Ileostomy Bag Leakage: Seeking Advice and Solutions

I've had my ileostomy for about 6 months. All of a sudden, my bags are leaking. As in 3 bag changes a day sometimes. I was able to go 4 or 5 days with no issues and no fears. Now, I'm afraid to leave home for any length of time. I use Hollister bags. Anyone else have these issues? I've tried using wafers, paste, and strips all to no avail. Any suggestions?

Hello,

Ileostomies are prone to leakage problems. Have you contacted an Ostomy nurse? All brands of Ostomy supplies have Ostomy nurses you can talk to. Also, medical supply companies have Ostomy nurses too.

How far does your stoma protrude above your skin? If a stoma is too low, leakage happens. Convex wafers are used to push the skin down, so output goes in the bag, and not under the wafer.

Be sure and use soap that contains no perfumes, lotions, or oils. These chemicals will interfere with wafer adhesion. I use Cetaphil bar soap with good results.

Some Ostomates use a blow dryer, set to low temp, to preheat the wafer before putting it on. Preheating helps the adhesive stick tighter.

Free samples are available from all the Ostomy medical suppliers. Call them and explain your leakage situation, they will recommend products that might help you, and send you free samples to try it out.

Have you developed a parastomal hernia? These hernias sneak up on you. They push your stoma up, causing uneven skin surface... which interferes with wafer adhesion.

Wow, I'm not sure about what the hernia is. My stoma protrudes normally. I've talked to a nurse, they've given me the same advice as what I'm doing. It's frustrating. I'll definitely try the soap.

I use a two-piece system and a wax ring. One nurse told me I didn't need the ring but I'm not comfy not using it. I have stoma powder for crusting and I use both adhesive spray and wipes depending on what I grab. I also use barrier wipes, although due to the recent leakage I am out of them.

There is a possibility that you got a bad batch. Call your supplier and report your lot number. I have had this happen. Are you using the prep wipes? Just be sure your skin is dry.

Hey, I've had several nurses tell me multiple things to do, and judge that I'm not using this or that. But I do continuously have leakage. It can happen in the next 12 hours or in the next few days, or after 4-5 days. It varies because of how I put the bag on initially. But some key points I've learned were to make sure the bag is warm before application, use barrier strips if I remember to grab them, use a wet towel to cool down the skin right after the removal of the previous bag, cut the next bag right up to the stoma but leave a tiny bit of room for the stoma to flex, and use Maalox. 

Once I take the previous bag off, I first put a paper towel down and wet it with water on my skin, to cool down anything that is red and inflamed, as well as take any sh*t off of the skin, so it's easier to rub off. I also don't eat or drink for quite a bit before a new bag is planned. The process can either be quick and dirty, or time-consuming because of how much time I may have without a bag on. "Quick and dirty" is usually more time with a bag on, and time-consuming I let the skin breathe, and just make sure a paper towel is covering the area for any spillage. The time-consuming side of replacing the bag is a longer process, I'd think because I'd rather have no bag on, hahaha (but that's just not gonna happen). 

I use Maalox, or an antacid liquid you can get at a CVS, Walgreens, or such for the skin around my stoma. Sometimes it's so red and irritated that the liquid lights it on fire for a few seconds but it adds a layer of protection. Sometimes my stoma just ejects some kind of liquid when I think it's done, but the skin burns less once it is on. I found this trick from one of the RNs at my hospital I frequent because of infections and such. But the older nurses knew about this, not the younger ones!! They put this on and it calms the skin down, it adds a layer if you let it dry and the skin turns white. The "quick and dirty" process is quicker because I put this on, dab a little to not wait for it to dry, and then spritz some powder on for the crust (like you do), pat it on and make sure the area isn't too covered, and then the barrier wipes (if I remember sometimes). Make sure the bag is warm, and heat up a heating pad or hot pack, and once the bag is on, I make sure to keep it warm so the skin around the stoma stays pink through the bag. The heating pad I leave on for about a half hour, because sometimes my bags form tunnels after a while. The pinker the bag looks, the longer it lasts. 

I've been asked if I use barrier rings, paste, or duoderm, and my stoma is not that raised above my skin to use those products, probably like yours, but my stoma is an oval or "eye shape." 

 

Hope this helps! 

Angie. 

Are prep wipes the skin barrier wipes? Then yes.

If you went six months without any of your current problems, then something has changed. I agree it could be a bad batch of pouches. I've had the odd defective pouch over the years, but it could definitely be the whole batch. You say you use rings, stoma powder and sprays/wipes. I'm just wondering if this is because of skin problems, because if your skin is healthy, you don't need stoma powder and wipes (crusting). You will get better adhesion without both. Clean dry healthy skin is the best surface for the flange to stick to. I get six to seven days wear time with just flange. Are you using a convex flange? If not, try that as it can make a big difference in wear time and avoiding leaks. I recently started developing ongoing skin problem, so started wearing a barrier ring, but nothing else, no powders, sprays, wipes, etc. I am getting an easy seven day wear time with this set-up. I think many ostomy nurses who are associated with the companies who sell the products will encourage you to buy more product than you need. My favourite ostomy nurse was the first one I ever had at the hospital I had my surgery in. She has given me the best advice and never steered me wrong. She always said "less is more". Look at the back of the flange when you remove it. This will reveal where exactly the leak is coming from. Is it in the same place all the time? Sometimes solving these problems is a matter of trial and error. Good luck figuring it out!

Terry

Thank you! Liquid Maalox that you drink? I'll definitely get some. Mine makes "tunnels" too. I'm confused on what you mean by my bag looking pink though. You mean around the stoma? I used to heat with a pad but now use direct skin contact while I'm prepping.

My stoma literally looks like a rose, like the ones we used to draw in school...lol. I often call it Rose for that reason. It's an inch round and protrudes maybe a little over half an inch? I've never measured to be sure.

I'll definitely get the Maalox once you clarify...and this is every change?

Yes, the leak is in basically the same area, always. Is the flange the barrier? The only wipes I use other than adhesive removers are called barrier wipes. I was told they protect my skin from adhesive issues. Is this not correct? I've tried a convex barrier but was told the wax rings do the same thing.

I did get a Coloplast sample and loved the bag itself but the barrier leaked on me within hours. Otherwise, I would definitely switch.

The flange is just another word for wafer, or the part of the appliance that adheres to your skin. A barrier is a separate product, i.e., a barrier ring. I don't know why anyone would need a barrier wipe to protect from adhesive. I've never used anything like that. If you found out you were allergic to a particular adhesive, maybe it would be something to use, but otherwise I would avoid it. The convex wafer and the barrier ring don't really do the same thing. I use a convex wafer and a barrier ring when I have skin problems, otherwise just the wafer by itself. The convex wafer is designed to put a little more pressure right around the base of your stoma to help seal it.

I always had problems with Coloplast products myself. Never could get one to stay put for more than a couple of days without leaking. Trying different products can make such a huge difference. For instance, I used to use a two-piece Hollister, but switched to a one-piece convex, and it was a game changer.

Terry

Hi there, you may want to remeasure your stoma. They shrink in the first several weeks but maybe yours changed after six months. Also, make sure that the skin around your stoma is absolutely dry before putting your barrier ring on. Heat with a hair dryer, put your bag on and apply some pressure for five minutes. Sometimes everything just goes back to normal with time anyway; that happened with me a year and a half ago. 🤷🏼‍♀️

Have you tried using a ring?

Lee

I don't think I've tried a convex then. Maybe I should. Apparently the barrier wipes add a seal or layer over your skin that helps protect it from skin problems as well as help the wafer stick better. I'll start trying to find samples. Thanks!

I use a ring, yes

Hi, from what has been said on here, I think you do need a convex wafer and I still use a seal or ring, whichever way you want to call it. If your skin is okay, you don't need to be crusting as this alone will create problems and leaks. When cleaning around my stoma getting ready to change, all I use is warm water. I hear people on here using so many chemicals, it makes me wonder if they have ever just tried warm water and then make it 100% dry. After fitting your bag, hold your hand over it, putting pressure on it, and the heat of your hand helps to make it stick better. I hope this helps, good luck. Regards, IGGIE

Definitely give the Convex a try. No barrier wipe will help the wafer stick to you, although many seem to have that impression. Clean, dry skin is the best surface as long as your skin is healthy. Another misconception is that the barrier wipe will protect your skin. It is meant to be used with stoma powder on raw or badly damaged skin to make the surface dry in order for the wafer to stick. A crusted dry surface is better than trying to apply the wafer to raw skin. If your peristomal skin surface is healthy, you just don't need any of these other products.

Terry

Thank you all so much! My oncologist's nurse is back from maternity leave and she used to be an ostomy nurse. I told her during chemo today all about you guys and your advice! She absolutely agreed, even with the antacids. She even mentioned antifungal cream/powder. Terry was right, something changed. My stoma is shorter towards the bottom so my ring needs to be thicker there and thinner at the top. The wax seems to "seep" around the stoma, apparently crowding it? Anyway, it needs to be thinned out there.

I've picked up all the stuff you all have mentioned and pulled out my blow dryer. I'll be experimenting with all of your advice.

My skin does get raw and broken with so many changes so crusting is necessary right now.

Hi, yeah… the liquid antacid drink that you can swallow would be good to simmer the skin down where it's mostly red and irritated. If it's slightly red, I only go over the skin once or twice and pat some off with a paper towel or something soft so the skin doesn't get scratched. I get the 12 fl oz bottles because they last for months at a time. In the beginning, my skin was red like an apple and irritated because of the leakage but also because my skin wasn't used to being peeled so many times—so a few coats and the skin had a protective barrier.

My tunnels usually form on my right side because of the bending or sitting up—makes a tunnel appear white and that's when I know it's no longer adhered to my skin anymore.

When I say pink around the stoma, I mean once you put the new bag on—you can tell it has skin contact because of the change in color. Not sure what bags you use, but I use Coloplast. If the bag and seal lift in any way and it's white, then I have to keep an eye on any tunnels forming.

I had some fistulas that I've named, but I haven't named my “front butt” yet, lol. But if you feel that a convex would be more helpful—and the stoma protrudes that much out, go for it. The convex bags never worked for me because my stoma is more in than out, and doesn't look like circles if anyone has those measuring tapes from the boxes for bags. Sometimes boxes come with measuring tapes for how big the stoma is circle-wise as well as a ruler on one side of the paper.

And every change can be different, sometimes I skip the Maalox/antacid and just stick to cooling down the skin with just water—not ice cold but room temp. Apply the powder and/or skin prep wipes, and stick the bag on. My friend has been putting the bag on every change because my view is not centered, I keep putting the bag too high or such and it ruins the longevity. Once your stoma stops changing forms and becomes less swollen, at least a few months after surgery, it'll stay in one place. But every now and then I change my templates because of the way the stoma has changed form. I do save my previous templates so I can understand where I'm not cutting well—or cutting too big or small.

Apologies for the late response, hope that answers your questions!

Angie

Hi TrueSurvivor101! I'm not sure about wax rings, as I think a wax ring could harden or crack. What I use is either Convatec or Hollister convex two-piece with an Eakin seal on the skin around my stoma first, then the convex barrier. I use Cavilon spray protectant if I have raw skin. What I do is give a couple of quick sprays then blow dry it before applying the Eakin seal. It may be good to use a non-deodorized soap in the shower, but I personally don't. Some are more sensitive than others, but try what's best for you. Others here have given you some good options. Hope you find something that works.