Recurring ostomy pouch leakage is a frustrating experience that significantly affects daily life. While common—with one study reporting that 76% of ostomates experience leakage at least once per month—it should not be endured frequently. Repeated seal failure signals a problem with the fit of the pouching system or the condition of the surrounding skin. Successfully managing recurring leaks requires a systematic approach, starting with immediate action and moving toward identifying and correcting the underlying cause.
Immediate Steps When a Leak Occurs
The moment a leak is detected, the priority is to contain the output and protect the peristomal skin. The entire pouching system should be removed immediately, as allowing stool or urine to remain in contact with the skin under the adhesive can lead to rapid irritation and breakdown. Do not attempt to patch the existing leak with tape or paste, as this will trap the caustic output against the skin and prevent proper adhesion of the next system.
Once the old system is gently peeled away, clean the skin using only warm water and a soft cloth. Avoid harsh chemicals, alcohol, or scented soaps, as these can irritate the skin or leave oily residue that interferes with adhesion. Thoroughly dry the peristomal area before applying any new products, as adhesives do not bond effectively to moist skin. A clean, dry surface is necessary to create a secure seal for the replacement pouching system.
Identifying the Root Cause of Leakage
Systematic diagnosis is necessary to stop recurring leakage, as the seal failure is almost always due to a physical or mechanical mismatch between the body and the appliance. A thorough assessment focuses on three main areas: the fit of the barrier, the integrity of the surrounding skin, and the nature of the stoma output.
The skin barrier opening must fit snugly around the base of the stoma, allowing no more than a 1-2 mm gap of exposed skin. A hole that is too large exposes skin to effluent, while one that is too small can cause trauma to the stoma. The size and shape of a stoma can change over time, meaning regular remeasurement is necessary to ensure a precise fit.
The condition of the peristomal skin is another significant factor. Irritated, red, or weepy peristomal skin prevents the adhesive from forming a secure bond. Leakage initiates a destructive cycle where irritated skin fails to hold the adhesive, leading to further damage. Skin irritation should be investigated, as it can be caused by leakage, an allergic reaction, or physical trauma from repeatedly stripping the adhesive.
Finally, the consistency and behavior of the output can undermine the seal prematurely. If the output is extremely liquid, it may erode the barrier adhesive more quickly than solid output, necessitating a reduced wear time or a different type of barrier. Another common problem is “pancaking,” which occurs when thick output collects around the stoma instead of dropping into the pouch, causing the barrier to lift away from the skin. An overfull pouch, especially one more than one-third to one-half full, will also exert excessive weight and pull on the adhesive seal, which can cause it to detach.
Advanced Adhesion Techniques and Accessories
Once the underlying cause of the seal failure is identified, specific accessories can be used to optimize the pouching system’s fit and enhance adhesion. Barrier rings and seals are moldable products used to fill in dips, creases, and irregular contours of the skin around the stoma, which creates a level surface for the barrier to adhere to. These rings can be stretched, cut, or stacked to customize the seal, effectively bridging gaps where output might otherwise seep under the adhesive and cause a leak.
Skin barrier paste is a caulking agent, not an adhesive, used to fill in minor imperfections and shallow folds, preventing output from tunneling underneath the barrier. Apply it in a thin bead around the inner edge of the barrier opening to create a smooth transition. Stoma powder is used on weeping or irritated skin to absorb excess moisture, allowing the skin to dry and promoting better adherence. After dusting, gently brush away excess powder, and apply a specialized skin barrier wipe or spray over the area to create a sticky surface.
For stomas that are flush with or retracted below the skin surface, or for those located in deep abdominal folds, a convex barrier system is often required. Convexity refers to a slight dome shape built into the barrier, which gently pushes down on the peristomal skin to encourage the stoma to protrude, directing the output into the center of the pouch. Using an ostomy belt in conjunction with a convex system provides additional support and pressure, ensuring a consistent, secure seal against the body, especially during movement or physical activity.
Knowing When to Contact Your Healthcare Provider
While many leakage issues can be resolved with careful troubleshooting and the use of accessories, certain situations require the specialized knowledge of a healthcare professional. Wound, Ostomy, and Continence (WOC) Nurses are specifically trained to assess stoma and peristomal complications and should be consulted for recurring problems. A consultation is warranted if leakage persists despite trying multiple types of systems or accessories, or if the normal wear time of the pouching system is suddenly reduced.
Immediate contact with a WOC nurse or physician is necessary for severe or rapidly worsening skin breakdown, such as open ulcers or a persistent rash. Professional intervention is also required for suspected structural changes to the stoma, including retraction (sinking below the skin), prolapse (protruding excessively), or a bulge indicating a hernia. Furthermore, the inability to achieve a secure seal for longer than 24 hours is urgent, as prolonged exposure to effluent risks serious skin damage.