Stoma and loose stools help

Hi and welcome to the Mac family and I am so sorry to hear of the problems your father is experiencing.

I would like to help but if I could ask for some more information first 

Could you tell me the following.

1. Is your dad using a 1 or 2 part pouch
2. Is the flange/wafer/ base plate flat or convex
3. What products do you use in addition to the pouch and Coloplast flange extenders (semi circular stickers)
4. Does he have an ileostomy or a Colostomy

Also could you tell me the complete procedure that you use when taking off an old pouch, cleaning and attaching new pouch including everything else you do.

Once I have the above information we can start to build a picture and examine alternative products that are new on the market that could make your dad's stoma management alot easier and hopefully leak free.

If you could come back to me I sincerely want to help you and work with you to resolve the problem.

When reply please start you message by doing the following

1. Type @Bodach 
2. Look for the little blue box
3. Click on the box, this will change to  and in green when you send your message and I will be alerted that you have responded.

I look forward to receiving your reply.

Ian

Hello,  and thank you for taking the time to reply.

Dad has a 'colostomy' and uses a 2 part system.

I use the little '3m wipes to clean around the stoma and wait until area is dry. First I stick on the base plate. I manually cut the hole to size and make it the largest size as we had problems when it was cut smaller. Things just didn't seem to push through. 

 Then I stick 4 'Coloplast' semi circular stickers around the edges of the stuck down base plate making sure there are no gaps.

I then put 'Adaptil' the lube stuff that helps things to drop down into the colostomy bag.

Then I click his bag into place.  Sometimes it works well for a couple of days, but then he will have a 'pancaking poo' and it pushes the base plate and stickers away and leaks.

I wonder if there is a better system than this?  This is the system that we stuck with after months of trying different wafers, build up pastes, one part bags etc etc. It seemed to last the longest [a couple of days] sometimes before needing changing.  I'm wondering if Dad is having more problems again as the carers in the nursing home do not have much time to spend with each person. It may be that they are not applying it very well in the first place, as they probably don't have the time to sit and wait for his skin to dry. It used to take me around 10 minutes to do it properly when I helped him at home with it sometimes.

Thanks for coming back and giving me some more information.

Your assumption about the carers not having time to do things properly is probably correct and I say this from a personal point of view as I was in a rehabilitation care home during last summer and the care assistants insisted on doing the change the fact that I have doing it myself for 5 years didn't seem to mean anything to them, I think they wanted to practice but they would not listen when I told them they were doing it wrong (remember they is no right or wrong way just the way that works for your dad)............... however let's get back to your dad.

Most of the following will be old hat to you but I do believe we all need to review our stoma management procedure every so often as our bodies change or the products we use are no longer compatible with our bodies.

Hole cutting

You say you cut the hole to the largest size.

Do you or in fact the care assistants measure the stoma size at every change and cut the hole accordingly.

Ideally the hole should form a close fit to the stoma but it should not be more than ⅛” oversize.

HAVE YOU TRIED THIS (no measuring no cutting)

Convatec mouldable base plate (no cutting required)

This might be of interest to you and something you might consider joining, lots of useful information in printed form and online

Convatec me+ program

SUGGESTION.

Have you tried also using a washer on top of the skin before applying the base plate.

CLEANING

You should use a dry wipe to clean away the faeces from the skin, then wet a dry wipe and wash the the skin with clean warm water to remove any excess then pat dry.

Don't be tempted to use wet wipes as they can interfere with the adhesive on the base plate.

NOTE

At this stage inspect the skin for any small hairs and shave any way (adhesive won't adhere properly to hairs)

Once the skin is dry apply the barrier film to the skin, this should also make the skin tacky to touch.

APPLY the base plate which should have been warmed, I have my pouch under my armpits whilst preparing my skin, attach the base plate to the skin and firmly hold it in. Position for up to 1 minute to ensure it achieves good adhesion then run a finger all round the wafer to iron out any creases.

APPLY the banana shaped plasters all round to complete the seal, ( I use to types of flange extenders to get a really good seal.

ATTACHING THE POUCH

Blow into the bag to separate the sides insert some Adapt or a similar product into the pouch and click in place.

SOLIDIFYING PRODUCTS

PANCAKING read this

PANCAKING

Drinking lots of fluids imperative

Diet and Fibre intake should be looked at.

How to prevent leaks

SORE SKIN/LEAKAGES

QUESTION

As the stoma is recessed are you using a CONVEX BASE PLATE.

You, but mainly the care home staff should be checking the pouch at regular intervals to check how full the bag is, no more than ⅓ to ½ full before emptying and also to check that the stools are dropping down all it needs is a pat to dislodge to clear the any blockage.

IT IS POSSIBLE TO GET LITTLE FOAM BRIDGES THAT KEEP THE SIDES OF THE BAG APART  

Stoma Bridge

Alternative barrier film and flange extenders

I would suggest that it might be advisable to draw up your own instructions on how you want your dad's stoma managed and give it to the care home staff.

A nice A4 sheet printed with the instructions and laminated to be placed by your father's bed side do a few copies just “in case” it disappears.

It is to the benefit to the care home staff to get it right and eliminate so many leaks which they have to clean up (when you are not there) and reduce laundering of bed linen and your dad's clothing.

Please let me know how things progress and just ask if you need any help with product selection. I am always available to offer suggestions.

When reading the above CLICKING ON ANY OF THE GREEN TEXT WILL OPEN UP NEW PAGES FOR YOU

I do hope this helps but we can keep addressing it until we get the problem solved

Ian

Thank you so much for your comprehensive reply Ian and taking the time to compose it all. I really appreciate it.

I agree that if the care home staff can get it right each time that it will save a lot of extra cleaning up and washing of clothes and bedding each time. It will give my Dad a bit more dignity as well as he has always hated having the stoma, and I know he is embarrassed when it leaks and he cannot look after it himself anymore.

I will read through all of the products listed and try to order some different bits and pieces. I actually forgot about the step of applying a barrier cream and as Dad is developing dementia he forgot to tell me. Luckily his skin has not been sore at all, so the care home have been looking after him well in that respect. 

He is due to move to a new nursing home soon and I am hoping that I can have a chat about his stoma with them. They were very open to hearing ideas on how to help which is good. Thanks for the idea of laminating a few sheets with the steps on. I have done one for Dads current home but it's a bit dog eared now, I didn't think of laminating it!

Kind Regards 

Hi again,

I wondered if you know how I would request an appointment for my Dad to see a stoma nurse again once he has moved to his new nursing home. Do you think the home manager would know?

I have been looking at a lot of the products, and I am guessing a stoma nurse would have all sorts of products with her that we could try on my Dad. It was never easy for me to just ring up the companies and order anything to try. I remember now that I had to try and get everything through a prescription each time. I don't know how I would be able to request any samples now that he is in a nursing home.

Appointment with a stoma nurse 

I know it's probably a long time since your dad was under the care of a stoma care nurse but if you can remember who she was and whether or not she was hospital based or a community nurse you could just call her and ask her to call.

or

You could just call the hospital stoma nurse department.

or

And this you may not be aware of this but most supply companies have stoma care nurses who work in the community.

My stoma nurse stopped calling on me December 2013 and I had no trouble contacting her when I had my new one fitted last summer.

Getting samples

I never phone anyone I send emails and if you see on the links I sent over they are all sample request forms and that is the way I do it. I am more than happy to prepare you links that you can follow if you wish just let me know what you would like to try, honest it's no problem

I shouldn't think it would be a problem to have samples sent to a nursing home.

Yes, stoma care nurses do carry samples but sometimes they are very limited. 

I still ask for samples when I need to try something new, I've even received sample pouches from 10 different pouch manufacturers when my nurse suggested I try different ones, I only sent one email with all the manufactures addresses in the bc box and each one sent me samples without problem or question.

Supply companies can also supply samples if you ask but they have to get them from the manufacturers first before they can send them to you.

Anything you need to know just ask and I will supply the information you need I do mean it when I day honestly it's no problem.

Hope this helps if not please give me another shout.

Ian

Thank you so much for your reply.

Kind Regards

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