Leakage of an ostomy pouching system is a common, yet manageable, concern for people with a stoma. An ostomy is a surgical opening that allows bodily waste to exit the body and be collected in an external pouch. This system includes a skin barrier or wafer that adheres to the abdomen. A leak occurs when output seeps under this adhesive seal and contacts the peristomal skin (the skin around the stoma). Even a small amount of effluent compromises the seal, leading to skin irritation and further leaks.
Issues Related to Appliance Sizing and Application Technique
Proper appliance fit is the most direct way to prevent leaks, requiring the skin barrier to form a complete seal against the abdomen. Improper sizing of the barrier opening is a frequent cause of leakage. If the opening is cut too large, corrosive output contacts the peristomal skin, quickly eroding the adhesive and causing premature failure. If the opening is too small, it may rub against the stoma, causing trauma or swelling that changes the stoma’s shape and compromises the seal.
The application technique also directly impacts the security of the seal. Applying the barrier to skin that is not completely clean and dry significantly weakens the adhesive bond. Residue from soaps, oils, or sprays creates a slick surface, preventing the hydrocolloid material from adhering effectively. Furthermore, the heat from the user’s hand is necessary to activate the adhesive properties, and failure to hold the wafer in place results in poor initial adhesion.
The product itself can be a source of mechanical failure if handled incorrectly or if it is past its effective lifespan. Using expired or improperly stored supplies degrades the adhesive’s quality, making it less reliable. The wear time of a pouching system is not indefinite; stretching the use of a barrier allows the hydrocolloid to erode from contact with output, especially liquid effluent. This causes the seal to break down from the inside out. Finally, a secure seal requires a smooth, wrinkle-free application, as any creases or bubbles create a channel for output to undermine the adhesive.
Stoma and Peristomal Skin Irregularities
The condition and contour of the peristomal skin are fundamental to maintaining a secure seal. Healthy peristomal skin is dry, intact, and free from irritation; inflammation or moisture prevents the adhesive barrier from sticking correctly. Irritant dermatitis, often presenting as redness or soreness, is commonly caused by output seeping onto the skin. This creates a cycle where damaged skin cannot hold the adhesive, leading to further leaks.
Changes in the stoma or the surrounding abdominal landscape can make achieving a secure fit difficult. Weight fluctuation, healing, or underlying conditions can cause the stoma to change size or shape, requiring regular re-measurement and adjustment of the appliance template. If the stoma is retracted or flush with the skin, or if a parastomal hernia develops, effluent is more likely to pool around the stoma base and compromise the seal.
Body contours, such as creases, folds, or scars near the stoma, pose a significant challenge by creating an uneven surface for the adhesive wafer. A standard flat barrier cannot conform perfectly to these irregularities, leaving gaps where output can seep underneath. Specialized products like convex barriers or paste can be used to fill in dips and apply gentle pressure, helping the stoma protrude slightly. This creates a smoother, more level surface for the adhesive to bond with. Sweating or high humidity can also introduce moisture to the skin surface, interfering with the hydrocolloid’s ability to maintain a strong bond.
Problems Related to Output Consistency and Pressure
Internal forces and the characteristics of the stoma output place significant stress on a well-fitted appliance, leading to leakage. Gas buildup, often called “ballooning,” occurs when gas is trapped inside the pouch, causing it to inflate. This internal pressure pushes the pouch outward, lifting the edges of the adhesive wafer and breaking the seal. While ostomy pouches include filters to vent gas, these can become clogged by moisture or thick output, rendering them ineffective.
The consistency and volume of the output directly affect the adhesive’s integrity and the seal’s longevity. Extremely liquid or high-volume output, common with ileostomies or urostomies, rapidly erodes the hydrocolloid material of the skin barrier. Constant exposure to this corrosive effluent dissolves the adhesive from the inside out, shortening the expected wear time and causing premature leaks. Conversely, output that is too thick, often seen with colostomies, can lead to “pancaking.”
Pancaking occurs when thick, pasty output sticks to the top of the pouch instead of dropping to the bottom. This is frequently caused by a vacuum effect when the pouch filter removes too much air. The accumulation of output around the stoma creates a physical blockage and exerts pressure against the skin barrier, forcing effluent out under the wafer. Dietary choices and certain medications influence output consistency, making it too watery or too thick. Allowing the pouch to become too full also increases the weight and pulling force on the adhesive, making the seal susceptible to detachment.