Coping with a stoma leak and why they can occur.

WARNING STOMA IMAGES

I have posted before about leaks, but never really mentioned why they happen and how best to deal with them. They are the number one cause for sore skin and as you can see from my photo I manage my peristomal skin fairly well, but am still prone to leaking at times.

This is probably the worst thing about living with a stoma, it brings it home to you that you are actually incontinent.

I am one of the luckier ones as I seem to leak about once a month, others can be every day. There can be a few reasons why this happens.

Creases in the skin – this can cause issues with getting the base plate to stick because the surface isn’t totally flat. I would suggest using a seal ring to help fill the gaps around the stoma, this is where the leaks will be from. Using a strong tape or duct tape at the point where leaks usually happen can help if you are going out too. If you can stretch the skin as much as possible, either by hand or lying flatter, this could flatten out the creases a bit. You can also use paste which can fill in any dips or separated stitches, this will also help keep the bag flatter. With all these issues, once the bag is on, press gently around the bag/ base plate and maybe even keep your hand on top with medium pressure to soften the adhesive with heat for a couple of minutes. I have also read that there was a trail in America at the Salford Royal hospital and a selection of patients who had uneven skin were given some types of collagen injections as fillers around the peristomal skin area , and the results seemed pretty good. I hope this may be offered more readily if the trials were approved.

Wet or moist skin – this is common if the skin is sore as it produces weeping so needs to be as dry as possible. I tend to air my stoma for ages if I have a sore patch, this helps to dry the skin out ,applying a bit of stoma powder ( notice I said a bit, because this can stop sticking too). Have plenty of tissues to hand to mop up spills and you could be there a good hour which would be amazing for the skin.

Wrong hole size – It is hard sometimes to cut the bag to the right size. especially if you have an odd shaped stoma or other complications. ( I have a fistula right at the base of mine which leaks poo as well as the usual way). I prefer to cut my own because of the issues I have, but again I use a seal around the stoma first, this helps because if the hole is cut slightly larger it won’t matter so much because the seal is there. You can ask the stoma suppliers to pre cut the hole size too if you want to. As you can see from the first image, my base is cut slightly bigger but the seal stops my skin being sore. The seal then swells when it gets wet and fills the gaps.

 

Ballooning –  This is my reason for leaks, there is nothing I can do to prevent ballooning because I can’t pinpoint what foods cause it. Mine always leaks from the base on the right hand side as I look at it. I know that when I sleep on my left and then the stoma balloons this can cause my leaks, the pressure from dragging the bag to the side. There are various flange extenders / tape that can help secure the base plate.

 

A stoma that is flush to the skin or below skin level – As you can imagine this could cause very sore skin if the output comes under the wafer. A convex bag is often the thing that will help, because it dips down in the centre to fit snuggly against the skin instead of raised to let output seep under. I didn’t realise that stomas could be flush as mine is protruding so I don’t have the same issues as these ostomates. Occasionally it can retract over time so it is a case of getting used to a new way of applying the bag again.

 

Using the crusting technique – So many people have asked about this technique or what it even means, so I have written an example.

Firstly you will need stoma powder, alcohol free barrier wipes or spray and some tissue or soft gauze to wipe away excess powder.

Sprinkle the powder over the weeping/ sore skin, leave for a minute then lightly brush away excess powder. The powder will stay on the affected area and any excess will come away.

Dab the barrier wipe or spray lightly onto the powdered area. Leave to dry for a few moments.

Repeat a few times, then test the area with the tip of your finger, you should feel that the area had hardened. This has formed a crust / scab that is exactly what you want. You can then apply the wafer or seal as the area is now dry.