Nothing can be more upsetting to an ostomate than leaks. While they’re often easy enough to deal with when you’ve got your supplies at hand, they are still an inconvenience, and quite embarrassing.
- Possible Causes & Their Solutions
- Improper Appliance Fit.
- Flush or Retracted Stoma
- Peristomal Hernia
- Skin allergies
- Improper Skin Care
- Skin Folds, Creases, and Scars Around the Stoma
- Abdominal Hair
- Pancaking (Stool Stuck Around the Stoma)
- Ballooning (When Gas Fills Your Pouch)
- Weak or Incompatible Adhesive
- Overusing or Misusing Supplies
- Letting Pouch Get Too Full / Improper Support
- Waiting Too Long to Change Your Appliance
- Liquid Output
- Overnight Leaks
- Changing Products Too Often
- “It’s Not You, It’s Your Appliance”
- Expired, Damaged or Faulty Product
- Your Seat Belt
- BONUS: Pouch Leaks
- Additional resources
Leaks can start in a number of different ways, but fortunately, we have a lot of options for dealing with them. In this article, I hope to give you some insight into the most common causes and ways of dealing with them.
As always, speak to your stoma nurse if you have ongoing issues with your appliance or skin – these are tips that I’ve used myself, and I’ve had my fair share of leaks over the years.
Possible Causes & Their Solutions
The first step when trying to solve a problem with leaks is to find the cause. This may or may not be easy, or obvious, but there are a few things that can cause a leak, and knowing what to look for can help you figure things out quickly.
Improper Appliance Fit.
This is the most logical place to start since leaks are often caused by an improperly fitted appliance. This can include the hole for your stoma being cut too large (or too small), or the adhesive not making proper contact with your skin.
These types of leaks are common in the first month after surgery, because our stoma is often swollen for some time, and as it shrinks, it leaves a larger gap for output to get in through. If you’re a new ostomate, don’t be discouraged by this! Once your stoma settles and you get the hang of your appliance changes, it will get better.
It’s important to follow your stoma nurses instructions when it comes to changing your appliance, especially if you have a stoma that’s irregularly shaped (like a loop ileostomy), but the process for most ostomates is pretty straight forward.
If you use a pre-cut or cut-to-fit wafer, it’s important to make sure that the hole your stoma goes through has a gap of about 1/8″ around it. Don’t worry about this gap – wafers will swell and fill it up that gap like magic!
If you’re using a moldable wafer, it’s suggested that the hole fits exactly around your stoma with no gap.
Moldable wafers should also be sampled to see if they work better than a pre-cut or cut-to-fit wafer. Both Hollister and ConvaTec have moldable wafers, but there may be others brands that have their own versions as well.
Flush or Retracted Stoma
Ideally, your stoma should stick out a bit, to allow output to fall away from your skin, but some ostomates aren’t so lucky. A stoma that doesn’t stick out enough, or is retracted, can cause leaks because output goes under the wafer instead of into the bottom of the bag.
If your stoma is flush with your skin or it retracts below the skin, you may need to use a convex wafer. The convexity pushes on the skin around your stoma and helps the stoma to pop out a bit, which many ostomates find dramatically reduces leaks.
There is one caveat, though: using convex wafers improperly can lead to pressure sores. If you have a flush or recessed stoma, have your ET nurse assess and recommend the right wafer. Some brands offer “deep convexity” and others “mild”, so you do have options!
I also want to add that even if your stoma sticks out, it’s normal for it to expand and contract, which you’ll probably see happening if you wear a clear pouch. This is caused by peristalsis and is often not enough to cause a leak. I do notice, however, that when I have a blockage (full or partial), my stoma will retract in waves as peristalsis tries to push things through. This has caused leaks for me, as the output gets pushed under the wafer, but resolving the blockage (and preventing it in the future) corrects this.
If you’ve got a hernia around or under your stoma, chances are that it’s causing some issues for you.
Some hernias can be repaired through surgery, but you can also try special hernia support belts that apply pressure to keep a hernia down.
I would strongly suggest speaking with your surgeon or stoma nurse if you’re struggling to cope with a hernia.
Unfortunately, allergies to the adhesives used in wafers do happen, and they often cause problems with wafers sticking to skin. If this happens, you may get leaks because you aren’t getting a proper seal around your stoma.
I would suggest talking to a stoma nurse to find ways of dealing with allergies. Sometimes, it may simply involve trying another brand of wafer, but if your skin is really sore and raw, it will need wound care.
Improper Skin Care
Did you know that your hair conditioner and/or shampoo can cause your wafer not to stick right? Anything you use on your skin can leave a residue, so it’s crucial to make sure that your skin is free of residue from any products you use (whether they are ostomy products or not).
It’s also important not to use skin moisturizer or oils near your stoma, including soaps that contain moisturizer or skin conditioners.
Some ostomates use baby wipes, which often contain ingredients that will stay on your skin and impact your wafer. If you need to use wipes, find one that’s made for cleaning peristomal skin, and make sure you rinse the skin after using it.
If you are using an adhesive remover when doing appliance changes, make sure to thoroughly wash your skin to remove all residue that it’s left behind. Some adhesive removers are better than others when it comes to washing off clean, so try a few to see which you prefer (but stay away from AllKare wipes, unless you want to spend a frustrating amount of time removing it from your skin!)
Applying your wafer when your skin is dry is also very important if you want a good seal.
Skin Folds, Creases, and Scars Around the Stoma
Let’s face it, our skin changes, and these changes can cause trouble for our appliance. Our weight, age, or surgical scars can create divots and creases around our stoma which can offer up a nice opportunity for leaks to tunnel under your wafer.
Get in touch with a stoma nurse if your leaks are caused by uneven skin, and they’ll help to give you specific instructions that are unique to your situation.
Yup, having hairy skin can create leaks by causing output to tunnel under your wafer as the hair pushes against the adhesive.
Pancaking (Stool Stuck Around the Stoma)
Pancaking is when the output from your stoma collects near the top of your pouch or around your stoma without falling to the bottom of the bag like it should. This can not only be annoying when you’re trying to empty your pouch, but it can also lead to leaks if your output pushes outwards on your appliance.
Ballooning (When Gas Fills Your Pouch)
Perhaps the most common reason why I get nighttime leaks is ballooning. This happens when gas fills your pouch without any escape. Naturally, as pressure builds up, the gas finds its way under the appliance, resulting in a leak.
The ideal way of dealing with ballooning is to use an appliance with an effective filter (easier said than done!). This may be something that you’ll have to experiment with, as some filters work better than others, and some are downright useless.
If you find a filter that works, but clogs after a few days, swap the pouch more often (if you use a 2pc), or replace your appliance more often (if using a 1pc). I have seen pouches that have removable filters (ConvaTec and Hollister have offered them before), but they are less common.
Other Ways of Dealing with Ballooning
- Keeping a food diary to help identify gas-causing foods, and eliminate/reduce those foods.
- Regular meals will help keep gas to a minimum.
- Digestive enzymes with food may help to reduce gas caused by eating certain foods.
- Waking up at night to release gas/empty your pouch.
- Periodically venting your pouch (do this away from other people, please!) by allowing gas to escape between the flange coupling or by using a product like the Osto EZ-Vent.
Weak or Incompatible Adhesive
Different adhesives and materials are used in wafers, but not all work equally well on everyone’s skin.
Most manufacturers like Coloplast, Hollister or ConvaTec will offer both regular wear (standard wear) or extended wear products. If you plan to wear your appliance for more than few days, it might be worth looking into extended wear products, especially if you have liquid output.
You may need to experiment with different wafers before finding one that sticks well to your skin. In my experience, regular wear wafers begin to peel within 24 hours, and I often don’t feel secure in them. When I do wear regular wear products, I find that wafer extenders can help to keep things fitting better.
You may also decide to use an adhesive product on your wafer to improve how well it sticks. I have more information about those adhesives HERE.
Overusing or Misusing Supplies
Admit it, sometimes we go overboard with the supplies we have. The goal when wearing an appliance is to use as few products as possible to achieve a good fit and long-wear. Sometimes, that might mean using a moldable ring or barrier wipe, but it’s often not necessary to use four, five or six different products at the same time.
One example of this is how some people use stoma powder. It’s not something you dump on your skin and slap a wafer on top of!
Another example is barrier wipes. Did you know that most extended wear wafers should NOT be used over barrier wipes because it affects the adhesive properties?
Use products only if indicated or if your stoma nurse suggests that you do; you may only be instructed to use these supplies temporarily in order to correct an acute skin problem, but most of the time less is best.
Letting Pouch Get Too Full / Improper Support
I’ve been guilty of letting my pouch fill up way too much before emptying it – call me lazy, but it happens. You may have a high-output stoma that fills before you get a chance to find a toilet, so it’s not always about something you have much control over.
It is often recommended that we empty our pouches when it gets to about 1/3 full. When you let your bag get too full and heavy, it naturally tugs on your skin and can cause a leak.
The easiest way to avoid this is to simply empty your pouch before it gets too full, but if you need a little more support, try a support garment or accessory belt (which hooks onto the belt loops on your appliance).
Be mindful if you’re wearing a large bag, since 1/3 full is still going to be heavy enough to tug on your wafer.
Waiting Too Long to Change Your Appliance
I know supplies can be expensive, and changing them can be time-consuming, but if you’re wearing your appliance longer than you should, you’re going to end up with leaks or skin problems.
There really is no right or wrong length of time to wear an ostomy appliance, and some people change their wafer every day while others go seven (or more) days with the same wafer. A lot will depend on the condition of your skin, quality of the wafer, how much you sweat, how much water exposure you get, if you’re using skin products, and so on.
As you become accustomed to having an ostomy, you’ll likely have a regular schedule for appliance changes that’ll keep your wear time consistent. There may be special cases when this schedule can’t be kept, and it’s important to keep in mind that if you experience any burning or itching under your wafer, it’s probably time to change that appliance.
Most regular wear wafers are designed to be worn for approx. 2-3 days, while extended wear get 5-7. Some are also designed to handle ileostomy (or liquid) output and break down slower than standard wafers do. Check with your supplier to make sure you’re using one that’s right for your output.
Liquid output can cause leaks to happen more often, but there are ways of dealing with it.
Gelling products are my favorite way of dealing with liquid output, since it doesn’t force me to change my dietary habits, but it’s only one of many ways to tackle this problem.
Barrier rings, stoma paste, stoma collars and moldable wafers are other products you can use to help with leaks due to liquid output. You should also make sure that the wafer you ‘re using is designed for liquid output (some do better than others).
While we can prevent or deal with most problems that occur during the day, many ostomates (including yours truly) have nighttime leaks.
For me, ballooning is often the cause of overnight leaks, but sometimes it’s just a matter of my pouch getting too full before I wake up.
If you’re a new ostomate, you’ll likely be getting up several times in the middle of the night to empty your pouch, but if you find that your pouch is filling up long after your surgery, you may need to get creative: Try setting an alarm in the middle of the night or use a higher-capacity pouch.
In some cases, a night drainage system might be worth looking at. I explore the different options in my post about ostomy pouches HERE.
Most people will suggest not eating after a certain time so your stoma is less active at night. To be honest, I’ve experimented with not eating past six but find that only affects my output in the following morning and early afternoon, not at night. Experiment to see if eating (or not eating) at a certain time helps you with nighttime leaks.
Changing Products Too Often
Ok, this might only be a problem for people like myself, but if you’re in the habit of using different brands of products every time you change your appliance, you’re probably not doing yourself any favors!
I like to try new things, but I always give myself, at least, two weeks before settling down with a product. I’ve noticed that my skin doesn’t adjust to new products until after that time has passed; sometimes I don’t notice problems until I’ve worn a product for at least two weeks!
This is one reason why my product reviews are based on extended usage and not just a few days.
“It’s Not You, It’s Your Appliance”
As much as we might fall in love with a certain brand or appliance, sometimes they just don’t work for us. I would always suggest getting samples of new products to try and see which one works best for you.
While I have reviewed several appliances, my experience may still be different from yours, so try samples whenever you can, and don’t be afraid to look for something better!
Expired, Damaged or Faulty Product
This doesn’t happen often, but I think it should be mentioned since I’ve not only experienced this but have had other ostomates mention this as well.
Ostomy products sometimes to bad (past their expiry date), become damaged in extreme temperature changes, or simply ship as part of a bad batch. When this occurs, your adhesives may not stick well, or the products may simply fail sooner than they should.
It’s always important to store ostomy products within the guidelines given on the box or instructions that come with each product.
Always use ostomy supplies before their expiry date, and much sooner if you’ve broken any air-tight “freshness seals” on bottles or packages.
If you believe that you received a faulty product, contact your supplier or the manufacturer of that product to report it; you’ll often receive a replacement at no extra cost to you.
Your Seat Belt
Because seat belts tend to come over your appliance and put pressure where it may not be welcome, they can also be a problem for ostomates.
They go on your seat belt and over your stoma, but they don’t put pressure on your appliance while keeping you safe at the same time.
BONUS: Pouch Leaks
Most leaks happen under your wafer, but there are situations where you may experience a leak from your bag. The most common reasons why bags leak are as follows:
Clogged filters can sometimes seep output through them. If this happens occasionally, you can cover the filter with tape (on the outside of your pouch) or replace the pouch with a fresh one. If this happens often, I’d suggest looking for a new brand of pouch that offers a better filter.
Bag Not Attached Properly to Wafer
On a two-piece appliance, there’s always a very small risk that you can get leaks where the pouch connects to the wafer via the flange (called a coupling).
It’s important to make sure that your mechanical coupling snaps together and is locked in place (if your pouch has that feature). You can give it a little tug to make sure that it’s secure.
If you’re using an adhesive coupling, make sure that the surface you are sticking your bag to is clean and free of any moisture. You’ll also want to make sure that the adhesive is smoothed out and that there are no bubbles or creases in it.
Physical Damage to the Pouch
If you let your cats sleep on your stomach, be prepared to have your pouch punctured from time to time. Other than avoidance, keep your pouch protected around things that can damage it, or try a stoma guard.
Leaks from the Pouch Outlet
If you use a drainable pouch, it is crucial to make sure that you are cleaning the outlet properly between pouch emptying; leaving stool at the end of the outlet will create leaks and odor.
One trick I use is to roll up toilet paper and feed it into the end of my outlet about 2-3 inches in, and then twist to clean my appliance.
Sometimes, the closure locks that we use don’t work very well; in the case of clips, they can snag and come off, while Velcro-like closures can undo if not secured properly.
Obviously, you’ll want to double check your closure to make sure that it’s being used properly, but if you have frequent issues, I would suggest switching brands or try a different style clip.
- Learn from previous leaks, like I have from at least ONE occasion.
- Make sure your skin is clean and dry with every appliance change. Sometimes I’ll use a hairdryer or fan my skin with my hands if my skin is still damp after a shower.
- Keep an emergency travel kit with you when you’re leaving the house. Having a leak in public is embarrassing enough, but you’ll want to have supplies with you in an emergency. HERE is my current travel kit.
- For minor leaks, you can TEMPORARILY use tape or a wafer extender over your appliance to keep things sealed, but it’s VERY STRONGLY recommended that you change your appliance as soon as possible so your skin doesn’t become damaged by your output.
- Book an appointment to see a stoma nurse if you’re faced with constant leaks that you can’t stop on your own. A stoma nurse can watch how you change your appliance and might be able to troubleshoot along the way.
- If you’re experiencing frequent leaks, be sure to keep extra supplies on hand so you aren’t caught off guard. An app like OstoBuddy can help you manage those supplies.
- Go easy on stoma powder – too much and you’ll leave little for your wafer to stick to.
- You may need to gently heat your wafer in order for the adhesive to properly bond to your skin. This could also be in a combination of pressure after applying your wafer (60-90 seconds should be enough).
- If you are using stoma powder, you may need to apply a liquid barrier product over top of it.
I hope that this guide has given you some ideas on how to tackle ostomy leaks. In time, you’ll become a pro at handling your ostomy, and you’ll find the best ways of preventing leaks for yourself.
Don’t be discouraged if you get more than one leak; find a stoma nurse that can help you, and you’ll get on the right track soon enough.