Securing an ostomy appliance is a frequent challenge for many people. The goal is to create a predictable, durable seal between the adhesive wafer and the skin, which maximizes the barrier’s lifespan and protects the sensitive area around the stoma. Achieving this requires a methodical approach that focuses on meticulous skin preparation, strategic use of supplemental products, and selecting the correct appliance design for one’s unique body shape. Addressing these three areas systematically can significantly improve confidence in the pouching system’s security and overall quality of life.
Optimizing Skin Preparation and Wafer Application
Clean, dry, and healthy peristomal skin (the skin around the stoma) is the basis for strong adhesion. When cleaning the area, use plain water or a specialized ostomy cleanser, strictly avoiding soaps that contain oils, lotions, or perfumes. These residues interfere with the adhesive’s ability to stick, and if any moisture remains, the hydrocolloid adhesive will not form a proper bond, leading to early failure.
The skin must be completely dry before applying any product. Using a soft cloth or gauze to gently pat the skin dry is effective. A quick pass with a hairdryer on a low, cool setting can also help ensure total dryness. If the peristomal skin is irritated, apply a light dusting of specialized stoma powder to absorb weeping moisture, then seal it in place by dabbing on a liquid skin barrier wipe.
Measure the wafer opening precisely to fit snugly around the stoma, leaving no more than an eighth of an inch of exposed skin. Hair removal is necessary for a flat surface; gentle trimming or shaving prevents hair from pulling when the wafer is removed, which can cause irritation and compromise the seal. The wafer benefits from being slightly warmed, either by rubbing it between the hands or using body heat, to enhance tackiness. Once the wafer is in place, apply gentle, sustained pressure with the palm for several minutes to mold the adhesive to the skin’s contours and activate the barrier’s sticking power.
Supplemental Products for Enhanced Security
When the primary wafer adhesive is insufficient, supplemental products can boost security and fill uneven areas. Barrier rings are soft, moldable hydrocolloid seals placed directly around the stoma before the wafer is applied. These rings absorb moisture and swell slightly to fill small gaps, dips, or creases in the skin, creating a smooth surface and preventing output from reaching the adhesive edge.
Barrier paste functions like a caulk, not a glue, to fill in larger creases or scars that could compromise the wafer’s seal. Apply the paste as a thin bead directly onto the skin or the back of the wafer. It is important to allow it to set for about a minute before applying the appliance, as many pastes contain alcohol that needs to evaporate. The paste creates an even plane for the wafer to adhere to, helping direct output away from the skin barrier edge.
Liquid skin barriers, available in wipes or sprays, are applied to the peristomal skin before the wafer to create a protective, tacky film. This film protects the skin from adhesive stripping trauma and can slightly increase the wafer’s initial tackiness, but it must be allowed to dry completely before the appliance is attached. For reinforcement, flexible medical adhesive tapes, often called barrier extenders, can be placed around the outside border of the wafer. These strips conform to movement and prevent the edges of the wafer from lifting prematurely, a common point of failure during physical activity or when clothing rubs against the appliance.
Adjusting for Anatomical and Output Challenges
Adhesion failure is often not a problem with the product itself but a mismatch between the appliance shape and the body’s contours or the nature of the stoma output. For stomas that are flush with the skin, retracted, or located in a crease or fold, a flat barrier may not provide a secure fit. In these situations, a convex barrier, which features a gentle, outward curve, is necessary to apply pressure to the peristomal skin.
This gentle pressure helps push the stoma slightly forward, ensuring the opening sits above the skin level so that output is funneled directly into the pouch. Convexity can be soft and flexible or firm and rigid, depending on the firmness of the abdomen and the depth of the skin irregularities. An ostomy support belt is used to maintain constant, gentle pressure on the appliance, which is especially useful when using a convex barrier.
The belt attaches to loops on the wafer or pouch and keeps the system securely against the body, preventing shifting or lifting during movement. This constant inward tension helps flatten subtle skin folds and ensures the adhesive remains in full contact with the skin, maximizing wear time. When dealing with high volume or liquid output, such as with an ileostomy, using an extended wear barrier is beneficial, as these adhesives resist breakdown from moisture. Additionally, thickening agents can be placed inside the pouch to turn liquid output into a gel, reducing the chance of undermining the seal.