Although leaks and accidents can and do happen to all of us, they are by no means the norm, and you should not accept constant leakage as a part of living with an ostomy. Most of the time, accidents are caused by the appliance not being put on correctly or poorly fitted, and it’s common for beginners to make errors.
Common causes of leakage:
The flange opening is not cut to the correct size. It would be best to cut the flange opening approximately 1/16″ larger than the stoma diameter.
A new stoma will shrink in circumference for up to 8 weeks after surgery. You should measure your stoma with each appliance change and cut the new flange accordingly.
Wearing the same flange for too long or a poorly placed stoma. You may need to adjust your beltline.
Dislodging or loosening the flange during physical activity. You might consider using an ostomy belt.
A very flush stoma that does not correctly exit waste into the bag. Consider using convex flanges to correct this problem.
Flanges not sticking properly. Your skin needs to be completely dry and clean before applying the flange. Avoid using soaps that leave a residue.
An uneven abdomen can make it difficult for the flange to stick correctly. To achieve a good, firm fit, you may need to use ostomy paste or a skin barrier ring.
Folds or creases. Suppose skin folds or creases have developed and leakages happen along the crease. In that case, you can use wafer pieces or ostomy paste to build up the area to avoid leakage.
Peristomal skin irritation. Pouches don’t stick well to irritated skin, so perform meticulous skincare to avoid irritated or denuded skin or a rash. If any of these problems develop, see your NSWOC.
Improper pouch angle. If the pouch doesn’t hang vertically, the weight of its contents can have an uneven pull on the wafer and cause leakage. Every ostomate must find their optimal angle based on individual body configuration.
Waiting too long to empty the pouch. Pouches should be emptied when they are one-third full or sooner. If allowed to overfill, the weight of the waste can break the seal and cause leakage.
Hot temperatures. Leakage in warm temperatures may be due to wafer ‘melt-out.’ You may require more frequent pouch changes or a change in wafer material to avoid leakage.
Excessive wear. If you wear a pouch to a week plus, leakage may be due to the wafer wearing out.
Faulty appliances. Although it is not common, some batches of appliances can leave the factory with flaws. Suppose you suspect your appliances have pinholes or faulty seams. In that case, you should stop using items from that box, report the lot number and return the unused items to your supplier. Manufacturers want and need to know if their products are not performing! Call their 1-800 helpline.
Source: A Handbook for New Ostomy Patients. Used with permission from Debra Rooney, Vancouver Ostomy Chapter
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