1. Check the bag is cut to the right size The stoma shrinks after surgery as it settles. You may have to readjust the cutting size on your bag over the course of the next few months, ensuring that the new cut is snug to the stoma and takes into account if it is not perfectly circular. Stomas differ a lot but the average size for the hole to be cut is about 25mm so do keep an eye out for shrinkage. Too big a cut can expose the peristomal skin and subject it to irritation from the output2. Is the stoma flush? If you have put on a bit of weight following the op, the stoma can retract and this causes leakage. Seek advice from the stoma nurse who can advise a changeover to a convex appliance if it is necessary. Convex appliances are curved and push the peristomal skin in, making the spout stick out more. The output drains better. 3. Are there any dips or creases in the skin that can channel faecal matter? Check for creases, dips or ruts in the skin as output being so liquid can channel along these. There are a number of products that can 'polyfilla' in the channel and stop leakage. I use a combination of malleable paste and a protective ring that swells up and forms a 'collar' around the stoma as I have a dip next to my stoma that causes leaks. 4. Extra skin protectionExtra skin protection is available from most suppliers. For milder skin protection, barrier creams are available that form a protective barrier against faecal matter. For more severe skin problems, protective film is available which 'waterproofs' the skin for a while.
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