An ostomy bag is a medical device designed to collect waste from a surgically created opening, known as a stoma, on the abdomen. While ostomy bags significantly improve quality of life for many, leaks are a common and often frustrating concern. Understanding the various reasons why leaks occur is the first step toward effective prevention and management.
Skin Barrier and Adhesion Challenges
The skin barrier (wafer or flange) is the adhesive part of the ostomy system that attaches to the skin around the stoma. Issues with this barrier and its adhesion are primary reasons for leaks. Improper sizing is a common problem: if the opening is too large, output can seep beneath it, irritating the skin and compromising the seal. If too small, it can cause friction and damage to the stoma, potentially leading to leaks.
Uneven skin (folds, creases, or scars) prevents the barrier from forming a flat, secure seal, creating pathways for leakage. Skin moisture, sweat, or residues from lotions and oils can interfere with the adhesive’s bond. Ensuring the peristomal skin is clean, dry, and free of oily residues before application is important for a strong seal.
Application technique also influences security. Not pressing firmly or failing to warm the adhesive can result in a weak bond. Proper application ensures the adhesive conforms to the skin, creating a reliable seal.
Leaving the barrier on for too long leads to adhesive breakdown as materials degrade, increasing leak risk. Peristomal skin irritation (damage or inflammation around the stoma) also contributes to leaks. When the skin is red, raw, or weepy, the adhesive struggles to form a proper seal, making it difficult for the appliance to stay securely in place. This irritation often results from leakage, creating a cycle where compromised skin leads to more leaks, and more leaks lead to further skin irritation.
Stoma-Related Factors
Characteristics and changes in the stoma can directly influence leaks. A stoma that is flush with the skin or retracted (sits below skin level) makes achieving a tight seal challenging, allowing output to escape under the barrier. An irregularly shaped stoma also presents difficulties in fitting the barrier snugly.
Stoma size can change over time, particularly in the initial weeks and months following surgery as swelling subsides. Weight fluctuations, pregnancy, or aging can also alter the stoma’s dimensions and surrounding abdominal contours. Regular measurement of the stoma is necessary to ensure the barrier opening remains the correct size, as an ill-fitting opening can lead to leaks.
A parastomal hernia (a bulge around the stoma caused by intestines pushing through a weakened abdominal wall) creates an uneven surface that complicates barrier adhesion. This bulge can distort the stoma’s shape and surrounding skin, making it difficult for the barrier to lie flat and maintain a secure seal.
High-volume or very liquid output from the stoma can also contribute to leaks. This type of output can erode the skin barrier more quickly than thicker waste, reducing its wear time and increasing the likelihood of adhesive breakdown. The constant flow of liquid output can also put more pressure on the seal, making it more susceptible to compromise.
Pouch System Issues
Problems with the ostomy pouch or its management can lead to leaks. Allowing the pouch to become too full is a common cause of leakage, as the weight of the contents pulls on the skin barrier, straining the adhesive seal. It is recommended to empty the pouch when it is about one-third to one-half full to prevent undue stress on the system.
Filter malfunctions or clogging also contribute to leaks. Filters release gas from the pouch, preventing it from ballooning. If a filter becomes wet or clogged, gas can accumulate, causing the pouch to inflate. This internal pressure, often called “pancaking” (when thicker output collects around the stoma), can push the barrier away from the skin, leading to leakage.
Using a pouch system incompatible with the type of stoma output can also result in leaks. For instance, a system for solid waste may not adequately contain highly liquid output, potentially leading to faster barrier erosion or overflow. Selecting the appropriate pouch type and barrier formulation for individual output consistency is important for optimal performance.
Improper or infrequent emptying of the pouch is another factor. If waste builds up near the stoma, it can exert pressure on the barrier, compromising the seal. Regular and complete emptying helps distribute the contents properly and reduces strain on the adhesive. Damage to the pouch material, such as small tears or holes, can also directly cause leaks, necessitating immediate replacement.
External and Lifestyle Influences
External factors and daily activities can impact the ostomy system and contribute to leaks. Strenuous physical activity or movements causing excessive sweating or friction can compromise the adhesive seal. The pulling and tugging during exercise can loosen the barrier’s bond, increasing leak risk.
Clothing choices also affect pouch security. Tight clothing, especially belts or waistbands that put direct pressure on the pouch system, can dislodge the barrier or create points of stress on the seal. Opting for looser clothing or specialized ostomy support wear can help prevent this issue.
Significant weight fluctuations, whether gain or loss, can alter abdominal contours and the area around the stoma. These changes can affect how well the skin barrier fits and adheres, potentially requiring adjustments to the ostomy system to maintain a secure seal.
Dietary factors influence the consistency and volume of stoma output, which in turn may affect pouch performance and wear time. Certain foods can increase gas production or result in more liquid stool, potentially putting more strain on the pouch and barrier. Adjusting diet to manage output characteristics can sometimes help prevent leaks.
Environmental factors, such as extreme heat or high humidity, can also impact adhesive integrity. These conditions can cause increased sweating, which may weaken the barrier’s bond. Maintaining a dry peristomal area and considering products designed for hot and humid climates can help mitigate these effects.