A leaking colostomy bag is an urgent situation requiring immediate attention. Leakage occurs when stoma output escapes the pouching system, compromising hygiene and quickly leading to severe skin irritation around the stoma, known as peristomal skin breakdown. This irritation makes it harder for the next appliance to adhere securely, increasing the risk of future leaks. Addressing the leak systematically, by first containing the output and then identifying the cause, is necessary to protect the skin and restore the security of the pouching system.
Immediate Steps for Containing the Leak
The moment a leak is suspected, the priority is to contain the contents and protect the skin. Gently apply light pressure over the leaking area of the appliance to temporarily stem the flow of stool. Immediately cover the pouch and the surrounding skin with absorbent material, such as paper towels or a thick cloth, to absorb escaping output.
Relocate to a private, clean space, preferably a bathroom, where all necessary supplies are accessible. This containment step buys time to gather the full replacement kit. Having a pre-prepared emergency kit with a full change of appliance, adhesive remover, and cleaning supplies is helpful. Protecting the peristomal skin from prolonged contact with digestive enzymes is paramount to preventing painful irritation and ensuring the next application is successful.
Diagnosing Why the Colostomy System Failed
After containing the initial leak, analyze the compromised system to understand the failure point. One of the most common reasons for leakage is an issue with the appliance fit around the stoma. The opening in the skin barrier, or wafer, may have been cut too large, allowing output to seep onto the skin. Alternatively, the stoma may have changed in size or shape, which frequently happens in the first months after surgery.
Barrier erosion is another frequent cause, often occurring when the appliance is worn past its recommended wear time, causing the adhesive to break down. The weight of a full pouch can also cause the seal to pull away from the skin if the pouch is allowed to become more than one-third full before emptying. Furthermore, the condition of the peristomal skin impacts adhesion; perspiration, oil-based products, or uneven surfaces due to folds or scarring can prevent a secure bond. If the stoma is flush with the skin or retracted, a standard flat barrier may not provide a sufficient seal, leading to persistent leaks.
Applying a New, Secure Appliance
Removal and Cleaning
Successfully applying a new appliance begins with the careful removal of the compromised system to avoid damaging the skin. Use an adhesive remover wipe or spray, working gently around the edge of the barrier while peeling it back slowly, supporting the skin with the other hand. Once the old system is off, thoroughly clean the peristomal skin using only warm water and a soft cloth. Avoid soaps that contain oils or perfumes, as they leave a residue that interferes with the new adhesive.
The skin must be completely dry before proceeding, as moisture will prevent proper adhesion. A stoma powder can be dusted lightly onto any weepy or irritated areas to absorb moisture before applying the new barrier.
Measuring and Prepping
Accurately measure the stoma using a specialized measuring guide to ensure the new barrier opening is the correct size. The opening should be cut to fit snugly around the stoma, leaving only a small gap of about one-eighth of an inch (3-4 mm) of skin exposed between the stoma and the barrier edge. If using a cut-to-fit barrier, trace the correct size onto the back of the wafer and use curved-tip scissors to cut the opening precisely.
For added security, a barrier ring or paste can be molded around the stoma base to fill in any minor dips or creases in the skin, creating a smoother surface for the wafer to adhere to.
Application
Before application, it is helpful to warm the adhesive wafer by holding it between the hands for a minute to improve its malleability and sticking power. Remove the protective backing and center the opening over the stoma, applying the barrier from the bottom up.
Once in place, apply firm, even pressure to the wafer, starting near the stoma and working outward. Hold the palm of the hand over the barrier for about 30 seconds, as the body heat transferred from the hand helps to activate the adhesive and ensures a complete, secure seal against the skin.
Routine Care to Prevent Future Leaks
Preventing future leaks relies on establishing consistent, proactive care routines. A regular replacement schedule is paramount, as waiting too long allows the barrier to degrade from continuous exposure to output and moisture. Most appliances are designed to be worn for a predictable amount of time, typically between three and five days. Changing the system before the adhesive begins to fail reduces the risk of leakage.
Frequent emptying of the pouch is also a practical preventative measure. The recommended practice is to empty the bag when it is only one-third full. This action prevents the weight of the contents from pulling down on the adhesive seal, which is a common cause of premature system failure. Regular re-measurement of the stoma is necessary, especially in the first few months post-surgery, because the stoma size often shrinks as swelling subsides. If leaks persist despite diligent care and proper fit, consulting a Wound, Ostomy, and Continence (WOC) nurse is advisable. They can recommend specialized products like convex barriers, belts, or different accessory seals designed to address unique body contours or stoma retraction.