No more itchy-scratchy. I recently healed a rash under my wafer that had been plaguing me for about four months. In the process, I discovered that figuring out the cause and solution to ostomy skin problems can take some serious detective work. Solving my stubborn case involved some help from my stoma nurse, medication, a wacky new wafer method, and a touch of inspiration from a childhood memory.
I grew up with two brothers, and sometimes we would get into spats. When these unfortunate events happened, I could handle hair pulling, pinching, being kicked and even getting spit at. However, there was one method of sibling warfare that I absolutely dreaded: the snake bite. This involved having my forearm gripped with two hands while the skin was twisted in opposite directions at the same time until a painful sting ensued. A well-executed snake bite would leave my arm red and throbbing.
On several occasions since getting my ostomy surgery, I was certain that my wafers were giving me snake bites.
When I was healing up from surgery and researching ostomy appliances and sports, I read that some people have trouble with their wafers sticking in warm weather due to sweating. As I got back into outdoor activities, I fully expected that this would be the main wafer issue I would have to deal with when doing active sports. However, this ended up not being the case at all; my wafers adhered well through any activity. Instead, I was faced with an entirely different problem related to my ostomy appliance and strenuous sports.
When I was hanging out at home in the months after surgery, I had absolutely no issues with my wafers causing any skin issues. However, once I healed up I started biking and hiking, it seemed like my wafer would get pulled in one direction as I moved, while the skin underneath wanted to move in another. The Coloplast wafers I wore for the initial months after surgery were made out of a fairly non-pliable plastic, and would leave a circle of painful blisters on my skin right around the outer edge of the wafer from this tension. I decided to experiment with a different brand.
I tried Hollister and then Convatec and found that the Convatec ones seemed to move the best with my body contours and movements. I had no further skin issues with my wafers for the first 10 months when I was mainly hiking, snowboarding and biking. Then in January, I started to do activities with more extreme movements, like yoga and climbing, on a weekly basis. All of a sudden, my wafers felt like they were giving me snake bites again–especially near my hip bone.
I have a narrow body, but my stoma measures 1.5 inches at its widest spot. This forces me to use larger sized wafers. When I put a wafer on, it extends past my midline incision scar on one side, and over my hip bone on the other. As I would do high steps while climbing, and twists and bends in yoga, my wafer would pull at my skin at the top of my belly and also near my hip bone. At first I tried protecting my skin with various brands of skin prep, but none made any difference. I tried to stand up while putting on my wafers and made sure I wasn’t pulling the tape part too tight while placing it on my skin. Neither of these things helped. As I was experimenting, I soon realized I had a bigger problem: a very itchy rash began to develop under the tape in the location where my skin had been pulled. Over a matter of weeks, the rash spread to other areas under the hip-bone-side of my wafer.
It was time to seek some help from my stoma nurse. After hearing about my symptoms, she felt it could be a yeast infection and recommended anti-fungal powder. I tried this for three weeks with no improvement.
In the meantime, I started to wonder if perhaps I had developed an allergic reaction to the tape part of my wafers. I really hoped this wasn’t the case. I didn’t want to have to change my ostomy system. I loved the way my wafers stuck so well through sports and swimming, and all my hernia belts and pouch covers were designed to work with my system. I thought an allergy was unlikely though, since there was no rash under the entire left-hand side of the wafer. If I had an allergy to the tape, I assumed it would show up under the entire tape part. Just to rule it out though, I decided to try Convatec’s tapeless wafers for a couple of weeks. My skin did not clear up and continued to get worse.
It was around this time that I recalled another memory. Several years ago, long before my ostomy surgery, I had a nasty, itchy rash that started on my knee and soon spread to my arms and legs. I went to a dermatologist and was diagnosed with bacterial folliculitis. The doctor felt that I had probably nicked my leg shaving and had some hair follicles get infected which eventually spread to follicles on other areas of my body. It took a while, but it finally cleared up with antibiotics.
The rash I was dealing with under my wafer looked exactly like that rash. To top it off, I now had a little area of rash on my stomach far away from my wafer. My stoma nurse recommended that I talk to my doctor to get a prescription for antibiotics. My doctor agreed that it looked like folliculitis, and I began to take Keflex. Within a week of starting the antibiotics, the rash that I had been dealing with for several months completely disappeared. Finally the mystery had been solved! I deduced that the pulling of my skin under the tape had damaged it and allowed a bacterial infection to set in. Without the Keflex, I am positive my rash would not have gone away.
The problem was, I soon felt the familiar sting of my skin being pulled under the tape when I would bend. I knew I had to change the way I was doing things, or my skin would be damaged again and the whole cycle would start over.
To attempt to solve the problem, I tried something a bit unusual. I continued to use my regular Convatec wafers, but cut off all the tape on the right half. The inner circle of Durahesive material seemed to stick just fine without the tape part, but I reinforced it with little strips of 3M Medipore tape in a few strategic spots for added confidence. My skin has always liked Medipore tape, and it is very stretchy so the strips did not place tension on my skin. When I was done, my new tape and wafer method looked a bit like the sun with rays of tape sticking out. I nicknamed it the “sunburst method.” I have now been using this method for two months and it has been working great. My skin is super happy with no more tape snake-bites and no more rash! It has held on perfectly through rock climbing, running a 10k, swimming, and even a recent three-day backpacking trip in warm weather.
This photo shows my new “sunburst method” for attaching my wafer. I trim the manufacturer’s tape away on the hip bone side of my wafer and replace it with strips of 3M Medipore tape. You can see the shine mark where my hip bone is. This new taping system completely avoids this area and my skin is no longer irritated under tape when I climb, do yoga or take part in other sports with a lot of stretching and bending movements.
Two months after starting this new taping method and my skin is still healed and happy. Unfortunately, I never took a photo of the rash. Picture hundreds of tiny red raised bumps under where the wafer tape would have been on the left side and you will get the idea.
From eating to product selection to skin care–when you first get an ostomy, everyone tells you that your situation is going to be unique and that you will have to experiment to figure out what works for you. I am only now beginning to realize how unbelievably true this. I wouldn’t be surprised if my sunburst-wafer method was a disaster for someone else even though it worked for me. The point is, make sure to try different things. Don’t settle for supplies and methods that aren’t working well for your individual needs. Keep sleuthing and find the solutions that make living with your one-of-a-kind body and ostomy comfortable.
When I was a kid I didn’t like snake bites, but I did like Nancy Drew books. Nancy would just finish solving some tough case when a new and interesting one would come her way. I have felt a bit like her lately. Now that I have solved the mystery of the itchy rash, what case is next? Last weekend while changing my appliance on the backpacking trip I just mentioned, I noticed a 1/4″ white ulcer-like depression on the side of my stoma about 1/2″ from its base. It looks just like a canker sore. My surgeon and stoma nurse both think it is trauma related, so I am experimenting with cutting my wafer differently to see if it helps. Hmmm–s0 far I haven’t noticed much of a change, but maybe if I try…..
Let the sleuthing fun begin!
How is that New skin issue doing?
Thanks for asking. My surgeon and stoma nurse were right. It was some sort of trauma and it is healing up and getting smaller and smaller. Just a dot now. I still am not sure how it happened. It didn’t seem like cutting my wafer differently really did anything. The sore was a 1/2 inch up from the base of my stoma… not really near the edge I cut in my wafer. Maybe I somehow nicked it during a change. Such a relief to have the skin on and around my stoma doing wonderfully again. My sunburst method is working brilliantly and is so comfortable. Even stayed on fine during a pool party last weekend.
That is great, I love this blog and am inching closer to a surgery decision. Your pictures and words really help. My surgeon says to go with the pouch and I have a lot of confidence in her abilities,but although I am not as active as you, I was veering towards the bag for similar reasons. she says I can always revert back if pouch doesn,t work.
I am glad you are closer to making your decision. I remember that it felt very good to finally come to peace with my choice to go for the surgery I wanted and to have a plan. My GI doctor encouraged me to go for the j-pouch, but I was never really interested in it. I found it to be a very personal decision that was hard to justify to others… I just knew in my heart that the permanent ileostomy was what I wanted to go for. I didn’t want to go through multiple surgeries and deal with all the missed work, healing time and possible complications, and then if the pouch failed, go through yet another surgery. If I would have been really interested in the j-pouch, I would have never let those things stop me. However, since I wasn’t, I didn’t want to put myself through all that just because someone else thought I should try it. I wanted to get my ostomy, become very good at managing it and move on with life after my horrible UC ordeal. I was always relieved that my surgeon put no pressure on me either way and encouraged me to make the decision that I thought was best for me. I couldn’t be happier with how everything turned out in my case, but you really have to go with what jives most with your values and lifestyle. Good luck with whatever you decide!
Cheers,
Heidi
Heidi,
As you mention rash around the stoma skln I just want to put my problem here to see if anyone has any ideas. I am using Hollister moldable wafers and the first couple of weeks were fine but then my skin started to break out. I used stoma powder and it helped a little but recently I have been having leaks and that is causing skin to irritate and break. Last night I am not sure how but the wafer leaked and by the time I woke up I have a thick layer of ouput below wafer and the wafer is just about to come off. I am scared to see such accidents without knowing the root cause. I am new to ostomy, I just had my surgery 6 weeks back and haven’t tried any other products. Does anyone have any ideas on how I should be dealing with my problem. Any ideas will be greatly appreciated.
Thanks
Bhavana
Hi Bhavana,
Thanks for the good question. I hope some readers chime in with suggestions.
I am not sure if you have an ileostomy or a colostomy. Many of the ileostomates at my monthly ostomy meetings have tried the Hollister moldable wafers and have found them to break down too quickly for use with an ileostomy. The stoma nurses that come to our meetings have also confirmed this and have said that they are usually better for use with a colostomy. If you like moldables, you may want to give Convatec’s moldable wafers a try. I have been unable to use this product because my stoma is an oblong oval and I fall right between sizes, but I have heard they work well for a lot of people who have ileostomies or colostomies.
Other than that, I would recommend calling for samples of different products from all the manufacturers. One product I swear by that has solved most of my skin issues are Eakin Cohesive Seals. These seals are putty-like rings that stretch, go over your stoma, and adhere to your peristomal skin. You then place your wafer on top of the ring. The ring swells up around the stoma and protects your skin while also preventing leaks.
If you already have a sore forming from the output touching your skin, you can put a small amount of stoma powder over it. Over the powder, dab on some skin prep like Cavillon, Smith and Nephew or Trio Silesse so that the powder stays in place. Do a couple more layers of this, ending with the skin prep (this method is called “crusting”). If you use powder without skin prep over it, the powder will prevent your appliance from sticking. When you are done crusting over the wound with the powder and prep, you can put an Eakin Seal over all of it followed by your wafer. Perhaps you have already tried the stoma powder part, but if you combine it with an Eakin Seal, it may help. Eakin Seals can go under any wafer including cut-to-fit ones or moldables. Hollister makes a similar product called an Adapt Ring, but I have had better luck with Convatec’s Eakin Seals.
Six weeks is still very early and there is such a large learning curve to managing an ostomy. Hang in there. You will find what works out for you with trial and error. I would also recommend visiting with a stoma nurse if you can. Every time I have had a skin issue, they have been very helpful in solving it.
-Heidi
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Man, am I familiar with the snake bite! Unfortunately my WOCN was a total washout (she told me the paste was for making the wafers adhere!). Weeks after surgery I had a raw, hideous mess and I had to heal with weeks of crusting. I have an ileostomy.
The good folks at Convatec were my biggest help. Rachel, my Convatec nurse, suggested the Stomahesive, which is like a thick smooth silicon. It’s a 4×4 square and I trim the edges so it makes a circle like Heidi’s. I windowpane mine with pink zinc Hy-tape for security and waterproofing. I also SWEAR BY Eakin seals! They eliminate the need to cut the hole in the wafer so precisely, since the seal (put on just as Heidi illustrates) makes a gasket seal around the stoma. I am nearly leak free with my two piece Naturas, which are a lot like Heidi’s.
However, sometimes the “tupperware ring” bothers me. I mentioned this Rachel, who sent me the new Convatec Esteem one-piece drainable (416719 in the catalog) which is cut to fit and has a soft, silky, thin wafer – no hard ring, almost like wearing nothing. I use the Eakin seal with it as well although I flatten it a bit more. You have to be careful to smooth the seal, because if it “ruffles” it will sometimes create a channel for leakage. I alternate these two pouches and my skin is perfect. The two-piece Natura is my faithful standby if I’m eating something that may cause a problem, and my Esteem is my “leisure suit”, I back it up with 1/2 ” Hy tape, but I am going to try the Medipore. Eakin seals were my best discovery. You will not know how you got along without them.
They’re great for blisters on your heels too!
My drainage is so dry and heavy and I am so OCD that I use water to help drain my pouch – I actually had a kitchen sprayer installed in my bathroom. My WOCN nurse said it couldn’t be done, but I didn’t know any better and I’ve been rinsing out my pouches while they are on me since I had my ostomy, and using the Eakin seal, I have had no problem. I rinse and drain until I am comfortable and no water has ever gotten behind the seal. I have done it with the more delicate Esteem too with no problem. Not everyone may get the same mileage but it does give you an example of how well the seals (and the Convatec pouches) work. And my hypersensive skin (I am diabetic too) is perfect. I try to alternate every two changes. I also use a small self-adhesive gauze pad under the pouch where my tummy tends to perspire and where I am nervous about seepage. I don’t think you’re ever 100% confident but it’s much better than it was.
Thank you, Heidi, for sharing so generously and bravely and helping me be brave too. I’ve had a bad time but it’s gotten easier with your help.
Allie,
I would have never guessed that Eakins could be used for foot blisters! I will have to try one next time I rub my heels raw.
Though I don’t rinse my pouch with water that often, I have on occasion when my output is really thick. It didn’t seem to cause any ill effect to my wafer or Eakin, so I am not sure why the nurse would say not to do it. Sometimes my output is the same consistency as water and certainly more corrosive, so I can’t see how regular water would do any harm.
The Esteem one-piece sounds like a nice pouch. I tried the two-piece Esteem and I found the adhesive coupling on it tricky to use. If I didn’t get the pouch stuck on the landing platform perfectly, output would seep out after the first day. It was also hard to peel off full pouches and attach a clean one out in the field. I often like to use closed-end pouches on climbs or in locations where I can’t drain, and I find the Tupperware-style plastic coupling much easier to use in these instances than adhesive coupling. The ability to interchange pouches is one of the main reasons I like the two-piece, but one-pieces are so wonderfully flat. I can see why you would use both.
You are right about the nurses at Convatec. They are so helpful!
Thanks for sharing and glad you find the site helpful!
-Heidi
I don’t know if I mentioned it but I actually learned about using more than one type of pouch after reading it in your blog. It made perfect sense that different situations would require different appliances. It seems obvious now but didn’t occur to me before.
In re using the seals for blisters, I center it over the blister (of course) and fill the hole with Neosporin, then top it with a large fabric type bandaid that covers the whole seal. The cushion is perfect and works for any wound that needs extra protection or any stress point like breaking in new boots.
I’m excited about your new goal (Mt Rainier) and eagerly await each new post.
Wow, your skin looks so beautiful and healthy in these pictures! I just got my ileostomy a little over a month ago and I’m having a ton of skin issues. Not only because I have a sensitivity to adhesives, but also the size and shape of my stoma plus my body contours make me prone to leaks around my stoma. I’m currently trying new products to see if there is any difference. Can’t wait to see if they work so I can get my skin to heal nicely like yours!
Hi Megan,
Yes! Keep experimenting. It took me a while to find something that worked. If you find you are allergic to the tape portion of the wafers, but not the hydrocolloid inner portion, you can either cut the tape off and replace it with another kind as I have, or you can purchase wafers that have no tape and are entirely made out of the hydrocolloid material. Hollister and Convatec both make these. All of Coloplast’s wafers are tapeless, but for some reason they bugged my skin anyway. The Convatec tapeless wafers worked okay for me skin sensitivity-wise, but I found that due to their footprint size, they were a little too rigid and would peel up when I bended. Cutting the tape off the regular Convatec wafers and then adding the 3M Medipore tape worked better. 3M Medipore tape is really good for sensitive skin. You may have already had it on at some point, as it is often what is used post-surgery in the hospital.
Another product that I have been experimenting with to hold my tapeless wafers on are Coloplast Brava Elastic Barrier Strips (http://www.us.coloplast.com/products/ostomy/accessories/elasticbarrierstrip/). I have been trying these instead of the 3M tape for the past couple of weeks and so far they haven’t bugged my skin.
I have really good luck with Eakin rings. I was still getting one irritated spot with them however, and at the recommendation of my stoma nurse, I put some stoma paste on my finger and work it into the crack between the Eakin ring and my stoma. Both the Eakin and paste sort of swell together and turtle neck around my stoma as my body warms them which gives me good protection. I am hoping to write a post about this at some point. So many ideas of what to write, so little time:)
Another thing you might try are Convatec moldeable wafers. I can’t wear them because my stoma is an extreme oval shape and falls right between sizes, but many people with ostomies swear by them because they hug the stoma so well. An Eakin ring can be worn under these too for added protection.
One other thing I have heard recommended (though I haven’t tried myself) is putting a barrier sheet under the wafer to completely cover the skin. http://www.coloplast.com/products/ostomy/accessories/protectivesheets/
Also, I am not sure if you stoma is short, but if so, a lot of people have good luck with convex wafers.
Do you have an ostomy nurse to help you out? I have found my nurse to be very helpful in figuring out the various skin issues I have had.
Hang in there and keep trying different things. A month post-op is early in the ileostomy journey and you may find that your output thickens up some too which makes things a little easier.
Best of luck!
-Heidi
I am a CWOCN and was looking for additional resources to assist one of my patients who is having a recurrent issue. Got a couple ideas. THANK YOU for your candid blog. I will be a follower for sure! Yall are the Folks who LIVE AND BREATHE ostomy 24/7. I am only an eager assistant.
Hi Linda,
I am so glad you will be able to put some of the info to use. We do live and breathe ostomies, but I can’t imagine getting to the confident place I am now with my stoma without all the WOCNs that have helped me. Thank you for the work you do to help those with ostomies!
-Heidi