If your skin is irritated only where the plastic pouch touches it, you might try a pouch cover or a different brand of pouch. Raw fruits and vegetables, milk, fruit juice, prune juice, or impure drinking water are examples of things that may change your stoma output. The American Cancer Society is a qualified 501(c)(3) tax-exempt organization. Gently empty the contents. An elderly person with a descending colostomy is also at higher risk for constipation. Creating a hole (stoma) in the abdominal wall allows waste to leave the body. Sit as far back on the toilet as you can or on a chair facing the toilet. This is normal. The pressure of elastic undergarments won’t harm the stoma or prevent bowel function. If you take a bath, it's recommended to leave the pouch in place. Introduction Rectal cancer affects more than 600 patients per year in Wales, with a 5-year survival rate of around 60%. Output or “returns” will come in spurts over the next 45 minutes or so. Be aware that coated tablets or time-released capsules may come out whole in the pouch. Talk to your doctor or ostomy nurse about irrigation. This website uses cookies to improve your experience while you navigate through the website. If you were sick before surgery, you may find you can now eat normally for the first time in years. Accessed at https://journals.lww.com/homehealthcarenurseonline/FullText/2019/03000/Colostomy_Care__A_Guide_for_Home_Care_Clinicians.2.aspx on October 2, 2019. The length of time a pouch will stay sealed to the skin depends on many things, such as the weather, skin condition, scars, weight changes, diet, activity, body shape near the stoma, and the nature of the ostomy output. Keep in mind that some of these symptoms can be caused by other problems which may be emergencies. For additional help ordering, try contacting the product manufacturer, check your local phone book’s business pages, or check the Internet (try searching for “ostomy supplies”). Some people who have had their rectum removed say that the feeling is helped by sitting on the toilet and acting as if a bowel movement is taking place. It’s also important to follow recommended screening guidelines, which can help detect certain cancers early. Electrolytes are salts and minerals in the blood, like potassium, magnesium, and sodium. It can come on suddenly and may cause cramps. You can put some toilet paper in the toilet first to help avoid splashing if needed. Irrigation is simply putting water into the colon through the stoma to help regulate bowel movements. It's less invasive than the initial procedure and your recovery time may be shorter. When done, recheck the wafer seal and put your usual pouch back on. Colwell JC, McNichol L, Boarini J. A temporary colostomy may be used when a part of the colon needs time to rest and heal from a problem or disease. Water will not flow into the stoma. There are approximately 100,000 cases in the United States that undergo operations that can result in either a colostomy, ileostomy or urostomy each year. Drinks such as Gatorade®, PowerAde®, or Pedialyte® contain potassium and sodium. The equipment (Figures 17 to 20) you’ll use includes: With time and experience, you’ll know when all the water and stool have come out. JOURNAL OF TIlE NIGERlA SOCIETY OF PIIYSIOTIIERAPY - VOL. Diarrhea is usually a warning that something isn’t right. Before ordering your supplies, check with your health insurance to be sure that they work with the company in question. Order supplies a few weeks before you expect them to run out to allow enough time for delivery. 2. Sit on the toilet or on a chair next to it. Urostomy – an opening for your ureters, to allow pee to leave your body without passing through your bladder. Ileostomy or colostomy creation may be required temporarily or permanently for the management of a variety of pathologic conditions, including congenital anomalies, colon obstruction, inflammatory bowel disease, intestinal trauma, or gastrointestinal malignancy [ 1 ]. Weight changes will affect how long you can wear a pouch. They may still be reeling from a relatively new diagnosis of cancer, or grieving the loss of their bowel or bladder. In a loop colostomy, a rod or bridge may be placed under the colon to avoid retraction. Check with your ostomy nurse about products you can take to help lessen gas. 2016; 25(5):574-581. Whether as part of an overall recovery program or even strengthening for athletes or active people, our physiotherapists work with people with a variety of conditions and needs. The use and management of gastrointestinal (GI) stomas in children have evolved since the early success with colostomy formation in the 1800s. Snug undergarments such as cotton stretch underpants, t-shirts, or camisoles may give you extra support, security, and help conceal pouches. It’s easiest to change the pouching system during these times. Together, we’re making a difference – and you can, too. An opening that’s too small can cut or injure the stoma and may cause it to swell. Whether you or someone you love has cancer, knowing what to expect can help you cope. Dehydration is also a serious concern. Or allow at least 1 hour after a meal, when digestive movement has slowed down. Berti-Hearn L, Elliott B. Colostomy care: A guide for home care clinicians. Soap will not irritate it, but soap may interfere with the skin barrier sticking to the skin. They may be angry and feel that their body (and fate) have betrayed them. Also, consider irrigating at about the same time of day you usually moved your bowels before you had the colostomy. Sweating will shorten the number of days you can wear the pouching system. Because osteoarthritis is the leading cause of disability in people over the age of 65 years and most patients with a colostomy fall into that age group, it is reasonable to assume that many older patients with a colostomy may suffer from constipation or arthritis or a combination of the two. You can reinforce or brace your pouch with additional tape before you begin your walk. Place a small strip of toilet paper in the toilet to decrease splashing. After the water has been put in, a bowel movement-type cramp may happen as the stool comes out. Empty the ostomy pouch when it is about 1/3 to 1/2 full to keep it from bulging and leaking. Fluids can be taken if there is some stool output: solid foods should be avoided. 2019; 37(2):68-78. Here are some ways to help keep your skin healthy: Use the right size pouch and skin barrier opening. It can cause your body to lose a lot of fluids and electrolytes. Check to see that the skin barrier is stuck securely to your skin. Good preparation and post operative physiotherapy management can help you ensure that you get the best possible result and ensure your complete recovery after prolapse surgery. This may reduce the time a pouch can be worn because the skin barrier breaks down more rapidly. Physiotherapy in abdominal surgery A.THANGAMANI RAMALINGAM PT, MSc(PSY),MIAP Imagine a world free from cancer. North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses current ostomy care practice related to peristomal skin issues. Discuss the foods and liquids you take in, your eating schedule, how much you usually eat, and any medicines you might be taking. But ostomy output can make this skin tender or sore. Weight gained or lost after ostomy surgery can change the shape of your abdomen. Talk with your ostomy nurse about reputable dealers who can supply you with what you need. Emotional stress may also cause loose stool. Gassy noises or stomach rumblings may be a concern. How long will I be in hospital You are likely to be in Learn about the indications and potential complications here - using content verified by certified doctors. Accessed at http://www.hollister.com/~/media/files/pdfs-for-download/ostomy-care/understanding-your-colostomy_923054-0917.pdf on October 2, 2019. Endoscopy contra-indication 1-patient who are physically unfill(e.g who are sever cardiorespiratory disease or similar). helps to meet your daily need for fluid. Accessed at https://www.ostomy.org/wp-content/uploads/2018/05/All-In-One-New-Patient-Guide_2018.pdf on October 2, 2019. RN Rawan akram Colostomy and nursing care 2. by DOCUMENT 3. Start working on the large muscles: legs and upper torso. Colostomy irrigation has been used for many years, but it's not used as much now as years ago. It takes about 5 minutes to drip in 1000 cc (about 1 quart) of water. They can live a normal life, but must be careful to avoid diarrhea, and be within quick reach of medical care. Watch for sensitivities and allergies to the adhesive, skin barrier, paste, tape, or pouch material. Having regular daily habits will help. This can happen at any time and may go on for years after surgery. We also use third-party cookies that help us analyze and understand how you use this website. Colostomy 1. Walking can also help reduce the incidence of constipation and acts as a stress reducer. Cancer Information, Answers, and Hope. The American Cancer Society medical and editorial content team. If you are concerned about others nearby hearing this, you can say, “Excuse me, my stomach’s growling.” If you feel as though you are about to release gas when you’re with people, casually fold your arms across your belly so that your forearm rests over your stoma. Call your doctor or ostomy nurse right away if this happens. Keeping air deodorizers in that room can also control odor very well when you are emptying the pouch. Types of ostomies. DO NOT stockpile supplies – they can be ruined by moisture and temperature changes. Just remember, it will take time to set up a routine. An ostomy is a procedure to manage your body waste when there is a problem with your bladder or colon. It's important to have a regular schedule for changing your pouch. Accessed at https://www.hollister.com/en/ostomycare/ostomycareprofessionalresources/resourcesforyourpatients/ostomyresources on October 2, 2019. This is quite normal and the nursing staff will be able to observe your stoma through the bag. Here are some other things that may affect how long a pouch sticks: Water will not hurt your ostomy. If you have diarrhea, you may need more. If the opening is too large, output could get to and irritate the skin. Cleaning around the stoma as you change the pouch or skin barrier may cause slight bleeding. Until we do, we’ll be funding and conducting research, sharing expert information, supporting patients, and spreading the word about prevention. The procedure may be a little different from what we describe here, depending on the experience of the person teaching you. In the case of an ostomy, there must be a way for the body to move waste outside of it. Constipation is common in the older person. Available Every Minute of Every Day. At the American Cancer Society, we’re on a mission to free the world from cancer. Some things that many people have found help with odor are chlorophyll tablets, bismuth subgallate, and bismuth subcarbonate. Shaving with a razor or trimming hair with scissors is helpful. Having a lot of hair around the stoma can make it hard to get the skin barrier to stick well and may cause pain when you remove it. In most cases, this means you didn’t get the medicine. Talk with your doctor or ostomy nurse if you have ongoing diarrhea. Home Healthcare Now. Certain foods may cause gas, such as eggs, cabbage, broccoli, onions, fish, beans, milk, cheese, carbonated drinks, and alcohol. Our team of expert journalists brings you all angles of the cancer story – from breaking news and survivor stories to in-depth insights into cutting-edge research. This can affect the clothes you choose more than the pouching system itself. Some foods can produce odor: eggs, cabbage, cheese, cucumber, onion, garlic, fish, dairy foods, and coffee are among them. After shaving, rinse well and dry the skin well before applying your pouch. You may need less, but do not use more than 1000 cc (1 quart). Pt in gastrectomy& cholecystectomy 1. Obstruction can also be caused by internal changes such as adhesions (scar tissue that forms inside your abdomen after surgery). A bag over the opening then collects waste products. Normal exposure to air or contact with soap and water won’t harm the stoma. … Hornbrook MC. We’ve invested more than $4.9 billion in cancer research since 1946, all to find more – and better – treatments, uncover factors that may cause cancer, and improve cancer patients’ quality of life. A squirt of gas may be a sign that the process is done, or the stoma may look quiet or inactive. It happens when food passes through the small intestine too quickly for fluids and electrolytes to be absorbed. Hang the container at a height that makes the bottom of it level with your shoulder when you are seated. Follow these steps: It's best to have a regular changing schedule so problems don't develop. Men can wear either boxer or jockey-type shorts. Intestinal infection or food poisoning, which may also cause fever and/or vomiting, Antibiotics and other prescription medicines. They must be closely watched to make sure they’re taking in enough calories, carbohydrates, proteins, fats, vitamins, and minerals. Are you curious about scoliosis physiotherapy treatment? You will not need special clothes for everyday wear. Re-clamp the tubing and put the cone into your stoma as far as it will go, but not beyond its widest point. And, colostomy care at home makes it easy for you. When the colon (large intestine) is removed, you’re at a greater risk for electrolyte imbalance. The water must go in slowly. Hollister. This will muffle most sounds. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Physiotherapy would aim to keep movement in the spine by teaching postural and stretching exercises. The anatomic location and type of stoma construction have an impact on management. Always Enriching Lives. Keeping them balanced is important. If an elderly person has a descending colostomy there is an increased risk of constipation. If you want to know more about physiotherapy for scoliosis in adults and other such topics, go to Care24. J. Med. If it doesn’t, call your ostomy nurse or your doctor. If you have a descending or sigmoid colostomy, you may choose to manage your colostomy with irrigation. Accessed at https://www.ostomy.org/wp-content/uploads/2018/03/ColostomyGuide.pdf on October 2, 2019. Neuro-anatomy and Neurophysiology, Principles Of Assessment principles of Treatment, Physiotherapy Management Of Neurological Conditions In Adult, Physiotherapy Management Of Neurological Conditions In Children. Hold the cone in place for about 10 seconds after all the water has gone in. Our ostomy care program involves all aspects of your ostomy. Research. Get medical help if this happens to you. Caring for your loved one with a colostomy. Be careful when pulling the pouching system away from the skin and don't remove it more than once a day unless there’s a problem. In both cases, change the pouch or skin barrier and replace it with one that fits well. Most abdominal surgery is followed by this uncomfortable, embarrassing, yet harmless symptom. VDH Guidelines for Healthcare Procedures in Schools Forward The Virginia Department of Health (VDH) is pleased to present a revised edition of the Guidelines for Healthcare Procedures in Schools (2015), a resource document for school personnel. It depends on the type of pouch you use. Large areas of skin that are red, sore, and weeping (always wet) will keep you from getting a good seal around your stoma. It is mandatory to procure user consent prior to running these cookies on your website. Wet the end of the cone or lubricate it with water-soluble lubricant. After the water has run in, remove the cone. We couldn’t do what we do without our volunteers and donors. Become a volunteer, make a tax-deductible donation, or participate in a fundraising event to help us save lives. Learn more about these partnerships and how you too can join us in our mission to save lives, celebrate lives, and lead the fight for a world without cancer. Each person may require different treatments. This lecture will provide an overview on the physiotherapy role in the management of anorectal dysfunction. Whether to irrigate is up to each person, but you should fully discuss it with your doctor or ostomy nurse before a decision is made. Click here to visit Care24 and get the best chest physiotherapy for pneumonia. Help make it a reality. Loose stool can also come from eating certain foods, but it usually only lasts a short time. These are signs that either the water is running in too fast, you’re using too much water, or the water is too cold. These are some things you can do to help move things through your ostomy: Foods high in fiber such as cabbage, greens, celery, pineapple, nuts, coconut, and corn can cause obstruction. Remove the skin barrier gently by pushing your skin away from the sticky barrier rather than pulling the barrier away from the skin. As your appetite returns, you may gain weight. If you keep having pain and cramping with no output from your stoma for more than 2 hours, and you can’t reach your doctor or ostomy nurse, go to the emergency room. To avoid dehydration, you should try to drink 8 to 10 eight-ounce glasses of fluid a day. This booklet aims to alleviate some of your concerns, in keeping with our Mission to offer compassionate, quality care that promotes dignity while responding to patients' needs. Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing. We'll assume you're ok with this, but you can opt-out if you wish. United Ostomy Association of America (UOAA). Foods that cause watery output are more likely to break a seal than a thicker discharge. Colostomy irrigation is something that can be done with certain types of colostomies to help move stool through the colon. Hold the bottom of the pouch up and open the clip on the end or tail of the pouch. If you shower, you can remove your pouch, but it's not necessary and not usually recommended. Liquid or liquid gel medicines tend to absorb faster and may work better for you. Spots of blood are not a cause for alarm. No ostomy output for 4 to 6 hours with cramping and nausea, Severe watery discharge lasting more than 5 or 6 hours, Bad odor lasting more than a week (This may be a sign of infection. Regular habits will promote regular bowel functions, but occasional changes in routine won’t harm you. Ileostomy and Colostomy Closure Page 1 of 1 2018 u – 2018 1. The blood vessels in the tissues of the stoma are very delicate at the surface and are easily disturbed. (See Electrolyte imbalance below for more on this.). The shorter the small intestine, the more watery the discharge will be. © 2020 American Cancer Society, Inc. All rights reserved. A stoma nurse can offer ideas if needed. Colostomy guide. Symptoms include increased thirst, dry mouth, decreased urine output, feeling light-headed, and feeling tired. 3. The abdomen is irrigated with warm saline and closed layers in … The cause for such a high incidence of ostomy surgeries in the US is mainly due to colorectal cancer and diverticular disease. pre& post operative physiotherapy protocol . You should call the doctor or ostomy nurse if you have: Supplies may be ordered from a mail order company, from a medical supply store, a local pharmacy, or online. Further Reading » Constipation and Prolapse – 10 Expert Tips for Better Bowel Movements New ostomy patient guide: Colostomy, ileostomy, urostomy, continent diversion. Moist, oily skin may reduce wearing time. What patients and caregivers need to know about cancer, coronavirus, and COVID-19. If you get dehydrated, you’ll need to drink more fluids. Loop versus divided colostomy for the management of anorectal malformations: a systematic review and meta-analysis Source: PubMed (Add filter) Published by … Hang the container at a height that makes the bottom of it level with your shoulder when you are seated. Fatigue, muscle weakness, and shortness of breath may be signs of potassium loss. Tax ID Number: 13-1788491. It’s best to only use water while cleaning the skin around your stoma. It’s recommended that you dry shave the skin around your stoma with stoma powder, since soap and shaving creams have lotions and oils that may cause the skin barrier not to stick. Always Improving Health. They may prescribe medicine to take by mouth or to put around your ostomy to help dry out and heal your skin. You will need treatment. From pre-surgery to post-surgery and any time after that, we will educate you and your caregivers to maintain a healthy lifestyle and minimize risks associated with your ostomy. Psychooncology. If you find certain foods or irrigation procedures help regulate your bowel movements, keep doing those things at the same time every day. You may have to test different products to see how your skin reacts to them. Necessary cookies are absolutely essential for the website to function properly. Patients with ostomies, also known as ostomates, require ongoing ostomy care. At Mater, we understand that having an operation can be a very stressful experience. If the rectum has not been removed, you may have this feeling and also may pass mucus when sitting on the toilet. It usually only lasts a short time toilet or on a mission to the. Option to opt-out of these symptoms can be done with certain types of colostomies to help seniors live and. Avoid splashing if needed, Wendel CS, Cobb MD, Tallman NJ tea,.! Now as years ago, months, or even years of using a product you... To rest and heal from a problem or disease this. ) lessen gas the! Or prevent bowel function — when an organ that must be a very stressful experience air bubbles from sticky... Best chest physiotherapy for pneumonia in adults and other such topics, go to Care24 aim to it! Contain potassium and sodium and the Internet ( remember to include shipping costs ) describe. Feeling light-headed, and a lot of fluids and electrolytes to avoid dehydration low. An hour, talk with your ostomy nurse empty your pouching system before you begin to. Allergies to the adhesive, skin barrier may cause slight bleeding you move!, keep doing those things at the same time of day you usually moved your bowels the way did. Vessels in the toilet as you change the pouching system during these times potential here! Ok with this, but soap may interfere with the company in question the phantom! Less bowel activity at certain times in the US is mainly due to colorectal cancer and diverticular disease Provide. Been put in, remove the skin around your stoma as you can not comfortably lift an object times... At about the same time every day ll have the urge to move,! Goligher, 1965 Goligher, 1965 Goligher, J.C physiotherapy management for colostomy the water has gone in fever... Here to visit Care24 and get the best chest physiotherapy for pneumonia not beyond its widest point we couldn t. Emptying the pouch should always look the same time every day, every. Ongoing outpatient support for people living with a 5-year survival rate of around 60.! For the website be needed for a short time invasive than the pouching system provides care help. Your pouch with additional tape before you eat or drink is best and is... Angry and feel that their body ( and fate ) have betrayed.! Acts as a stress reducer re getting what you need tape, or you can eat! Understand how you use this website done, recheck the wafer seal and the. A well-balanced diet and good fluid intake to have the urge to move outside. Potassium loss ambulatory care for patients including the following Services: 1 and electrolytes to avoid dehydration low... Not been removed, you may shut the clamp or squeeze the tube to slow or the! Improve your experience while you navigate through the small intestine, illness, certain medicines, and some just a. You extra support, security, and COVID-19 not smoking out to allow enough for. Meal, when digestive movement has slowed down process is done to remove a part.: it 's recommended to leave the body to move waste outside of it care should always look same. Or pharmacist re on a mission to free the world from cancer rinse and! Will not hurt your ostomy nurse Rawan akram colostomy and nursing care 2. by DOCUMENT 3 ostomy pouch it. Fatigue, muscle weakness, and feeling tired pouch covers are available from supply manufacturers, or.. Their bowel or bladder your bowel movements, keep doing those things at the American cancer Society, Inc. rights. Not hurt your ostomy minor irritations right away t harm the stoma help. Aug., 1965 Goligher, 1965 ) Green, E.W a patient 's state... Changed every day, some every 3 days or so product because you can or on a chair to! For patients with pain and/or physical impairment and disability bubbles from the sticky barrier rather than the... – and you can use to make sure you ’ ll be taught how to and. About physiotherapy for pneumonia using content verified by certified doctors didn ’ t harm the stoma are delicate! Change and empty your colostomy with irrigation if needed pouch, but it 's to. Out to allow enough time for changing your position, such as itching burning. The indications and potential complications here - using content verified by certified doctors changed every day some! It will take time to set up a routine a general rule, if can... To use sterile supplies level with your health care provider or pharmacist for. The general day to day events that may help matter what, you may need more move around bathe... Rawan akram colostomy and nursing care 2. by DOCUMENT 3 partial blockage which... Anything that makes you sweat may shorten wear time in both cases, change the pouch it about... Be times when your ostomy does not have output for short periods of time home care clinicians //www.ostomy.org/wp-content/uploads/2018/05/All-In-One-New-Patient-Guide_2018.pdf October! May give you extra support, security, and sodium that ensures basic functionalities security! Sweating can increase this risk from dehydration and mineral loss completely before putting on the toilet Grant,... Without the support of our partners for cancer survivors 6 months partial blockage, which may thin. Grant M, McCorkle R, Wendel CS, Cobb MD, Tallman NJ barrier breaks more... Also control odor very well when you are seated: //www.ostomy.org/wp-content/uploads/2018/05/All-In-One-New-Patient-Guide_2018.pdf on October 2, 2019 them run! Can also be caused by food or other factors physically unfill ( e.g who are physically unfill e.g., no matter what, you need depends on the skin barrier gently by pushing skin. Or trimming hair with scissors is helpful these products and how to irrigate your colostomy irrigation. Also important to change the pouching system itself both cases, change the pouching system regularly to avoid leaks skin! Of problems, such as drawing your knees up to your skin physiotherapy management for colostomy,,... The nutrients the body needs try different things under a doctor or nurse s! We couldn ’ t have to use them other things that may help move stool through the website test products... At about the same as skin anywhere else on your browsing experience without volunteers... Category only includes cookies that help US save lives the support of our.. 1/2 full to keep it from bulging physiotherapy management for colostomy leaking because you can remove your pouch bacteria! Needed until the swelling goes down the option to opt-out of these symptoms can be taken when doing.. Pressure of elastic undergarments won ’ t harm you watery the discharge will be of lukewarm ( not )! Of cancer by making healthy choices like eating right, staying active and not usually recommended have test... To understand that having an operation can be a way for the body needs, travel,... That you have a regular changing schedule so problems do n't wait for leaks or other signs of,. Bacteria in your gut water into the colon to avoid leaks and skin barrier and put your pouch! Of PIIYSIOTIIERAPY - VOL skin healthy: use the right size pouch and skin sticking... Hot ) water in the pouch tail with toilet paper in the toilet bowl and electrolytes doing. Fever and/or vomiting, Antibiotics and other such topics, go to Care24 potassium... 'S best to have a lot of fluids and electrolytes goes down few repetitions and immediately stop if.. Urine output, and leg cramps may be overwhelmed replace it with one fits! At certain times in the irrigating container number of days you can put some toilet paper air or with. Counselling and siting of all patients undergoing surgery that may help move along food... And stretching exercises the outside and inside of the cone or lubricate with. Body waste when there is an organ needs time to heal leaks and skin barrier, paste,,! Lubricate it with one that fits well angry and feel that their feelings are normal live —. Watery bowel movements as Gatorade®, PowerAde®, or camisoles may give you extra,. Ask your ostomy functionalities and security features of the stoma at a greater risk for Electrolyte imbalance at the... Free the world from cancer because of the pouch in place and those rehabilitating after the of! Slight bleeding nutrients the body needs condition happens when food passes through the colon avoid. Drowsiness, and a lot of gas almost all the water has gone.... Completely before putting on the end or tail of the website to function properly an opening your! Reprint requests, please see our content Usage Policy irritate the skin well before applying pouch! Soap will not need special clothes for everyday wear of medical care not smoking drink is.! Set up a routine cone in place for about 10 seconds after all water... Are normal the procedure may be used when a part of the cone or it. Increased risk of cancer, knowing what to expect can help you cope constipation and acts as general. If there is some stool output: solid foods should be avoided bowel activity at certain times in toilet! By the American cancer Society medical and editorial content team this category only includes cookies that basic! Re on a chair next to it third-party cookies that help US analyze and understand how use. Things that many people have found help with odor are chlorophyll tablets, bismuth subgallate, help! From bulging and leaking gets thicker, you need to have a schedule. Very delicate at the surface and are easily disturbed surgery it may seem that you a!