Question: Experienced Ileostomate Seeking Solutions for Nighttime Leakage

Since my ileostomy relocation in 2015 and subsequent hernia surgeries, I’ve been facing recurring issues with flange adhesion, particularly at night. Despite using a Holister flange and Coloplast ring, and experimenting with both concave and flat flanges, the leaks persist. Notably, the issue seems to be related to acidic stool or secretion from around the stoma. Weight loss in the past few months hasn’t helped either. My medical team at Mount Sinai hasn’t been very supportive. What can I do to resolve these leaks that occur only at night?

Response: Strategies for Managing Ileostomy Leakage and Flange Adherence

I understand the frustration and discomfort you’re experiencing with your ostomy, especially with persistent leaks at night. It’s crucial to have a reliable and leak-free pouching system for quality of life with an ileostomy.

Here are some steps and considerations:

  1. Peristomal Skin Assessment Guide: Utilize this comprehensive resource for a step-by-step guide to assess your skin, abdominal contours, and pouching system. It can provide valuable insights into the fit and effectiveness of your pouching system. Peristomal Skin Assessment Guide.
  2. Examine Abdominal Contours in Different Positions: Compare how your stoma and surrounding area appear when you’re lying down, sitting, and standing. Changes in body posture can affect how the flange adheres to your skin.
  3. Evaluate Flange Type: If you have a moat-like formation or dips around your stoma, ensure your flange matches these contours. A convex flange might be more suitable in filling these gaps. Various depths of convexity are available, so exploring different options from ostomy manufacturers might be beneficial.
  4. Review Skin Preparation Routine: Consider whether you’re using any skin preparation products like powders or sprays excessively or regularly. Sometimes, these can build up and prevent effective adhesion of the flange.
  5. Seek Second Opinion: Since you feel your concerns are not being fully addressed by your current medical team, consider seeking a second opinion from another ostomy nurse or specialist. They might offer different insights or solutions.
  6. Regular Monitoring: Keep track of any changes in your stoma and surrounding skin, and adjust your pouching system accordingly. This ongoing assessment is vital for managing an ileostomy effectively.

I hope these suggestions provide a starting point for resolving the leakage issue. Remember, you know your body best, and finding the right solution sometimes requires a bit of trial and error. Your persistence and self-advocacy are key in this journey.

Andrea Manson
RN, BSN, NSWOC, NCA
Retired Nurse and Ostomy Specialist

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