A stoma is a surgically created opening on the abdomen that allows waste to exit the body, requiring an external pouching system to collect output. While a stoma improves quality of life, the concern of leaks causes significant distress. A compromised seal risks accidents and exposes the delicate peri-stomal skin to corrosive waste, leading to irritation. Preventing leaks depends on selecting the correct equipment, mastering application techniques, and managing daily output factors.
Appliance Selection and Sizing
The foundation of leak prevention begins with choosing a pouching system that precisely matches the stoma’s characteristics and the abdomen’s contours. Since the stoma’s size and shape change after surgery, continuous, accurate measurement is necessary to ensure the skin barrier opening is a proper fit. The opening should be cut to allow only a minimal gap—about 1/8 inch (3–4 mm)—around the stoma’s base. This prevents output from touching the skin without causing pressure or trauma to the stoma itself.
Users must choose between a one-piece system, where the adhesive barrier and pouch are permanently combined, and a two-piece system. The two-piece system allows the pouch to be detached from a separate adhesive barrier (wafer or flange), offering flexibility for changing the pouch without removing the skin barrier. One-piece systems are generally lower profile and simpler. The stoma opening can be pre-cut to a specific size or a cut-to-fit style, which requires the user to trim the opening to the exact dimension.
The use of convexity is often the most significant factor for preventing leaks. Convexity refers to an outward curve built into the skin barrier. These barriers apply gentle pressure to the skin surrounding the stoma, helping to push a flush or retracted stoma outward. This protrusion directs the waste stream away from the skin and into the pouch, preventing output from eroding the adhesive.
Convexity is categorized by depth—soft, light, or deep—and is recommended when the stoma is level with or below the skin, or when the abdomen has creases, folds, or dips close to the stoma. The pressure created by the convex shape helps flatten minor skin contours, providing a more secure surface for the adhesive to bond. Selecting the correct depth is necessary, as excessive pressure can cause skin trauma or lacerations to the stoma. Replacing the system before the adhesive begins to degrade, known as the wear time, is a proactive step to avoid leaks.
Skin Preparation and Barrier Application Techniques
Achieving a durable, leak-proof seal requires careful preparation of the peri-stomal skin, the area immediately surrounding the stoma. The skin must be cleaned gently using only warm water or a mild, non-oil-based soap that will not leave a film residue. After cleansing, the skin must be completely dry before applying any product. Moisture prevents the adhesive from securely sticking and can also lead to fungal infections.
Hair around the stoma should be trimmed or shaved to ensure the adhesive contacts the skin directly, allowing for a tighter seal and preventing discomfort during removal. Barrier wipes or protective films are applied to the clean, dry skin to create a thin, protective layer. This film shields the skin from corrosive output and minimizes skin stripping when the adhesive is removed.
Using Accessory Products
Accessory products, such as barrier rings, seals, and paste, are used to create a smoother, more even surface for the wafer. Barrier rings or seals are moldable, putty-like substances placed around the stoma opening to fill in minor depressions, creases, or scars on the abdomen. This filling action creates a continuous, flat plane for the skin barrier to adhere to. This prevents waste from tunneling underneath the adhesive and causing a premature leak. Stoma paste is used similarly to caulk to fill in small gaps and irregularities directly at the stoma’s edge.
The application of the skin barrier must be performed with care to maximize adhesion. The barrier is pressed firmly onto the skin, starting from the center and working outward to avoid trapping air bubbles or creating wrinkles. Applying light pressure with a warm hand for 30 seconds to two minutes helps warm the adhesive. This allows the material to conform to the skin’s contours and achieve a stronger, more secure bond. If the adhesive immediately lifts or peels, the skin may not have been completely dry, or accessory products may have been overused.
Addressing Output and Lifestyle Factors
Even with a perfect seal, the internal dynamics of the pouch can place stress on the adhesive, leading to unexpected leaks. Output consistency plays a large role, as very thick output can cause “pancaking.” This occurs when waste sticks to the top of the pouch instead of sliding down, accumulating around the stoma and potentially pushing the skin barrier away. Using a few drops of a pouch-safe lubricant or lubricating deodorant inside the pouch creates a slick surface, helping contents slide down easily and mitigating the risk of pancaking.
Another internal issue is “ballooning,” the buildup of gas within the pouch that causes it to swell. This gas creates pressure on the weakest points of the appliance, often resulting in a leak at the skin barrier’s edge or sudden detachment. Most modern pouches include filters designed to vent gas automatically. However, these can become blocked by moisture or thick output, so covering the filter temporarily with a provided sticker during bathing is advisable.
Managing output consistency through diet can help prevent issues like pancaking. For individuals with colostomies, whose output is naturally thicker due to the colon’s water absorption, increasing fluid intake may soften the stool. This allows the output to drop to the bottom of the pouch more easily.
Physical activity and heavy lifting can place strain on the abdominal muscles, causing the skin around the stoma to stretch and pull, potentially breaking the adhesive seal. Emptying the pouch when it is no more than one-third full prevents the weight of the contents from causing a downward tugging effect. This downward tugging also stresses the seal.