Hey Chris,

These are great questions.

I don't use (and have never used) Convex appliances, so my experience here is limited. However, here are a few points to keep in mind:

- Convexity is usually recommended to patients who have flush or retracted stomas. The pressure that convex wafers apply around the stoma is sometimes enough to cause it to put our a little and prevent stool from going under the wafer (causing a leak). 

- Convex appliances come with some risk (pressure sores), which is why you should only consider them if a stoma nurse has given you guidance. There are many types of convex wafers, ranging from soft and shallow to hard and deep (that totally came out wrong).

- Barrier rings may inadvertently provide convexity, especially thicker rings, but because they tend to "melt", it's inconsistent. 

- Barrier rings are meant primarily to offer an extra buffer between your skin and your output, and they can be used with convex appliances.

- the adhesiveness of a convex wafer is the same as a regular wafer, but it may not offer you the same flexibility as flat wafers (although, there are some really nice flexible convex appliances). 

There's no real harm in trying a thicker barrier ring to see if that helps you more than not using one. If it's too thick, you can go with a thin barrier ring, and if it's not thick enough you have convex appliances! 

You may need to try several brands of barrier rings before you find one that works best and doesn't melt or go mushy too fast.

Another use of a convex appliance is for those people with a bit of a tummy, it makes the appliance fit a bit more securing around the stoma.

There is a small risk with a convex bag that it can increase the risk of a prolapse, which is why in the UK a stoma nurse has to approve switching to a convex bag, but to be honest I think that that risk is minimal

Barrier rings can be used in a variety of ways. Some people mould the ring around the stoma to form a water tight seal. Other people (like me) cut up a seal and mould it into the necessary shape to fill in dips in the skin (a common one is a dip between the stoma and the belly button)

If I were you, and I'm not medically trained. I would cut up a barrier ring to fill in any dips in the skin to create a flat surface, then use a thin barrier ring around the stoma, and a convex bag on top. 

Have you tried a stoma collar instead of a barrier ring? They are a great alternative for ileostomies. They are really soft and flexible, encourage output to go into the bag (and not under) and you don't need to worry about the the edge of the bag going mushy. You can wear one underneath a convex bag

Ok thanks! I have a few changes I can make and experiment with the flat wafers I already own along with some barrier rings. I guess I'll see how it goes before I purchase convex ones. So far I'm three days with the flat wafer and barrier ring. If I can get away with a few of these changes I'll just stick to it and maybe request a convex sample in the future along with, perhaps a stoma collar. ( I have never heard of those)

Also, I don't know how long it takes for my stoma to shrink to its permanent size, but perhaps it'll still change size and give me issues over the next little while. I think I'm 5 weeks out of surgery.

Anywsy, thanks for all the clarification and tips. 

Hey Chris, your stoma should stop shrinking any time soon, but it may never settle to a consistent size (mine doesn't). Keep measuring with every appliance change until you know things are consistent enough. 

And for more info on those stoma collars check out :

https://www.veganostomy.ca/guide-to-ostomy-stoma-collars/

Chris, my situation may be different than yours because I have a colostomy. My stoma sticks out very little and sometime retracts to flat. I started with the flat wafers and used them for a long time with no big problems. I tried a lot of rings and Eakin was the best, but for me it seemed paste worked better, until the new Coloplast ring came out. I have gone over to it and found it is much easier to form around the stoma before placing the wafer. I tried a convex a couple weeks ago and didn't like it. Really it comes down to everyone is different and what works for one isn't right for others. Just my two cents worth, call and get samples of anything you want to try. They will send them.

A barrier ring and a wafer are not the same thing. The ring is an extra layer of protection, designed to prevent leakage under the wafer itself. It is so thin that I'm not sure it could take the place of an actual convex wafer. I have heard of some people "stacking" their barrier rings to create convexity, but I have never done this. Seems to me it would be easier just buying convex wafers.

In the Mayo Clinic hospital, right after my ileostomy surgery, the stoma nurses had me use flat wafers with a barrier ring so I have always assumed rings are a good thing to use. I now use a convex wafer and a barrier ring after I had one instance of "stella stoma" temporarily retracting herself under the skin (my stoma sticks out only 1/2") and causing leakage under the wafer. I've never had any issue at all with the convex wafer being less able to adhere to the skin than a flat wafer, but my tummy/skin is pretty flat to begin with, so maybe that helps. I guess if you've never had any issues with the stoma doing its little disappearing act for a bit and leaking, I'd stick with flat wafers and a ring for now, especially until things reach a level of stability. If it ain't broke, don't fix it!

I use a convex bag- it is RX only when u order as only allowed for flush and retracted stoma - in US at least. I wish I had your stoma!! I still use a barrier ring and mold to fit around my stoma to protect skin as I leak. Convexity is used to try and pop the stoma out or will leak everywhere if flush or retracted - good luck 

The convex wafer really works for me too. I have a smallish stoma ( less than an inch across) and its only about 3/4 of an inch tall ( I guess tall?) on a good day. Its retracted and often flush with my skin.

That started happening as I was healing and it really freaked me out the first time I saw it like that..no one mentioned that it was a possibility). Anyway, that lead to leaks so after talking to stoma nurse I started with the Hollister wafers with the least convexity in them and I also use an Eakins barrier ring under it. That seems to help it stick and adds some convexity at least before it starts to degrade. Hardly any leaks now.

Good luck to everyone out there .. like I have said before these things should come with better owner's manuals. Fortunately we have Eric's cool web site.

Like someone else saidx the manufacturers are usually pretty good about sending samples, i left the hospital with three or four, had samples waiting for me at home, ended up switching to convex, so got like 10 more samples, i have settled on coloplasts convex, they have three,  a more rigid 8mm deep, a rigid 6 mm deep, and a softer less rigid 6mm.  Ive had all three, and you can tell the difference.  I had used an eakin ring the first couple of changes,  but for me they dissolved into a gooey mess so i stopped using them.  If you are working with a stoma nurse, discuss your concerns with them, they are probablt the best people to ask.  

I use a light convex wafer and an Eakin seal.  They do have convex rings that you could try too.  I think a lot of it is just trial and error.  I would definitely send from some samples and do some experimenting.  

I used to be afraid of system failure,  wearing so much more than what was necessary. My dear WOCN Ostomy nurse, Coleen, suggested that I was "crazy " to be so afraid.  She showed me the Moldable wafer. It is available in flat and convex . I use convex.

The trick is to roll back and then squeeze the lip tightly . 

Basibecally, we shouldn't be afraid of the wafer falling off. It is made well and does its job. Fear is the enemy. (Though,  accidents are known to happen. )

Before I leave you, I will admit to a terrible beginning .the first time I went home, I used 14 bags in 2 days and dehydrated myself back into the hospital. It took me a long time to calm down and stop worrying. 

I was traumatized with leaking at first.  Now I'm trusting the system enough to even forget about it sometimes for a few minutes.  I'm using a convex wafer. I use an Eakin seal on it.  I tried paste but it burned my skin and my nurse said "less is more" for me, so I think I found MY solution.  Everyone's is so different but it's interesting to read about the differences.

Posted by: Illona

I was traumatized with leaking at first.  Now I'm trusting the system enough to even forget about it sometimes for a few minutes.  

Yes, once you find a system that works, it's amazing how much anxiety is lifted and you become more confident because of your ongoing experiences. 

I noticed that most of the advice is aimed at Newbies , who need to have a helping hand. Once you have a grip on the new situation,  and stop feeling sorry for your self,  things calm down. 

Yes, accidents do happen.  But that doesn't define 'you'.

Presently, I am volunteering to bring food to patients at the hospital.  Seeing them , I am grateful to God, that I am giving and not receiving. 

I just turned 66. Now,  I am looking forward to my next step in life.

I seem to be doing well with the mio regular wafer - do all companies have nice soft wafers like these? (I'd like to get those samples when I do get some)

I tried the coloplast assura but it feels like the wafer is made of glass and only lasted three hours on me before I put on a sensura mio.

So, unless things change (and I know they can), I'm liking the sensura mio regular wafer with half an eakin ring.

Now that I said that, I'm definitely getting a leak today :/ (I'm actually out and justate a panzo twice the size of my bag, so I shouldn't joke.)

Posted by: Chris

I seem to be doing well with the mio regular wafer - do all companies have nice soft wafers like these? (I'd like to get those samples when I do get some)

Not all companies do, but some have products that are very similar to the Mio's. Unfortunately, not all brands have these products available in every country.

Posted by: KamiH

I use a light convex wafer and an Eakin seal.  They do have convex rings that you could try too.  I think a lot of it is just trial and error.  I would definitely send from some samples and do some experimenting.  

Hi KamiH:

Have you used the convex rings with a flat wafer before? I am thinking about getting samples of the convex rings and seeing how they work while still using flat wafers. My stoma does not become flush with my skin, but it sometimes retracts a little bit. The opening of my stoma is also slightly off-centered so I was wondering if a convex ring would maybe help with directing stool more into the right spot.

I would be interested in hearing other folk's experience with the convex barrier rings working with flat wafers. Thank you!

I  use Eakin rings on my SenSura Mio barrier when I use the two-piece system. I mold it around and over the "cut to fit" area before putting it on since the barrier is of rather firm material and can be a bit rough after cutting it. I don't use it when I use the one-piece system since the material is much more flexible. I can't use the flat wafers - I get leaks. The convex work out much better for me and I use them consistently from whatever source or supplier I get them from.