Stoma leaks are an unfortunate part of the stoma journey, almost all ostomates experience them once or twice along the way. Experiencing a leak can be a miserable experience for ostomates. Not only is the skin at risk of becoming irritated, sore and uncomfortable, but a leaking bag can have a huge impact on both the mood and lifestyle of an ostomate. Preventing and learning how to control stoma leakage is therefore crucial in ensuring comfort, confidence, and overall wellbeing.
Common causes:
Leaks with a stoma may occur for a variety of reasons, it is always a good idea to link with your Stoma Care Nurse for support in finding out the reason why it is happening, so a plan can be made to resolve these leaks. Often, it is down to the stoma bag not fitting securely around the stoma, but there can be many other reasons.
Changes in stoma size/shape, especially soon after surgery:
Following stoma surgery both your stomach and the stoma itself can be quite swollen. Over the first six weeks this swelling slowly reduces and your stoma care nurse will be monitoring this with the size of your stoma.
Poor fit (hole too big/small, wrong product for stoma type):
Making sure the aperture (hole) is a good size is important to prevent leaks. During the first 6 weeks following stoma surgery a stoma care nurse will help monitor and re-size this aperture as your swelling reduces and your stoma becomes smaller in size.
Weight gain or loss:
This is another factor which may affect the fit of the stoma bag. You may have noticed you have lost weight before and after the surgery or have gained further down the line, either way it can affect the way the stoma bag sticks to your body.
Skin folds, dips creases, uneven abdominal contours and scarring:
No one has a perfectly flat stomach, but all these additional issues may prevent a tight seal of the stoma bag to your abdominal area.
High output or liquid stool:
If your output becomes loose, the liquid can quickly find a way of escaping and causing leaks. It might be an idea to see if you have changed your diet, fluid intake, started new medications or recognising whether you have had an infection or illness recently. Monitor the number of times you are draining your stoma bag and if this suddenly increases with a loose output, touch base with your stoma care nurse for support. Being aware of what is normal for you is important.
Moist skin:
Some of us may experience moist skin, or oily skin, through sweating or excess moisture. This may affect the stoma pouch sticking affectively. Try to keep the area dry after washing and changing the stoma pouch.
Excessive wear time (left on too long):
If your stoma pouch is left on too long the adhesive may start to erode and break down, this will compromise the adhesion to your skin.
Prevention tips:
Choose the right stoma bag:
Selecting the appropriate stoma bag is the first step in preventing leakage. There are two main types of appliances: one-piece and two-piece systems. One-piece systems consist of a pouch and a skin barrier (wafer/flange) combined into a single unit, while two-piece systems have a separate pouch and barrier. The choice between these systems depends on individual preferences and stoma characteristics. Ensure that the appliance is the correct size and shape for your stoma to create a secure seal.
Maintain good hygiene:
Proper hygiene is essential to prevent irritation and infection around the stoma site. Clean the skin around the stoma gently with warm water. If you feel you need to use a soap, try a mild, scent-free soap. Avoid using alcohol-based wipes, as they can be harsh on the skin. Pat the area dry with a soft towel and make sure it is completely clean and dry before applying a new appliance.
Stoma assessment:
Regularly assess the condition of your stoma and the surrounding skin (peristomal skin). Look for any signs of skin irritation, redness, or changes in the stoma’s size and shape. If you notice any issues, or your stoma has changed shape or size contact your Stoma Care Nurse to be re-sized and for guidance on appliance adjustments or changes.
Monitor your diet:
Your diet can significantly impact stoma output and the consistency of your stool. Pay attention to the foods you eat and their effect on your stoma output. Some foods may lead to increased gas or liquid output, which can increase the risk of leakage.
On the go leak management:
Empty your pouch regularly: Keep an eye on the level of output in your pouch and empty it when it’s about one-third to half full. Frequent emptying helps prevent excessive weight and pressure on the appliance, reducing the risk of leakage.
Be mindful of your activities: Certain activities may increase the risk of stoma leakage. Be cautious when participating in activities that involve vigorous movement, pressure on the abdomen, or tight clothing. Consider using a stoma guard or belt to protect your stoma during physical activities.
Takes spares with you. Pack a little bag of spare stoma bags, wipes and disposable bags so you have them to hand if you were to experience a leak.
Emotional side of leaks:
Living with a stoma can be challenging, especially when it comes to preventing and managing leakage. Many ostomates feel anxiety, fear and embarrassment which can lead to a loss of feeling in control. The unpredictability of a leak can lead to worry about potential accidents in public. In turn this can lead to social isolation as the ostomate may withdraw from friends, family and loved ones.
Leaks may impact intimate relationships with partners and have an impact on work too. This can all have an effect of self-esteem and self-image. So try to be prepared where you can, and take additional supplies with you so you can nip into the nearest toilet.
Don’t feel alone and don’t put up with any pesky leaks, especially those which persist! Reach out to support groups who can provide guidance, tips, and emotional support. Education and emotional support can make a significant difference in your confidence and ability to manage your stoma effectively.
More importantly, reach out to your stoma care nurse, who can help to find out the cause of the leaks and show you ways of coping. There are products out there which can help solidify loose output, fit into creases and dips and create a better seal for your stoma.
