Leaking stoma

Sazzlej

Hi and welcome to the Ileostomy, colostomy and stoma support Group and I am sorry that we have to meet this way.

First of all please don't panic leaks happen they shouldn't but they do and I'm going try and help you tonight.

We have to establish what could be causing the leak and need to ask you about your stoma management with regard to changing your pouch either as a routine change or because of a leak.

Do you ensure that your skin is clean and dry before you attach a new pouch.

As you're only two weeks in your stoma could be changing size, do you measure your stoma and cut the hole in the wafer/flange accordingly. Cutting the hole too small or too large can cause leaks.

Do you have some one who could help you measure your stoma, it's not easy doing it by yourself.

When applying your pouch are you ensuring that you have a good seal all round. With this cold weather your pouches may be cold try warning them up before you apply to the skin

TIP place pouch under armpit whilst doing your clean up to warm it up 

Many people also use a hairdryer set on a low setting and run it over the pouch to aid sealing but the normal way is to press your hand over the pouch for up to 60 seconds and ensure that the flange is attached all round without any creases.

To help sealing apply flange extenders around the flange.

If you have barrier wipes or spray this can make the skin tacky and help adhesion

Do you have any creases or dips in your skin that could be causing the leak.

Any weakness between the pouch and your skin and your output will find it.

At your next change take a pouch out of a new box and try it, it is unusual to get a bad batch but it can happen.

Remember my opening words Don't panic and between us we will solve this for you and I will be on hand all night until midnight and I will work with you on this.

Please tell me the following

Type of pouch you are using

And all the accessories you are using

Is your skin broken or damaged 

Please come back to me and let me know how things are doing together with the information I have asked you for 

We will resolve this for you, please let me help you, you are not alone I promise you.

Ian

Online community champion for both the 

Ileostomy, colostomy and stoma support

and

Bowel (colon and rectal) cancer forum

Hi Ian,

thanks for all the tips and hints. 

Things settled down yesterday so I think I must have applied the bags incorrectly. 

What is a flange extender? I don’t have these or barrier wipes.

at the moment I am only using a variety of bags given to me by the stoma nurse - I don’t have a box. The ones I used yesterday are Salts Confidence BE and Dansac Novalife.

I haven’t cut any holes myself but I think that the hole that the stoma nurse cut for me might be too big as I have redness and sore skin surrounding where it is attached. 

Sarah

Sazzlej

Hi Sarah

Thanks for the update and I'm pleased to see that things settled yesterday and I hope you are leak free today 

I am surprised that you are still trialling bags I take it your stoma care nurse has asked you to keep a note of how you get on with each bag.

Do you have a measuring guide which ideally should be plastic and not paper or card, please let me know.

You can do your own research on bags and get samples from all the manufacturers let me know if you want to get your own samples and I will send you links to the manufacturers with an easy way to get them.

Flange Extenders 

These are banana shaped and fit over the pouch flange/wafer to extend the diameter of the pouch flange/wafer and can give some extra protection from leaks

Film Barriers

These come in either wipes or spray and serve two purposes 

1. Protect the skin

2. Make the skin tacky and help adhesion.

You can obtain samples of products from the sources shown in green below just click on each company and their sample page will open, select the products you would like samples of fill in the form and send it off and post man will deliver them direct to your door 

Independence Products free Samples

I like the above companies fusion applicator which protects the skin and makes the skin extremely tacky and really helps the pouch to stick. 

Also like their flange Extenders as they stick very well and move with the body.

Trio Ostomy Care free Samples

All their products are silicon based.

OPUS HEALTHCARE free samples

Have a good range of products which they sample including room deodorants in various fragrances. You can ask for samples of all their products.

CLINIMED free samples

A good range of products

Images of flange extenders

I hope this information is of help to you please keep coming back to me if you have any further problems and if you need help I am always around please just give me a shout at anytime.

Ian

Hi Sarah 

I've had mine for roughly the same time. I went to stoma clinic this week and they were concerned about how red and inflamed my skin around the site was. I think this started from when the hospital didn't change my bag for ages when I was recovering from 2 ops. I was using a flange extender too and barrier wipes but the spout of my stoma is downwards facing and always seems to be pouring out when I change my bag. Anyway my stoma nurse gave me a bag where the round it elevated and raised so that there is minimal contact of the output with the skin. It's been 3 days and it's already improved! Hope it works out for you x mags 

Hi Ian,

thanks for all the extra info and links. 

No I don’t have a measuring guide. The stoma nurse is due to come back and see me in 2 weeks. Do you think I should ask her to come back before then and show me how to measure the stoma myself?

I’ll take a look at the links you sent me and order some samples.

Thanks again

Sarah

Sazzlej

Hi Sarah

Pleased the information is of interest.

I am wondering how your stoma care nurse is measuring your stoma if you don't have a cutting guide, does she have her own.

Does this mean also you don't have a pair of pouch cutting scissors.

If you contact 

dansacuk.samples@dansac.com

www.dansac.co.uk

and send them your name and address details ask them for a plastic hole cutting guide tell them you are a new ostomate and are using their pouches and they should send you one.

If you don't have any major problems you could wait until your next scheduled appointment but I definitely would ask her to show you how to measure your stoma and cut a pouch so you know for the future.

The basic equipment you should have for pouch change is

New Pouch

Scissors

Measuring guide

Dry wipes

Disposable bags

Mirror

With optional accessories, which I think are essential

Flange extenders

Washers

Paste (non alcoholic - alcoholic stings like mad.

Barrier film spray or wipes

Stoma powder

Have you prepared an emergency bag yet for when you leave home.

Do you have a supply company, if so could you let me know their name and I'll be able to tell you what complimentary items you should get from them.

All the manufacturers will gladly give you samples if you ask, in my opinion you can never have enough samples as a backup that can also be used in your away from home emergency bag which amongst other items you should have

A Radar Key available from supply companies 

No waiting toilet card available from supply companies and also Macmillans.

More details can be sent on emergency bag contents if you want to see what should be included ( I will make one up for you tonight and send it off later, watch this space)

Hope this helps if you need information on anything else please just shout and I'll be there (online until about Midnight to night and all weekend.

Ian

Sazzlej

Hi Sarah

As promised contents of emergency kit bag.

1 x carry bag (toilet/make up type)

3 x Stoma bags (1piece)

or

3 X stoma pouches and 3 base plates (2 piece)
1 x Pre-cut template
1 x pack of sterilised wet wipes (should be supplied by supply company)
8 x dry wipes (should be supplied by supply company)
3 x Barrier rings

1 x small tube stoma paste (samples)
1 x Adhesive remover wipes (samples)

or

1 x Adhesive remover spray (samples)
3 x Disposable Bags (should be supplied by supply company)
3 x Barrier film wipes (samples)
1 x Pair of curved nail scissors to cut base plate to size (should be supplied by supply company)
1 x Ball point pen

1 x small mirror (should be supplied by supply company)
1 x Disposal bed pad to protect clothing or sanitise where you are sitting to change pouch (some supply companies supply them free)

1 x Can't wait Toilet card (free from supply companies or Macmillans)

Macmillans Toilet card

1 x Radar key (free from supply companies)

Optional but could be essential

Change of clothing especially under wear.

When do you need one anytime you are out shopping, visiting friends, having a meal out and when you least expect to need it!

Hopefully you'll never need it but you'll be glad you had one if you have a problem.

Ian

Wow they didn't give you a measuring guide? Mine went from 35 to 28 within a week so I can only assume that yours would have shrunk aswell - defo  don't wait 2 weeks that's ridiculous! They need to give you all the necessary stuff so you can manage it yourself. Can you not get them to send you out a measuring guide, I get calls almost everyday from the company about supplies so they should be on it. Hope it gets resolved soon x

Hi again Ian,

Thanks for the emergency bag contents guide.

I am missing most of those items so I will order some free samples today and I will contact the stoma nurse on Monday to ask that she comes round and shows me how to cut the base plate.

With the barrier rings / extenders is it obvious how to use them?

Also, any tips on how to stop the output being liquidy - I am taking loperamide but it doesn't seem to make much difference.

Thanks 

Sarah

Sazzlej

Hi Sarah

It's a good idea that you request your stoma care nurse to help cut the base plate but as you have your pouches pre cut I think you ask for a box of uncut pouches in case you have a change of stoma size.

A change of diet can effect your output some foods make it very watery whilst others can thicken up to porridge consistency.

I hope this helps (apologies it's lengthy)

To thicken up your output

Foods containing gelatine e.g. fruit gums, jelly, marshmallows, jelly babies.
Stewed apple.
Pectin (used for making jam).
Other foods: Eggs, cheese, milk, yoghurt, puddings, one banana/day and smooth peanut butter.

Foods to avoid which loosen output
Raw fruits and fresh fruit juices.
Raw vegetables.
Spicy foods e.g. curry.
Fried and fatty foods.
Leafy green vegetables.
Some sweeteners e.g. sorbitol have a laxative effect.
Remember to avoid fluids while you are eating as this increases the rate that food passes through the digestive tract. Sip rather than gulp fluids and eat slowly, chewing food properly.

How much Loperamide are you taking if you buying it over the counter the pack leaflet will tell you how many should take per day but if you get it prescribed by your GP he can increase it to a much higher dose.

There are products available which are inserted into the pouch which could thicken up the output in your bag, again samples can be obtained from the manufacturers, open up the link below for a list of manufacturers I have added a few more after the link

SOLIDIFYING PRODUCTS

Convatec Trio Diamonds samples

Respond sample request

Open link and scroll down and click on samples and request Ostosorb it's on 2nd page or below will take you direct to the page.

Ostosorb sample request

Trio Ostomy care Pearls samples

You have to scroll down the pop up box and look for PEARLS

I hope all of the above is of interest please keep asking it's no problem to help, advise and support you.

Ian