An ostomy pouching system is a medical appliance worn externally over a surgically created opening, or stoma, to collect bodily waste. While these systems are designed for security and discretion, the challenge of maintaining a perfect seal against the skin is a common concern for users. Preventing leaks is important not only for comfort and confidence but also for protecting the delicate peristomal skin immediately surrounding the stoma. Achieving a dependable seal requires understanding the causes of failure and adopting precise application and maintenance routines.
Troubleshooting: Why Seals Fail
The physical characteristics of the stoma and the surrounding abdomen can shift over time, impacting the fit of the skin barrier. Changes in body weight, even slight fluctuations, can alter the abdominal contour, creating new folds or depressions near the stoma site. Similarly, the stoma itself can change in size or shape in the months following surgery, requiring a reassessment of the appliance opening.
Residual moisture from bathing or cleaning prevents the adhesive from bonding fully to the epidermis. Likewise, oils or residues from soaps, lotions, or certain barrier removal sprays can create a slick surface that weakens the adhesive bond over time. A seal can also fail prematurely if the opening cut into the wafer is not accurately sized for the stoma.
If the opening is too large, exposed skin around the stoma is subject to constant irritation from effluent, leading to a condition called peristomal dermatitis. This irritated, often moist skin cannot hold an adhesive barrier effectively, creating a vicious cycle of irritation and seal failure. Conversely, if the opening is too small, the barrier may rub against the stoma, causing trauma and swelling that can push the appliance away from the skin. Addressing these underlying physical and preparation issues is necessary to diagnose and resolve chronic leakage problems.
Proper Technique for Appliance Application
A proper technique during the appliance change process determines a secure and long-lasting seal. Begin by gently removing the old pouch and cleaning the peristomal skin thoroughly with warm water. Avoid using harsh soaps, as many contain moisturizers or perfumes that leave a residue that interferes with the adhesive. If an adhesive remover is used, ensure that the skin is rinsed afterward to remove any oily film left behind by the solvent.
After cleaning, the skin must be completely dry before proceeding with the new application. Use a soft cloth or gauze to pat the area dry, ensuring that all moisture is gone, especially within any skin folds or creases. The next step involves precisely measuring the stoma to ensure the barrier opening is the correct size. The opening should provide a snug fit, leaving only about an eighth of an inch of space around the base of the stoma.
When cutting the opening into the skin barrier or wafer, use small, curved scissors to create a smooth, even edge. Before applying the barrier, use the warmth of your hands to gently heat the adhesive side for a minute or two. Warming the material helps the adhesive become more pliable, allowing it to conform better to the body’s contours upon application. Position the barrier over the stoma carefully, starting from the bottom and working upward, ensuring there are no air bubbles trapped underneath.
Once the barrier is in place, apply firm, gentle pressure across the entire surface for 30 to 60 seconds. Concentrating this pressure directly around the stoma is important, as this area is most susceptible to output erosion and early failure. This sustained pressure activates the adhesive and encourages it to mold into the microscopic ridges of the skin, maximizing the initial bond strength. Patience during this brief application process significantly increases the barrier’s wear time and security.
Enhancing Security with Barrier Accessories
Accessories provide an extra layer of security, particularly for people with irregular abdominal surfaces. Barrier rings, which resemble thick, pliable gaskets, are designed to fill in depressions, scars, or uneven areas around the stoma. These rings mold to the abdomen’s unique topography, creating a smooth, level platform for the adhesive wafer. They are placed directly around the stoma before the primary skin barrier is applied, effectively stopping output from reaching the underlying skin.
Barrier paste serves a similar function but acts more like caulk, filling in small gaps or irregularities at the junction where the stoma meets the skin barrier. Paste is a gap filler and not an adhesive, so it should be used sparingly to smooth the transition between the skin and the wafer. For skin that is perpetually moist or weeping due to previous irritation, barrier powder can be dusted onto the affected area. The powder absorbs excess moisture, allowing the skin to dry enough for the adhesive to stick, though any excess powder must be brushed away before the barrier is applied.
External support devices, such as ostomy support belts or wraps, reinforce the seal. These devices provide gentle, circumferential pressure across the entire pouching system. This external force helps maintain continuous contact between the adhesive wafer and the skin, which is beneficial during physical activity or for individuals with a retracted stoma. Using a belt ensures that the wafer edges remain secured against the body, reducing the chance of premature lift or separation.
Routine Care and Lifestyle Adjustments
A common cause of premature seal failure is allowing the pouch to become too full before emptying the contents. As the pouch fills, the increasing weight exerts a downward pull on the adhesive barrier, stressing the seal, particularly at the bottom edge. Emptying the pouch when it is about one-third to one-half full minimizes this mechanical stress on the wafer.
Dietary choices influence the consistency and volume of output, both of which affect seal security. Foods that produce very liquid or high-volume output can increase the risk of effluent eroding the barrier material quickly. Working with a healthcare professional or registered dietitian to manage output consistency helps ensure the contents are manageable and less likely to undermine the adhesive.
Physical activity can generate significant perspiration. Sweat that accumulates underneath the barrier can weaken the adhesive prematurely. Individuals should ensure the appliance is securely fastened before exercise and consider using accessory products to manage moisture if heavy sweating is anticipated. Proactively changing the entire pouching system on a schedule, rather than waiting for a leak to occur, is the best preventative measure. Adhering to the scheduled wear time ensures the adhesive remains effective.