cases it can be treated without abrasive solutions.

Retraction of the stoma is the opposite of a prolaspe. This can happen when the bowel pulls back inside the body taking the stoma with it. Then it will basically leave a hole in the tummy where the stoma should be instead of having a spouty ileostomy stoma or a flatter colostomy one. Getting a seal with it is a nightmare and convexity definitely should be used and not "flat" wafers. If it becomes too big of an issue then some kind of surgery may be required to fix the problem.

Blockages. These occur when an ostomate has eaten something that did not digest right and has plugged the bowel or stoma and feces cannot pass. Also adhesions or scar tissue in the bowel can swell and cause walls or obstructions that stop the flow of stool. They can be mild or severe. Symptoms include and are not limited to pain and tenderness in the stoma or abdominal area, no output from the stoma for a period of more then 4-5 hours, cramping, nausea and /or vomiting, swelling of the stoma, and high watery output which can sometimes be green in appearance indicating bile from the stomach. If the pain is severe and the symptoms have lasted more then a few hours a person should seek medical advice immediately. This problem should never be left unattended. If it is a mild blockage then drinking hot tea to increase fluids in the body and output, having a warm bath or shower and while in there massaging the tummy can help release an obstruction. Some say that having a glass of wine helps relax the muscles in the abdomen.

Phantom Rectal Pain. This is a common complaint of new ostomates. The sensation of having to pass a movement thru the rectum the old fashioned way even though they actually cant anymore. The system needs time to adjust to the new plumbing and the mind makes the body think it is still able to go to the bathroom the regular way. Sitting on the toilet as they would normally do if it was still possible to poop the usual way can help to trick the mind and system into believing its had a bowel movement and it will ease the pressure down there. Over time PRP will fritter away and disappear altogether.

And finally Parastomal Hernias. These are characterized by a bulge in the around surrounding the stoma, redness, and pain. For hernias that are small and not too bad a hernia belt can be used. Nu-Hope makes them and I'm sure other manufacturers do too. If the hernia is large and causing too many difficulties then medical advice is needed and possible surgery to rectify the problem.

Please be aware that the recommendations given should be used as a guide and not substituted for professional medical opinions. If you are in any doubts about the condition of your skin and stoma you should seek therapeutic advice as soon as possible.

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DISCLAIMER: The documents contained within these WWW pages are presented expressly for informational purposes only. In no way are any of the materials presented here meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such. ALWAYS check with your doctor if you have any questions or concerns about your condition, or before starting a new program of treatment. Ostomy Network of Windsor is not responsible or liable, directly or indirectly, for ANY form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by these documents.
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If u find this site useful, please click on these links. Its free to you and helps pay our bills. Thank you.