Question

This message is to request your assistance with the following: 1) Bedding and daily solutions for protection from leakage 2) Dignity – Ways to make my Dad feel better about himself and not embarrassed about his condition. My Dad is a wonderful man. He has helped others expecting nothing in return for many years. He is very strong and has always been resilient to illness. My mother is very fussy and is concerned about accidents cleanliness. Currently, there are tarps on the bed. He is using leak pads on furniture and adult diapers. I am arranging for a sheep fur mat for his chair to make him more comfortable. If you have any suggestions so my Dad can retain his dignity and prevent accidents or leaks etc. I would greatly appreciate your advice. Thank you so much for your time.  

Response

Having a colostomy, urostomy or an ileostomy does not mean that an ostomate will experience consistent leakage, resulting in embarrassment and irritated skin conditions. Your Dad’s dignity is of the utmost importance. There will certainly be some lifestyle changes, and in the beginning, your Dad and his caregiver will have questions, therefore, I highly recommend that you connect with your local ostomy support group. Meeting other people who’ve adjusted their lifestyles after this surgery and have managed to return to their regular activities can ease any anxieties you have. New and seasoned people with ostomies find value in our connection with one another. There are many Ostomy Support Groups across Canada. Ostomy Canada Society chapters, satellites, and peer support groups have been organized, and are meant to provide an opportunity for persons who have had or may have ostomy surgery and their families, partners, caregivers and friends to meet, provide support and understanding and share information. Chapters often invite a health care professional, such as an Enterostomal Therapist Nurse (NSWOC), a physician, pharmacist, or dietician to speak at the chapter meeting. There may also be a presentation from a representative of one of the manufacturers or suppliers of ostomy products. To find a Support Group near you go to www.ostomycanada.ca. On top of the page, you will find the site menu, click on “Support”. At this time a drop-down menu will appear, click on “Find Your Local Ostomy Group,” and follow the instructions. Ongoing leakage should not be a part of the ostomy experience neither the expected lifestyle. Having said this, occasional ostomy leakage can be a problem that all ostomates will no doubt encounter at some point during their time with a stoma. For most people, it’s a common occurrence in their early weeks of managing an ostomy when you are still finding your ostomy-feet and working out which products are best for each individual and which routine gives the best results. If leakage is an ongoing issue, in most cases it will be due to improper fitting ostomy equipment. If leakage continues there are several options you will want to follow. I recommend that you contact an NSWOC – Nurses Specialized in Wound, Ostomy and Continence, (formerly called The Canadian Association for Enterostomal Therapy (CAET). They are specialized nurses with the experience and expertise to help your Dad with his ostomy and equipment challenges. To find a NSWOC professional in your community, go to: NSWOC website – https://memberscaet.ca/find.phtml Tips: To find out what is causing the leakage start by checking the back of the flange after it’s leaked and you’ve removed it. This holds the biggest clue of all, you will be able to see what path the stool took on its break to freedom. Compare this to your skin and see what problems are present.

1. Condition of the skin. Is it raw, or does it have a rash all over it, or on part of it? If so, you may be allergic to the flange, and it may be interfering with the adhesive properties of the flange. Also, check to see if the area around where the flange leaks is any worse than elsewhere.
2. With leakage, the stool will always follow the path of least resistance. Do you have a belly crease which in turn is creasing the flange and creating a nice little tunnel for your stool to escape?
3. Look at your flange. Was the gap around the stoma too large? Or was it too tight? Or just right? Do you have protruding stitches around your stoma which the flange has trouble moulding around?
4. Do you have a belly cavity near the stoma? Flanges may struggle to adhere to these dips in your belly and lead to leakage.
5. Check your stoma. Is it flat/flush to the skin? Is it inverted/pulled in?

Some causes of leakage could be:

• Flush to the skin or inverted stoma
• Poor-fitting flange/odd shaped stoma
• Belly cavity around stoma
• Parastomal hernia and/or Pancaking

Once you’ve discovered the source of your leakage then you are in a better position to be successful in stopping your leakage in its track, and there are several products available on the market which are designed to help reduce opportunities for leakage to occur. One thing to bear in mind with all ostomy products is that our bodies are very individual, and because of that, a product which works great for one person may not work anywhere near as successfully for another, and vice versa. You may need to sample various rings and seals to find the one that works best for you, which the various ostomy product companies will also assist you in finding the seal that will work for you. So there is no reason why you cannot use multiple products to help combat leakage. The many ostomy equipment manufacturers design skin barriers. Contact the manufacturer of your current equipment and/or choice by phone or email, most of the manufacturers have experts on call who will discuss your concerns, provide advise/solutions on their products that are available, and in most cases send you a free sample to try, and will be ready for your feedback. Try several manufactures/products if you feel the need to. All of the manufacturers are competent and provide excellent products, a flange barrier is placed on and adheres on peristomal (around the stoma) skin, helping protect skin from stoma output, and attaching the pouch to the body. In a two-piece system, the skin barrier is separate from the pouch; in a one-piece system, they are combined. As stated all of the manufacturers provide excellent products. Skin barriers include:

• Standard wear: Best for colostomy.
• Extended wear: Designed to provide greater protection from stoma output for people living with an ileostomy or urostomy as output can cause skin irritation.

Basic guidelines for applying your pouching system. For complete instructions, always refer to the product insert. Skin barrier openings vary in fashion, including:

• Cut-to-fit: Can be cut to accommodate your unique stoma size.
• Pre-cut: Available in a wide variety of sizes to accommodate your stoma, without the need for cutting.
• Moldable: By moulding around the stoma, this skin barrier creates a snug fit designed to provide greater leakage protection than traditional barriers.

One-Piece Systems This system type combines both the barrier and pouch into one convenient unit.

• Clean and dry peristomal skin.
• Measure your stoma.
• Prepare the skin barrier.
- For cut-to-fit barriers: Using the guidelines, cut an appropriate size.
• Remove the paper from the adhesive.
• Gently place the pouching system over your stoma.
• Press the skin barrier against the skin, paying particular attention to the area closest to the stoma.
• Smooth onto your skin. Maintain slight pressure on the skin barrier for 30-60 seconds to ensure a good seal.

Remove the release paper from the skin barrier. Traditional Two-Piece Systems This system is made up of both a barrier and a pouch. The two pieces connect with a plastic coupling ring.

• Clean and dry peristomal skin.
• Measure your stoma.
• Prepare the skin barrier.
- For cut-to-fit skin barriers: Using the guidelines, cut an appropriate size.
- For moldable skin barriers: Roll the adhesive back to fit your stoma.
• Remove the paper from the adhesive.
• Center the hole over your stoma, onto your skin.
• Press the skin barrier gently against your skin. Align the plastic ring on the pouch with the ring on the skin barrier and press together. You should hear and feel the system locking together.

Place the skin barrier gently over the stoma and press it firmly against the skin with attention to the area closest to the stoma. Position the flange on the pouch over the skin barrier flange. Gently press the bottom of the pouch flange against the skin barrier and move upward.

Long-term outlook

Once an ostomate learns to take care of their new elimination system, they’ll be able to participate in most of your regular activities:

• swim
• hike
• play sports
• eat in restaurants
• camp
• travel
• work in most occupations

Leakage Protective Equipment: For your Dad’s peace of mind about any concerns that he may experience leakage while in bed, he can invest in a quality waterproof washable bed cover, there are many versions available on the market today for purchase. These covers create a discreet and comfortable waterproof barrier between liquid, sheets, and mattress. There are also smaller portable barrier pads available for purchase, that your Dad can invest in for when he travels. Jo-Ann L. Tremblay
THE OSTOMY FACTOR Blog – joannltremblay.wordpress.com
FACEBOOK – Author Jo-Ann L. Tremblay
TWITTER @joanntremblay
Author of “The Self-Coaching Toolbox” , “Better With A Bag Than In A Bag” , “Another BAG Another DAY”, “BAGs Around the World”, Why Buttercup Wears a BAG!”, “The Sibs Gang Cave of the Golden Heart”
amazon.com, amazon.ca, amazon.co.uk
Member OstomyCanada /Medical Lifestyle Advisory Committee Member- Ostomy Lifestyle Expert
https://ostomycanada.ca
Member Arteast – www.arteastottawa.com
Website: jo-annltremblay.com     Our friends over at Nurses Specialized In Wound, Ostomy And Continence Canada (formerly called The Canadian Association for Enterostomal Therapy (CAET)) have renamed their handy look-up page on their website. It was formerly called “Find An ET Nurse” and is now called “Find a NSWOC“. Click on the image to the left or link here to go to their site.