Sister is new to stoma and we need help

Hi and welcome to the online community

I'm sorry to hear that your sister is struggling with her stoma bag. Could I suggest that you join and post in the ileostomy, colostomy and stoma group and I'm sure you'll find plenty of help there.

To join just click on the link I've created and then choose 'join this group' on the page that opens. You can then introduce yourself and post questions after selecting 'start a discussion' and join in with existing conversations by clicking on 'reply'.

When you have a minute it would be useful if could pop something about your sister's journey so far into your profile as it really helps others when answering or looking for someone with a similar diagnosis. It also means that you don't have to keep repeating yourself. To do this click on your username and then select 'Edit Profile'. You can amend it at any time and if you're not sure what to write you can take a look at mine by clicking on my username.

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Hi and welcome to your online community.

My name is Ian  and I have the pleasure of looking after the Ileostomy, colostomy, urostomy and any other stoma support and I would really like to see you over there very soon.

I am very sorry to hear about your sister and her pouching issues and I would like to help her find solutions to the problem.

First of all it doesn't necessarily follow that ostomates should be plagued by leakages; they happen for a reason and we need to find the reason for your sister having them.

The usual causes of leakages are

• The hole is being cut to the wrong size.
• Allowing the pouch to get too full.

At 4 weeks her stoma could be still reducing in size, and at every pouch change her stoma should be measured and the hole cut out accordingly. The hole must fit exactly the shape of her stoma, If the hole is too big, the skin around the stoma is exposed to output, which can damage the skin. If the hole is too small, it can rub against the stoma or irritate the skin around it. By being too large or too small can contribute to leaks occurring

After the soiled pouch has been removed and she has cleaned up her skin she should examine the skin around the stoma for any dips or creases that might affect the ability of the flange lying flat against the skin.

If she finds any dips, creases or operation scars There are several things that can be tried

• Fitting a protective barrier seal between her skin and flange.
• Filling in any dips with stoma paste

At any place on the skin where the flange is not making a good adhesion will allow waste output to seek away out and cause leakages.

Depending on the type of stoma your sister has it might mean a change of pouch from a different manufacturer or even changing to a convex pouch (a decision that only your stoma care nurse can make with you).It is not unusual to experiment with different pouch until one is found that ticks all the boxes.

Adding flange extenders all round the pouch wafer can help stem leakages

It is essential that her pouch is emptied when it reaches ⅓ full

As pouches have the filter in different positions it is imperative that the output does not reach the filter and block it which could result in gas not being able to filter out and cause ballooning 

Ballooning occurs when air from the stoma inflates the bag and cannot escape through the filter. The resulting air pressure can cause the adhesive to detach from the skin. 

If your sister is using a one piece drainable pouch it is possible to release the gas build up by carefully opening up the tail and letting the gas out.

Overnight leakages are the worst they catch us unaware and not at our best to be changing bed linen and ourselves so we have to look at our eating habits and the suggestion is, as she probably was told prior to leaving hospital, to eat small meals throughout the day with her main meal being at lunchtime and her last meal of the day (small one) being between 5 - 6 pm. The theory is that the tea time meal, depending on the type of stoma she has, ileostomy or colostomy, should have made its way down and into the bag before bedtime 10 - 11 pm. It is not unusual for ostomates to set their alarm clocks for between 1 and 2 am to check and empty their bags.

I hope you don't mind me stopping here and allowing me to come back to you on foods and its effects on the output.

I hope the above is of interest to you and your sister and elaborates slightly on the previous advice given by her stoma care nurse.

Over in the Ileostomy, colostomy and stoma support (Group) group I am available 7 days a week from early morning until late at night and often during the night to answer any questions that may arise even if you think it to be daft or stupid always ask it, you will receive an answer and if you could ask them over in stoma support group that would be great, but for the moment anywhere you feel comfortable is fine.

Will be back soon to answer your food question.

Ian

CC

Thank you so much Ian for the time and effort you have put into this very comprehensive reply.  We will look at your suggestions and see what we can change.  Would be great if you had any advice on the food side of things as my sister is eating small and often with her main meal no later than 7.  It just feels as though the gas is not filtering out enough to avoid ballooning.

KKind regards

Maureen x

Hi Maureen

Apologies a bit later than I intended, unfortunately my food chart has become distorted on my computer and I need to do again which I've done about 50% when its finished I'll send it over to you.

However please see this Foods that ?????? which maybe of interest to you.

Ian

CC