Question

I got my ileostomy in December 2019 and can’t seem to get the flange attached so it doesn’t leak.  I have had home care, I have watched videos, I have tried ConvaTec, Hollister, Coloplast and it doesn’t seem to matter.  I have used 8 in the last 8 days.  I am afraid to go out anywhere, and they are so expensive I am beginning to panic.  Do you have any suggestions as I seriously can’t afford to have this continue?  It was an emergency surgery due to a perforated bowel and it is close to my navel and a lot of times that is where it tends to leak, but not always.  I would appreciate any ideas you have as I am reaching a breaking point.  

Response

I highly recommend that you arrange a visit with an NSWOC NURSE (A Nurse Specialized in Wound, Ostomy and Continence (NSWOC) is a registered nurse with advanced and specialized knowledge and clinical skills in wound, ostomy and continence care who has graduated from a World Council of Enterostomal Therapists (WCET) recognized education program., who has specialized training in treating patients with ostomies), who can assist you in assessing the leakage issue and make equipment product recommendations for ensuring a good seal.) To find a NSWOC professional in or near your location please click on this link – https://memberscaet.ca/find.phtml . Ostomy leakage is 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 you, and which routine gives the best results. It can cause a heck of a mess, not only to our clothes but to our self-confidence too. 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 are 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 molding 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 the 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. Although I am always reluctant to name any particular manufacturer, as they are all competent and provide excellent products, for me the flange barrier that has worked best is, “Salts – Flange Extender” (with Aloe). Salts is a Healthcare manufacturer. This particular flange barrier does not expand, swell, etc. The Flange Extender is a semi-circle strip and there are 30 strips per package. I cut the strips in half. Then, I apply 3 half-strips to cover the 360-degree area around my stoma. This ensures that I have full coverage around the stoma. If you do not use the Salts product preferring another manufacturer’s equipment, apply the flange barrier, it is placed on and adheres to your peristomal (around the stoma) skin, helping protect your skin from stoma output, and attaching the pouch to your 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 a 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. 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”
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Member OstomyCanada /Medical Lifestyle Advisory Committee Member- Ostomy Lifestyle Expert
https://ostomycanada.ca
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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.