Ostomy Pouch Leaks

Leaks … *sigh*.

If there is one thing that makes many people hate their ostomy, it’s leaking. While many ostomates find a routine that leads to few, if any, leaks, it sometimes take a little trial and error to get there. After surgery, stomas change shape and size until they heal and remain about the same.

In order to reduce leaks, my best advice is to figure out your exact issue (Is your stool pushing under your wafer in a specific spot, possibly due to pancaking? Do you have a body crease allowing stool to get under your wafer? Is your stool pushing your wafer away from your belly? etc.). Once you have found out the exact problem, brainstorm. Also, other ostomates may have encountered this and may be able to offer advice, so research other’s ideas and reach out! In general, here are some techniques to help reduce leaks that I have encountered either through my own experience or from listening to others:

First and foremost, make sure you are using the correct wafer for your stoma and body.

After my surgery, I had leak after leak for several days because my wafer was not right for my body type. I was using a flat wafer and stool was just pushing it off of my abdomen as it came out of my stoma. Once I switched to convex wafers, this stopped happening. I have a friend, however, who had leaks when he was using convex wafers and needed flat wafers because his stomach is very flat. So, which wafer/pouching system works best for you will be specific to your body type and may, unfortunately, be a trial-and-error process.

In addition to having the correct wafer type, you need the correct opening that fits your stoma.

If you are using a cut-to-fit wafer, make sure there is enough space to allow stool to exit your stoma. If the wafer is too tight around the stoma or covering any part of it, the stool can get under the wafer and lift it away from your abdomen. Having your wafer cut too small can also be dangerous for your stoma as it can “strangle” it. If the hole in your wafer is cut is too large, however, this compromises the integrity of the skin immediately surrounding your stoma (aka peristomal skin), because the stool will come in contact with that skin. Some people can order pre-cut wafers in a size that fits their stoma well and thus do not have to cut it each time (after your stoma is well-healed and settled, of course).

Speaking of skin integrity, this is another important factor in preventing leaks. Maintaining the integrity of your peristomal skin helps you create a better seal. The wafer sticks to skin best when that skin looks like the skin on the rest of your body – healthy, clean and smooth. If you do have a leak, taking care of it right away and cleaning off your skin is important to its health. Another way to protect peristomal skin is to change your wafer when needed. I am guilty of sometimes pushing this out further than I should because life gets busy. It is recommended that you change your wafer every three to four days regularly (though if your doctor or stoma nurse has told you differently, please follow their instructions). If you pick two days of the week that are appropriately spaced and change it those two days every week, then you will develop a routine and not have to think about when you last changed it. For example, I try to change my wafer every Tuesday and Friday. Picking two days that fit your weekly schedule will help you fit this into your life.

Another way to maintain peristomal skin health: be gentle when peeling off your appliance. Ripping wafers off your skin like you would a Band-Aid is detrimental. Use adhesive remover wipes if necessary. However, if you use adhesive remover, be sure to clean the adhesive remover entirely off your skin with mild soap and water so you won’t compromise the seal of the new wafer (the soap should be free of dyes and scents – a lot of people seem to like Dial or Dove Unscented and Ivory).

Emptying you bag before it’s full also prevents leaks.

When I first got my ostomy, my nurse suggested emptying it when it is about 2/3 full. This prevents the weight of the stool from pulling the wafer off your body. If you experience leaks before it is 2/3 full, you may need to empty it at 1/2 full, or even 1/3 full. Using a support belt or wrap can also prevent the weight of stool in the bag from pulling your wafer off.

If you still experience leaks even with these measures, or if you want additional security, you might want to consider using barrier strips. These are wide, thick, sticky strips that are waterproof and can be used to frame your wafer. This helps add support to your seal. A lot of people use Brava Barrier Strips. I tried these once and at first I thought they weren’t very sticky, but after I had them on for a while, they sealed to my skin with body heat (similar to how wafers do) and were SO stuck that I almost couldn’t peel them off. So, give them time to stick. However, keep in mind that these are only good to help prevent leaks, NOT to reinforce your wafer if you have a leak already. If you have a leak already, you want to change your wafer, not reinforce it, to protect your skin.

A final piece of advice for avoiding leaks: use only soap and water to clean around your stoma. I learned this the hard way. While on a medical mission in Honduras, I thought I would use baby wipes to clean around my stoma between pouch changes due to lack of facilities with sinks. With this, my wafers only lasted two days instead of three to four. I had minor leaks every time. I thought this was due to the heat and sweating, but upon telling my nurse when I got home, she told me it was probably from the baby wipes and I agree, because I’ve been in the heat before and not had this problem. If you find yourself in a situation with limited sinks, use bottled water and paper towels to clean the skin around your stoma instead of baby wipes.

I hope this article provides helpful tips to prevent ostomy leaks. Check out the links below for specific articles and recorded webinars that address leaks and the issues that cause them. Or, if you have a question, feel free to ask it on our OstomyLife Facebook page or “Ask Laura.”

Happy Ostomy-ing!

• Clinical and Lifestyle Concerns with an Ostomy Recorded Webinar cued to Difficulty Getting a Good Seal section
• Tips and Tricks to Avoid Ostomy Pancaking
• Ostomy Products: Finding What Works Best For You
• Things That Still Bother Me Since Getting Ostomy Surgery – And How I Resolve Them
• Recorded Webinar with Lifestyle Specialist Laura Cox cued to How to Prevent Leaks section

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