Five Reasons Pouches Leak

By Janice M Erbe Gorski, DNP, APNP, FNP-BC, CWON-AP

A well-fitting ostomy pouch system should not leak. The urine or stool should go into the pouch, not leak under the skin barrier. Keeping the urine or stool off the skin keeps it healthy. Intact skin prevents leakage of urine or stool. This article will help find the cause of any leakage if it occurs.

1. Improper Application:
The pouch system sticks to the skin with initial tack and melts into the skin to adhere. It will not stick to the skin if the skin is wet. The stoma is always moist and can cause wetness on the skin. It is important to wipe the skin to make sure it is clean and dry just before applying the skin barrier. Warm the pouch system with a hand for 1-2 minutes, to allow it to melt into the body.

2. Incorrect Fit of Pouch System:
Many people experience leakage after returning home from surgery. This is due to the changes the abdomen undergoes. Right after surgery, the belly is firm and distended. The abdomen softens over time. The pouch system may need to be changed to fit the belly as it changes.

Weight loss or weight gain and aging can change the shape of the abdomen. This can affect the fit of the pouch system.
There are many options for pouch systems. There are flat skin barriers which work well for firm abdomens. A convex skin barrier may work better as the belly softens or if the stoma is at skin level. There are many types of convex wafers – soft convex, light convex, and deep convex. The least amount of convexity should be used to obtain a good seal. A belt may be used to increase the convexity too. Your ostomy nurse can help you find the right pouch system for you. The ostomy manufacturers have sample programs if needed.

3. Not Changing the Pouch System Routinely:
The pouch system needs to be changed regularly. Do not wait to change it until it leaks. The product wears away in time even with the best fit. Most people change the pouch system twice a week. If leakage is experienced on day four, change it every three days. This will keep the skin healthy.

4. Too Much Product
Keep the pouch system simple! The skin barrier should be in direct contact with the skin. Adding additional products can cause leakage. The following tips can be helpful if using more product:
• Adhesive removers – Some are oil based and need to be washed off the skin with soap and water. Only use adhesive removers made for use around ostomies.
• Barrier rings/strips – Add height around the stoma. May cause urine or stool to leak under the skin barrier if the opening of the stoma is at skin level.
• Paste – May cause leakage if too much is used.
• Skin protective wipe or spray – Adds a layer between ostomy product and skin. May prevent the skin barrier from sticking to the skin, especially if more than one layer is used.
• Stoma powder – Only use if the skin is open.

5. Broken Skin
It can be hard to get the pouch system to stick to the skin when the skin is weepy. If your skin is open, apply stoma powder (see Peristomal Skin Care article) to help heal the skin. The Wound, Ostomy, and Continence Nurses Society™ has a Peristomal Skin Guide for Consumers, https://psag-consumer.wocn.org/#use-guideline, to help treat broken skin around the ostomy. If your skin does not heal, contact your ostomy nurse or your provider.

Conclusion
You do not have to do this alone! A proper fitting pouch system should not leak. The pouch system should be changed on a regular basis using minimal products. Leakage of a pouch system should not occur. Contact an ostomy nurse for assistance if continued leakage is experienced. Resources are available at www.ostomy.org or call 800-826-0826.