Question:

I cannot get anything to stick within 5 cm of my stoma. The soft part of the flange lifts, so output gets underneath, whether liquid or mushy. If I use the tiniest amount of paste or strips or rings, they swell and block my stoma. On the last trip to our useless ostomy clinic, I asked if I could show her photos. She refused. I told her how my surgeon suggested placing my flange and she said no surgeon would suggest that. She tried a very thin roll of strip paste and I asked if I could return in an hour to show her it swollen, and she said I could. But 90 minutes later, when the extremely thin ring of Coloplast strip paste was swollen over my stoma, she said I could not go, and booked an appointment for 2 weeks later! I don’t feel listened to. I don’t know how to get anything to stick near my stoma without swelling. I heat everything well.

Response:

Finding the right ostomy equipment for each person is challenging indeed, we are all unique. Although paste works well for some people, I myself do not use the paste as it has never worked for me. Instead, I use a skin barrier that adheres to my peristomal (around the stoma) skin, that helps protect my skin from the stoma output, and the flange attaches very easily and successfully for me.

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 a number of 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 together. 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.Ba

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 molding 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 together 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.