An ostomy bag leak occurs when the seal between the skin barrier and the abdomen fails, allowing stoma output to escape onto the surrounding skin. While a leak is an urgent problem that requires immediate attention, it is not a permanent failure. Understanding the immediate steps to manage a leak and then identifying the underlying cause are necessary parts of regaining control over the situation.
Immediate Troubleshooting and Response
The moment a leak is detected, the first priority is to contain the output and protect the skin from corrosive fluids. Carefully and gently remove the entire pouching system, using an adhesive remover wipe or spray to minimize trauma to the peristomal skin, which can cause subsequent irritation and poor adhesion.
After the system is off, the peristomal skin must be cleaned thoroughly. Use only warm water and a soft cloth or dry wipe, avoiding soaps that contain oils, perfumes, or lotions. Pat the skin completely dry, or use a low-heat setting on a hairdryer to ensure all moisture is gone before applying the new barrier.
It is helpful to keep a dedicated emergency kit of supplies available for these unexpected events. This kit should contain:
- At least one full spare pouching system
- Adhesive remover wipes
- Skin barrier wipes
- Stoma powder
- Disposal bags
Pre-cutting the hole in the spare wafer or barrier can save crucial time and ensure a precise fit during an emergency change. Having these supplies ready allows for a swift and effective response, stopping the leak and preventing further skin damage.
Identifying the Root Cause of Leakage
Once the immediate crisis has been managed with a successful pouch change, the next step is determining why the previous seal failed. The most frequent reason for leakage is an improper fit of the skin barrier around the stoma. If the barrier opening is too large, output contacts the sensitive skin, quickly breaking down the adhesive seal. The stoma often changes size and shape, particularly in the first few months after surgery.
Skin irregularities on the abdomen also compromise the seal by preventing the barrier from lying perfectly flat. Folds, creases, scars, or a parastomal hernia create valleys where output can tunnel beneath the adhesive. The consistency of the output itself is another factor contributing to early seal failure.
Very liquid, high-volume output, common with ileostomies or urostomies, tends to erode the adhesive more rapidly than thicker output. Conversely, thick output can cause “pancaking,” where the stool collects at the top of the pouch instead of dropping, pushing against the seal from the inside. Attempting to stretch the wear time of the system beyond its capacity leads to material degradation and seal erosion.
Techniques for Maintaining a Secure Seal
Proactively addressing the factors that cause leaks involves meticulous skin preparation and the strategic use of accessory products. The peristomal skin must be clean, dry, and free of any residue for the barrier to adhere correctly. A skin barrier protective spray or wipe can be applied before the wafer to create a thin, breathable film that shields the skin and improves adhesion.
Various accessories are designed to enhance the seal and manage abdominal contours. Barrier rings or seals are moldable, putty-like products placed directly around the stoma to fill in any dips or creases between the skin and the wafer. Ostomy paste, which functions as a gap-filler, can also be used to fill small irregularities, creating a smoother surface for the barrier.
For stomas that are flush with the skin, retracted, or located near prominent skin folds, a convex barrier system may be necessary. Convexity provides slight outward pressure around the stoma, causing it to protrude slightly and improving the seal by flattening surrounding skin folds. Regularly re-measuring the stoma is a proactive step to ensure the barrier opening remains snug and accurate.
When to Consult a Wound, Ostomy, and Continence Nurse
While many leaks can be resolved with at-home troubleshooting, certain signs indicate that professional help is needed from a Wound, Ostomy, and Continence Nurse (WOCN). A WOCN specializes in ostomy management and has the expertise to assess complex fit issues. If the leakage becomes recurrent despite system changes, it is time to seek consultation.
Severe or rapidly worsening skin breakdown around the stoma, such as open sores, significant redness, or bleeding, requires immediate attention. Any change in the stoma itself, including a change in color, retraction into the abdomen, or prolapse, warrants a call to a healthcare provider.
Persistent symptoms like pain, burning, or itching under the barrier may indicate infection or a product reaction. These issues should also be reviewed by a WOCN to prevent a cycle of poor adhesion and skin damage.