Preventing pouch leaks
Tuesday, April 30, 2019
Leaks are a common issue for people with a stoma, but handling them right can keep them from happening again
Nobody wants to experience a leak from their stoma pouch. Unfortunately, it happens to every ostomate at some time or another. The cause of a leak is often simple and easily sorted. Perhaps the pouch has been put on the wrong way, or in a hurry, or on skin that hasn’t fully dried after a shower. Occasional leaks that can be accounted for and rectified are not a problem. But if leaks become a regular occurrence—daily or more than once a week—it is important to contact a stoma care nurse to seek advice.
Doing the detective work
If you have a leak, it is always worth finding out why it happened. Firstly, note when you applied your new pouch, which should help you work out if it was caused by:
• Wet skin after showering, bathing or swimming
• Adhesive remover that hadn’t been fully washed off
• Slightly greasy skin from oils in cream, moisturiser or shower gel.
Consider whether you had to apply the new pouch in a rush, in an inconvenient place or at an awkward time, maybe late at night or early morning. If so, you may have simply made a small mistake, which you can watch out for in future. Likewise, if you have recently been discharged home after surgery and are still new to stoma care, mistakes are more likely to happen. Stoma care is a skill, and it takes a little while to master.
In these situations, leaks can easily happen, but they are soon sorted. However, ostomates may sometimes have frequent leaks with no obvious cause or solution, which often stops them leaving the house. The first point of call should be a hospital or community stoma care nurse. They will almost certainly be able to find the cause of the leak and advise on how to stop them.
Looking out for changes
Following major surgery, most people will lose at least 6 kg in weight, and this naturally affects the shape of their tummy. This weight loss may cause the skin to hang loosely and potentially develop dips or creases. Surgery can also leave large scars or wounds, which cause the skin to pucker as it heals and leave an uneven surface on the abdomen. As you recover, the weight will come back on, but your shape will probably be different than before. All of these rapid weight changes and the wound healing that takes place can certainly affect how the stoma pouch adheres to the abdomen.
The best way to accommodate the rapid changes after surgery is to frequently check the template for the pouch. This is why most nurses don’t arrange for pouches to be pre-cut straight away after surgery, as the stoma itself will change shape, as well as your tummy. The stoma usually takes 4–6 weeks to settle to the size it will remain at. However, as time goes on, it can still get bigger or smaller. Using a measuring guide to check the stoma template once a month, before you place your next order, will save ordering the wrong size.
Another way to check if the pouch is cut correctly is to remove the plastic backing and place that over the stoma. The stoma should fit nicely in the middle without a large area of skin showing. It is also important to note if the hole looks too small. It is a very common misconception to think the hole should be as small as possible to ensure there is a tight fit to create a seal. The aperture (hole) of the flange should sit around 1 mm away from the stoma, to allow the stoma and your body to move slightly.
Flanges need to be attached to dry skin to stick properly. As stomas are moist, if the flange edge is touching it, it will lift away, leaving a space underneath for the output to leak through.
Making room for a hernia
Parastomal hernias are very common, especially if people put a lot of strain on their abdominal muscles and do not provide them with appropriate support. A hernia first appears as a small or moderate swelling behind or to the side of the stoma. The hernia can stretch the stoma to an irregular shape and make it much larger than it originally was.
The first thing to do is check the template, as described above, and a change in cutting instructions is often all that is required. However, a hernia can require a different pouch all together, depending on the new shape of your tummy and stoma.
If the stoma is flush (flat) against the skin, or if there are major creases and dips, a stoma care nurse may recommend switching to a convex pouch. In cases where a hernia causes the stoma to stick out from the surface of the skin or makes a large bulge in the abdomen, a convex pouch would not be appropriate. In this case, the stoma care nurse will usually suggest trying a flat pouch to see if it will fit more easily over the uneven surface and prevent pressure on the hernia. There are a wide variety of stoma pouches readily available that have been created to assist with uneven abdomens and hernias, and your stoma nurse will be able to provide suitable samples for you to try safely.
Your body, your skin and your stoma will change over time, and the stoma care products you have been using may stop being suitable for you. Products themselves might change over time, as older ones are discontinued or updated with minor alterations.
Accessories such as seals and paste should be reviewed by a stoma nurse every 6–12 months, who can check if they are still required. The issue they were originally used for may no longer be a problem. Certain medications may alter your output, which can have an effect on the adhesive, in which case an alternative may be required. Keeping your stoma care routine updated will not only help you avoid leaks, it will avoid wasting your time and health resources.
Keeping a routine
Every ostomate develops their own particular routine for performing stoma care. This can be disrupted by a change in venue, perhaps by visiting family or friends, going on holiday or staying overnight for work. These changes are easier to accommodate if you to keep your stoma care routine as straightforward as possible.
Plan ahead when travelling and try to think of any obstacles that may cause a problem, so that you will always have a possible solution just in case a leak happens. It’s a good idea to keep a handy stash of spare products in key places, whether it’s a handbag, pocket or glove compartment of your car, and it’s worth asking to keep spares at places that you visit regularly, such as work or the houses of close friends and family.
An emergency travel kit need only contain a stoma pouch, a pack of wet wipes and a disposal bag, with a couple of sheets of kitchen roll. These can be kept in a makeup bag, wallet or pencil case. If you don’t use the pouch after a few months, swap it with a new pouch, as changes in temperature may have affected the adhesion of the flange. For example, the flange on a pouch kept in a car glove compartment may become compromised over time, due to changes in weather conditions. Most delivery companies will provide a RADAR key free of charge, and these can be used in most disabled toilets around the UK. While away from home, it can be handy to keep loperamide (Immodium) melts or a sachet of Dioralyte in case of diarrhoea.
If you become unwell, this can affect your stoma output, perhaps making you constipated or giving you loose motions. Urostomates who get a urine infection will certainly notice that they need to change their pouch more frequently, as the adhesive on the flange can quickly disintegrate around the stoma. Medication can alter the stoma output, and if your GP or consultant prescribes any new tablets or other treatments, you should discuss this with them.
Chemotherapy can alter stoma output and the condition of the skin, potentially causing ulcers around the stoma. This must be discussed with the stoma nurse or chemotherapy nurse specialists before or during treatment.
Leaks are fairly common, but they shouldn’t be expected or a regular occurrence. They’re certainly not something ostomates must simply endure. The solution might be the addition of a seal or paste, or it might involve changing the template or pouch. Do discuss your problems and concerns with your stoma nurse, as they will be able to offer the best assistance and guidance to resolve any problems you experience.
Lisa Hall is a Stoma Care Nurse at Salts Healthcare
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