Using Duoderm to protect peristomal skin

What’s a mountain girl to write about when my hip injury is keeping me from the slopes and summits? Skin care, of course! After all, taking care of your peristomal skin is of utmost importance. It is hard to enjoy outdoor sports if your skin is irritated and painful or if your appliance won’t stick to weepy, damaged areas.

My stoma is fairly long at 1.5″and doesn’t have the best posture. It flops downward and a bit to the right — especially under the weight of my clothing and pouch. This actually  works great because my output goes toward the bottom of my pouch which helps prevent leaks. On the downside, the area of skin just under my stoma sometimes gets irritated because stool tends to collect in that spot. Also, as my stoma flops down, it compresses my Eakin barrier ring in that area and causes it to erode more quickly. Fortunately, I discovered a great solution to this problem soon after surgery thanks to the help of my home health nurse.

When I don't protect the skin underneath the area where my stoma flops over, I get a strip of irritation.
When I don’t protect the skin underneath the area where my stoma flops over, I get a strip of irritation.

There was a six-week time period after my surgery during which I had a complication with my mid-line abdominal incision (due to a rare reaction to sutures). I ended up having to leave the wound open for healing with the help of a wound vac. While this was certainly a disappointment at the time, the situation also held a hidden blessing. Every other day, a home health nurse would come and change the sponge dressing for my wound vac. In order to do this, my ostomy wafer had to be removed and replaced each time. Along with being a wound vac guru, my home health nurse also had a great knowledge of ostomy skin care. Having the nurse watch and help me change my appliance so frequently over a period of many weeks provided an amazing opportunity to practice the task and troubleshoot problems. As time progressed, my nurse saw that a sliver of skin under my stoma was consistently raw.  She told me that this would likely become a chronic issue unless I did something to better protect that section of skin. I was already using Eakin barrier rings, so she suggested I add a product called Duoderm Signal to my ostomy system.

Duoderm Signal comes in a 4″ x 4″ sheet and custom-sized pieces can be cut out of it to cover whatever area needs protection. To care for the sliver of skin right under my stoma, I cut a 1/2″ by  1″ comma-shaped piece that contours with the edge of my stoma. When I place it on my skin in the trouble spot, it provides a much needed extra layer of protection. When my Eakin barrier ring erodes a little sooner in that section, my output touches the Duoderm layer instead of my skin.

Duoderm can be placed right on the skin, but it does not adhere well if the area is wet. Therefore, if I get irritation that is weepy,  I must put a layer of stoma powder and skin prep under the Duoderm in order for it to stick. The best way to do this is to use the “crusting” method. First I put a small bit of powder on the sliver of skin that is irritated. I then dab it with 3M Cavillon Skin Prep. Once it dries, I add one more layer of stoma powder and one more layer of Cavillon. I give the area a final dry with a hair dryer on a low setting for a few seconds. Then, I add the strip of Duoderm over the crusted area. Finally, I put my Eakin barrier ring over the Duoderm followed by my wafer.

This method works wonderfully to protect the skin under my stoma. However, I can’t stretch wafer changes longer than four days when using the Duoderm. If I do, the Duoderm will start to peel up from being so close to my wet stoma. Then output starts to seep under it and cause skin breakdown.

If I develop a sore under my stoma, I put a layer of stoma powder just on the tiny sliver of irritated skin. I then dab the powder with Cavilllon skin prep to form a seal over it. Once dry, I add one more layer of stoma powder followed by one more layer of Cavillon skin prep. This forms a "crust" over the sore that the Duoderm can stick to. The stoma powder also helps heal the sore.
If I develop a sore under my stoma, I put a layer of stoma powder just on the tiny sliver of irritated skin. I then dab the powder with Cavilllon skin prep to form a seal over it. Once dry, I add one more layer of stoma powder followed by one more layer of Cavillon skin prep. This forms a “crust” over the sore that the Duoderm can stick to. The stoma powder also helps heal the sore.
A small piece of Duoderm Signal adds another layer of protection for my skin. I put the Duoderm under my Eakin barrier ring. Both of these things then go under my wafer.
A small piece of Duoderm Signal adds another layer of protection for my skin. I place it right on top of the stoma powder/Cavillon skin prep “crust” in the photo above. If I happen to not have a weepy sore and just want to protect the skin, I skip the powder and Cavillon step and place the Duoderm right on my skin.
I place my Eakin barrier ring over the Duoderm. You can see the Duoderm peeking out in this photo.
I place my Eakin barrier ring over the Duoderm. You can see the Duoderm peeking out towards the bottom of the ring in this photo.
The Duoderm and Eakin barrier ring protect the trouble spot beautifully and help me maintain healthy paristomal skin. As long as I put the Duoderm on at every change, I rarely get a sore anymore unless some output happens to seep under the Duoderm. In these cases, the layer of stoma powder and Cavillon mentioned above clears it up by the my next change.
The Duoderm and Eakin barrier ring protect the trouble spot beautifully and help me maintain healthy peristomal skin. As long as I put the Duoderm on at every change, I rarely get a sore anymore unless some output happens to seep under the Duoderm. In these cases, the layers of stoma powder and Cavillon mentioned above clear it up by my next change.

Some people with ostomies are lucky enough to be able to stick their wafer right to their skin with no additional products. Unfortunately, that does not work for me. I need to build up several layers of things in order to maintain healthy skin. As soon as I try going back to more simple methods, my skin suffers. Appliance changes typically take me over 45 minutes if I include the time it takes to set up my materials, remove my old appliance, shower and do all the steps to get my new wafer on well. I never worry about it. It is not a race. Having my appliance off for a little while actually helps my skin get some fresh air. Between eating about five marshmallow prior to my change to slow down my output, and then wrapping paper towel strips around my stoma to catch any stool that might come out as I work, things go fairly smoothly when having my appliance off for that long. Of course there are always those days when my stoma doesn’t cooperate! Still, even with the occasional mishap, taking the extra time needed to better protect the skin around my stoma is worth it. Having happy skin helps me feel good about my ostomy and gives me confidence that my appliance will adhere well through all my adventures.

I do have one more skin care tip that I use which involves using both an Eakin ring and stoma paste, but that will have to wait for a future post!

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18 thoughts on “Using Duoderm to protect peristomal skin

  1. What a great post! My stoma is very much like yours, a little longer and wants to “flop” over. I get weepy underneath sometimes too! Definitely going to give this a try. I am a little nervous about the caking method, I have read about others that use it, but I am afraid I will make a mess or have a leakage issue. Your techniques sound really good! Thanks again for sharing!!!

    1. Hi Pam,

      Glad you found the post helpful. Definitely give the crusting technique a try. The key for me is getting the powder/skin prep just on the sore. It can interfere with things sticking, so by making the area with the crust the smallest size necessary, it will help things around it stick better. I put the tiniest bit of powder on the sore and then spread it across the area with my finger so I get a very thin layer rather than a huge pile. If I accidentally get powder where I don’t need it, I take a moist washcloth and wipe it away before adding the Cavillon skin prep. I find it easier to put on powder in a reclined position so it stays in place. Otherwise it just seems to scatter all over my belly. Make sure things are absolutely dry too… especially under the Duoderm but also everywhere else. If your sore is pretty bad at first, I would change the wafer after 3 days just to make sure the Duoderm hasn’t peeled up. As the sore heals, you can probably go a little longer. As I mentioned… the most I am ever able to go with my system is 4 days. That is partially because my barrier ring always erodes away after that amount of time, but also because the Duoderm starts to peel up by then too. Good luck!

      -Heidi

      1. Heidi, I had an ileostomy 4 months ago, a decision made for much the same reasons you describe. Can you tell me why you have chosen to use a two-piece system? Does a two piece gives you more flexibility with sports, perspiration, swimming, and soaking in the hot tub after? I am fortunate to not need to be concerned with costs, just convenience and skin care.

      2. Hi Matilda,

        Hope things are going well with your ileostomy. You are right at the point time-wise when I really started to experiment with products. Up to the four-month mark I used a one-piece appliance because I had abdominal incision healing complications and my stoma nurse didn’t want me to press on my belly to attach the parts of a two-piece together.

        Anyway- as soon as I tried the two-piece I was hooked! The shape of my stoma is sort of an odd blobby tear-drop oval (that is the best description I can come up with:) If I didn’t cut the hole in the one-piece wafer at the exact right angle, the whole appliance would either be tilted towards my hip or towards my pubic bone. I much prefer it to hang straight down so this drove me crazy. Plus, I would have to use a transparent pouch so I could see through the plastic and make sure the wafer was centered over my stoma. I don’t like transparent pouches very much. There is no way I could have centered it over my stoma correctly with a opaque one-piece though.

        The two-piece was amazing. If I cut the hole at the wrong angle on my wafer it didn’t matter because the pouch attached separately and could hang down straight no matter what. Plus I could center the wafer over my stoma much more effectively because I could see better when there was no plastic in the way. And I could use an opaque pouch!

        Those things aside, the main reason I love the two-piece is that when necessary I can easily take a drainable pouch off and use a closed-end instead. For instance, a couple weeks ago I went snowshoeing in the mountains all day. The snow was many feet deep so there was no way I could dig a hole in the dirt to bury my waste. I could have buried it in the snow, but then when the snow melted my poop would have ended up above the soil which isn’t good because it can run into water sources when it rains and pollute them. Not to mention it is just a bit yucky. With a closed-end pouches, I can pop off the full one, put on a clean pouch and then pack out the full one in a double-layered ziplock bag to toss in the trash when I get home. I do this same thing anytime I am in places where it is hard to dig a hole or drain a pouch, for example on cliff face when I am on an all-day rock climb, on a rocky peak, or on a busy semi-urban hiking trail. It is really easy to step behind a tree, lower just the front waistband of my pants and swap out the pouch. It is also completely doable when tied into a rope on a cliff with my harness on. I even keep closed-end pouches in my glove compartment in case I ever got stuck in a multi-hour traffic jam. I could swap out a pouch in the front seat of my car with absolutely no mess at all if I had to. I did have to practice swapping out pouches a few times to get the hang of it, but now it is a breeze. Otherwise, I use drainables 95% of the time and only use the closed-end pouches for the situations mentioned above.

        Above all, a two-piece gives one more flexibility. Along with closed-end pouches, sometimes people will swap to a smaller sized drainable pouch for some situations (for instance- swimming and intimacy).

        The only disadvantage is that due to the coupling ring, two-piece systems do have a slightly higher profile. I haven’t found it to be that noticeable though. I am still able to wear form-fitting clothing without my appliance showing. There are adhesive coupling two-pieces that lie flatter too, but I find them too difficult and messy to swap out on the trail or cliff side.

        As far as perspiration, swimming or hot tubbing, one- or two-piece doesn’t matter so much. You just want to find the wafer that sticks to you the best. For me, the Convatec Sur-fit Natura Durahesive wafers adhere amazingly well. I am sensitive to the tape on them though, so I trim it off and add strips of a tape I like better (3M Medipore).

        Two piece systems are more expensive, but I make it a priority to purchase the stuff that gives me the best quality of life possible. I can trim other things from the budget.

        Hope this helps!

        Best wishes,
        Heidi

    1. Hi Joyce,

      Thanks so much for thinking of me for the award. I am honored! The acceptance steps sound great too and I definitely want to do them. It might just take me a week or so due to a busy schedule right now. I enjoyed reading your post and finding out the 7 interesting things about you. Nutella is addicting!

  2. Dear Heidi
    Thanks very much for your detailed and prompt reply to my question about one vs two piece systems. I really appreciate your practical approach to solving problems and your generosity in sharing your experiences with us online.

  3. Heidi, hello my name is Katie. I have had a transverse Colostomy since January of this year. First of all, I want to thank you for this post about using Duoderm. The little red irritated ring around my stoma is finally healing since I started using it. So thank you so very much for that!
    That is not all I want to thank you for though. You have been an inspiration to me as well. I have maintained a positive attitude during the past 7 years as I have dealt with both cervical and breast cancer and the damage that the cancer treatment has done to my body. Lots of intestinal damage hence the colostomy. My friends say that I am an inspiration to them because of how I don’t let all of the “set backs” set me back. I don’t see how I could react any other way. I am alive and grateful and want to LIVE my life in capital letters. Your blog has helped me to see that I don’t need to let any of my physical problems hold me back from living my life with adventure as well. Since my colostomy surgery I have done day hikes on the Superior Hiking trail and am thinking about the possibility of doing some longer hikes. I’ve taken up Kayaking and have gotten my bicycle out of storage to ride the Cannon Valley Trail with my husband. I’m 65 years old and am still working on developing more stamina after seven years of battling cancer and the side effects of treatment. Isn’t that wonderful? I am developing stamina, overcoming fatigue and getting stronger and more active every day.
    Thank you so much for showing me that it can be done!

    1. Hi Katie,

      Thank you for the kind words. I am sorry to hear that you have gone through such difficult times, but am really happy that you are back to hiking, kayaking and biking. I find that when I jump back into the activities I love, all the obstacles I imagined in my head seem to sort themselves out. Where there is a will there is a way:) Yeah… perhaps I might go slower than I used to or not climb quite as hard… but who cares! I am still out there doing the things I love with the people I love. That is what matters. Way to go with keeping a positive attitude and living your life to the fullest!

      I am also glad to hear that the Duoderm worked out for you.

      Best wishes with your future adventures!

      Cheers,
      Heidi

    1. Hi Arlene,

      I am so sorry for the slow response. I somehow missed seeing this comment come in. The sticky side of the Duoderm should go against your skin. Make sure your skin is very dry before applying it.

      I hope this helps!

      Cheers,
      Heidi

  4. Hello: I want to thank you for your website. My daughter has a temporary ostomy, and we are having difficulties with it. It leaks at night and she gets a bad rash. We tried a skin prep before and it stung her skin really bad. I want to try the Cavilon skin prep you suggested. Is it the non-stinging barrier film in the form of wipes? Carol

    1. Hi Carol,

      Thanks so much for your patience in waiting for a reply. Yes- the Cavillon prep is no-sting and is in the form of wipes. They are like tiny little sponges saturated with skin prep and you dab it onto the skin. I have never had one burn even on very weepy and irritated skin.

      http://www.3m.com/3M/en_US/company-us/all-3m-products/~/3M-Cavilon-No-Sting-Barrier-Film?N=5002385+8707795+8707798+8710696+8711017+8711098+8717783+3293321921&rt=rud

      Another cool product I have been experimenting with are Coloplast Brava Protective Sheets. They are basically designed so that you cut a hole in the square sheet for your stoma, place the sheet over the stoma onto the skin and then put the wafer on top of that. I don’t use them exactly that way as I cut smaller pieces off the sheet
      and place them over irritated skin. However, in your daughter’s case, using the whole sheet as they show on the package might work best. Coloplast provides samples. I filled out the form on their website and received a few sheets in a week to try.

      http://www.coloplast.us/brava-protective-sheet-en-us.aspx

      Hope this helps!

      Take Care,
      Heidi

  5. Hi Arlene!

    Thanks for your helpful post about skin care around a stoma.

    I’ve had an ileostomy since my colon was removed in 2011. I used pouches and wafers from the Big Three, Hollister, Coloplast, and Convatec. All of them buy their glue from the same manufacturer. They’re inexpensive, and my Medicare Advantage Plan covered them.

    The glue on the wafer is made from an epoxy resin that is a known skin irritant. The Big Three employ ostomy nurses who walk customers through the usual complaints, dermatitis, cellutis, weepy skin rashes, persistent leaks, etc. The fixes are the same. The Big Three sell Stoma Adhesive powder, paste, skin barrier protection spray, barrier strips, adhesive thin strips, stoma rings, all to support a defective wafer. If you have an oval-shaped stoma, none of the Big Three have a wafer for that.

    NuHope, based in California, produced a pouch with a wafer that neither irritates the skin, nor leaks. The 30- ounce sized pouch can be worn overnight without leaking. The problem is that the NuHope pouches cost more and are usually cash products , too expensive to be covered by insurance. I was fortunate enough to get them by going to a distributor who buys so much of them, that they were able to cut a deal for me.

    As a former consultant for the FDA, and the V.A., my primary concern is that the Big Three are very familiar with the issues with their wafer. They can make a better product that won’t injure their customers, but the profits from the numerous add-ons, would drop. Meanwhile, the costs to insurance companies and Medicare have run close to a billion dollars a year. The Big Three are not concerned. They continue to buy the same resin for their wafers. Their customers go to the hospital, ending up on IV antibiotics to treat serious skin infections, they do two loads of laundry a day to clean up leaks, they’re forced into retirement far too early. For whatever reason, with all of the FDA complaints, the Big Three simply choose profits over the well-being of their customers.

    Marlen and NuHope, Cymed, and others who produce the high end products, won’t do that. They care.

    Bernie McCann

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