Jul
22
2011

Overcoming the Challenge of Pouching in Difficult Situations

“How do I get my pouch to work with the creases in my abdomen?”  “How do I get a difficult pouch to stick?”  “What can I do to pouch a retracted stoma?”  These are just some of the questions heard from ostomates on a daily basis, the world over.  With the help of these tips today, hopefully you can avoid the trip to see your ET Nurse with these situations.

“How do I get my pouch to work with the creases in my abdomen?” Creases tend to be a constant source of frustration for an ostomate, both new patients and vets alike.  One of the best tools to combat this frustration is to use a moldable adhesive ostomy strip.  Moldable Adhesive Ostomy Strips are used as fillers to protect and even out skin surfaces next to and around the ostomy, fistula, or wound.  Ostomates choose these stomahesive skin barriers because they are moldable and can easily conform to the affected area.  Making sure your skin in dry first, apply the moldable strip over the crease with a wet finger, to prevent it from sticking to you, and form a smooth level surface for the appliance to adhere to.

“How do I get a difficult pouch to stick?” Even under the best situations, sometimes a pouch will tend to pull loose at a corner or in a certain spot on your body.  A little bit of skin bond cement or skin adhesive can be a great help!  Be sure to protect the skin first with skin prep, skin gel, or any of the protective coatings made for ostomates.  Be sure to let the cement dry thoroughly before applying the pouch according to the manufacturer’s recommendations for the type used.

With more troublesome situations, it may help to add a thin layer to both the skin and the pouch itself.  Remember to use only a thin amount on both sides as too much can actually prevent adhesion as well as make a mess of the area.

If you do resort to using an adhesive to help keep your appliance in place, then it is important to use an adhesive remover when the time comes to remove your appliance.

“What can I do to pouch a retracted stoma?” An ideal stoma is one that protrudes above the skin.  However often times that is not possible due to the surgery procedure itself, or often times the stoma may retract after the surgery due to weight gain, infection, malnutrition, steroids or scar tissue formation.

If you are using a ConvaTec two-piece system, it might help to try a Convex Insert. A convex insert is a disk that snaps into the ring of the flange.  The shape of the insert pushes the skin in towards the body while leaving the stoma itself exposed.  The Convex insert also provides extra protection by snapping into the coupling ring of a SUR-FIT Natura Durahesive or Stomahesive skin barrier. The convex inserts are disposable, however they could be washed and reused as well, making them a wonderful cost saving tool to help with your retracted stoma.

If you are using another brand, or a one-piece system, many manufactures have created convex wafers as well.

The addition of skin barrier rings or washers around the stoma can also help with your retracted stoma.  These can be cut to fit for your exact needs or can be purchased precut.  The use of one layer, or even several layers, can help extrude the stoma for more efficient pouching.  

“What do I do if my weight change has affected my ability to pouch?” Sometimes weight change, both a loss or a gain, can affect your stoma.  Most often a weight change will result in a stoma being in a crease or even retracted.  If the tips above for dealing with creases or a retraction do not help, you may also want to try using a more flexible pouch rather than a stiff one.  Several of the flexible pouches now have skin barrier attached to the pouch for an even better fit.

“What happens if I am allergic to my ostomy appliance materials?” For some patients, allergies to a specific appliance or material will develop even if they were never allergic to the product before.  This is often seen in ostomates that use the same appliance for a long time.  If this does occur, switching to another brand appliance on a temporary basis will give your skin a break and allow it to begin healing.

The first step is to heal your existing skin irritation.  If a rash occurs and the skin is weepy & irritated, stomahesive powders may help along with proper skin procedures before applying appliances.  After your skin clears up, try using your original appliance on another spot other than your peristomal skin to test if you are still sensitive to the original appliance and accessories.  Simply tape a small piece of the pouch or flange, apply some skin prep or skin barrier to your skin and see how it reacts.

Many people develop a rash under adhesive tape with prolonged use.  If this happens, as above, try another tape product.  Many manufactures offer hypoallergenic tapes that allow the skin to breathe in order to extend the wear time and comfort of the tape.

Good luck with your difficult situations!  Remember if these solutions do not help with your difficult situations, contact your ET Nurse for an evaluation and professional assistance.

We would love to hear more tips from our readers.  Please feel free to comment with your tips for dealing with these difficult situations and more!

Written by OstomyHelp Staff and Express Medical Supply

 

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