Leaking pouches

Hi. I had a bad accident in July 2023, and ended up with a colostomy. Things went well for 4 plus months, and then they didn't. My pouch leaks almost daily!  My stoma is round and protrudes about an inch. I use a Coloplast 1-piece, cut-to-fit, drainable pouch with a flat barrier and a moldable barrier ring. Currently I use "adhesive removal" wipes because when I remove the leaking pouch, part of the ring is still adhered to my skin. But I follow that by thoroughly rinsing the skin with water, and drying it. (In the past I have used stoma powder and/or skin prep wipes - before I understood their purpose.) I am on the "thin-side". My peristomal skin is pretty flat, no creases or folds, and generally pretty healthy (i..e., not irritated). I warm up the barriers prior to applying. I am very careful to get the pouch on properly. I take my time.  I also empty the pouch frequently during the day and night, to avoid it overfilling. The pouch has leaked during the day, but leaks mostly at night. I am desparate.  [I don't know what, if anything, changed when I started having problems.  It might be linked to my switching from Hollister to Coloplast, because I much prefer the filter and closure on the Coloplast pouches, but I am not certain.] I have been told conflicting things by well-meaning WOC nurses, but have yet to figure out what I am doing wrong. Does anyone have any insight or advise?  Thanks. 

Hello

It sounds like you have a good grasp of what you are doing, does it always leak at the same location ? I would consider changing back to your previous appliances to prove/eliminate the product change from the equation as a first step in isolating your problem then move on from that.

I’m confused about your setup…you use a 1 piece drainable bag, a flat barrier ring, and a moldable ring? If so, why? If your stoma sticks out an inch and you have a fairly flat stomach, 1 barrier ring should be enough. Also, 1 brand might adhere better than another brand. I started with Hollister and then tried Coloplast. I had my 1 and only messy blowout with that Coloplast brand. Went back to Hollister since and no issues. 

yes....I guess I don't want Hollister to be the answer. :(  Thanks! 

Hi, I use a combination of brands as using all coloplast I had constant leaks as well but I prefer their bag and flange. I had leaks both at the stoma from the barrier ring coming up as well as from the flange pulling away at the top edge. 

I found that using the hollister barrier ring and warming it up sticks better to the coloplast flange for me. I also had issues with the coloplast flange peeling away at the top edge just from rubbing against clothes etc. I added the coloplast elastic barrier strips on the top edge and that stops the peeling. Between the two modifications I can now get as many as 12 days with out any leaks. 

A 1 pc is harder to make sure you get it set right and sealed have you tried a coloplast 2 pc to compare? They will send you free samples if you call of any product you want.

Did your stoma shrink leaving the hole in the bag too large?

G-Day Pat, I used Coloplast once and had leaks all the time, but now I am back with Hollister, no leaks at all. My stoma also is about 1 inch long and I use a "Salts collar Seal" see photo. This as helped so much as the soft caller directs the poo forward and stops any chance of a leak. Give it a go "Salts" will send you a sample but you have to measure the diameter of the stoma. Mine is 29m/m so I order part number DC29. Good luck  Regards IGGE

I have a permanent colostomy.  Now at 1 year post op.

Like most everyone else, a couple of days post op, I had a few lessons from a stoma nurse teaching me wafer/bag basics.  Putting it on, taking it off.  But that's baby steps.  There's so much more.  You have to discover everything on your own.

The experienced, helpful Ostomymates on this web site taught me what I really needed to know.  So I could get to the point where, today....   I can live with this. 

My wafer/bag change routine has evolved in the last 6 months.  At first, I was changing wafer/bag every 3 days.  This tore up my peristomal skin.  And was a pain in the ass time wise.  I experimented, and now change the wafer every 7 days.  My skin looks great. 

I used to always shower with the wafer bag on.  You can shower just fine with everything off, stoma sticking out.  Use a soap that has no lotions, fragrance, fillers.  These chemicals interfere with wafer adhesion. I use Cetaphil soap.  You can soap up your stoma, won't hurt it.  Just be careful you don't rub too hard or hit it with a fingernail.  When I shower between wafer/bag changes, I leave wafer/bag on.  Just dry em off afterward and use a blow dryer.

I used to cut the hole in the wafer exactly to fit my stoma.  Pain in the ass, and time consuming because my stoma is oblong shaped.  If I cut the wafer hole a little too close to my stoma shape..... my stoma would sting all day, and I'd have to change everything again.

Then I discovered moldable barrier rings.  Now I first mold a ring around my stoma.  Then cut a big hole in the wafer (bigger than stoma, smaller than ring diameter).  I hold wafer against my leg for a minute to warm it up. Take off plastic wafer seal protector, fit wafer over stoma and ring.  Put hands on wafer, press it against skin for a minute.  Change hands position, hold again for a minute.  Then use a blow dryer on the wafer, set on low, for a minute while holding wafer firm against my skin.  Helps sealing.  Save wafer plastic protector, use it as a guide for next wafer change.  I also put on a Nu-Hope support belt for an hour to hold wafer firm against my skin for a good seal.  I tried Hollister and Coloplast rings.  Both work the same for me.  7 days later when I remove the wafer, (gently, with spray medical adhesive remover), it all comes off in one piece.  Moldable ring completely stuck on wafer, nothing remaining on my skin, no leaks.  

I use Hollister 2 piece system.  Every couple of days I snap off a fouled bag, snap on a new one.  Takes only a minute.  And like I mentioned, change wafer every 7 days.

 At the bottom of my bag, I roll up the velcro drain closure 1 time, then put on a small paper binder clip over the velcro.  Clip has foldable arms, that I fold back up against the bag.  Makes a great guard against velcro drain failure.  Called an IGGIE clip, after its inventor.  You can look up posts from IGGIE on this web site to see pictures of the clip in use.

Also look up "crusting" techniques to help repair damaged peristomal skin.

You mentioned your pouch leaks.  Try a 2 piece system, gives you more options.  Like putting a moldable ring on top of the wafer around your stoma, then snapping on the pouch/bag.  This way you can have 2 sealing rings.  One under the wafer against your skin and fitted to your stoma, and one on top of the wafer fitted to your stoma and stuck to the wafer.  Note:  use nitrile gloves when handling/molding rings, rings are very sticky. 

Ring 101

Take ring out of plastic container.  Leave plastic strips on.  Put under arm for a minute to warm ring up.  Remove 2 plastic strips.  Use ostomy scissor to cut through one side of ring.  Spread ring slightly apart.  Starting in the middle of the ring, squeeze  while gently pulling to lengthen it.  Take your time.  Work your way to the ends of ring.  Piece of ring breaks off... no problem, just place it at the top of your stoma, right where stoma and skin meet.  Stand in front of mirror.  Starting at stoma bottom, fit middle section of ring right against stoma.  Work your way up each side until the ends of the ring are at the top of your stoma.  Rings can stretch a lot.  Many times the molded ring length is too short at the top of my stoma.  I gently peel back one ring side, squeeze and gently pull it to increase length.  Then do the other ring side.  It's OK to have a small gap between ring ends or ring ends overlaping.  When ring placed to your liking, lightly press ring down against skin for a minute with gloved fingers.

  Rings are sticky.  Takes a couple of tries at first to get the hang of it.  Eventually you'll get good at it.

There are also wider ring sections available from medical suppliers.  Can be used for problem leakage areas.  I have these too, just in case I ever need em.

Experiment, try different wafer/bag styles.  Maybe try a convex wafer.  Takes time..... but you'll get there.

Good luck

Thank you sooo much for your detailed instructions! I will try them. 

Thanks, Iggie! very helpful. 

G-Day Pat,

Let us know the outcome, did you fix the leaks? I hope so for your sake. Beachboy is my Promoter for the IGGIE CLIP. See photo.  When you fold it over the Magnet hold it together. I have upgraded to gold. Regards IGGIE

Thanks IGGIE.  A picture tells a thousand words.

I use your invention everyday.  Easy and effective.

Do you use any Skin Perp before your ring and flange? When you mention filters are you talking about the big round one inside? I use coloplast 2 piece and I use coloplast protective seal. with just about any Skin Prep. Skin Prep first then the seal then the flange then bag I can keep one flange on for a week before I need to change. And Bag changes 2x a day sometimes,  but I use a bag without the big round filter or I cut the filter out the filter cause's me problems but never had a leak. hop that helps

Thanks, Iggie! I appreciate your re-sharing the picture of your "invention", b/c I looked and didn't find it. 

Update: For the first time ever, when I was changing my bag/pouch AGAIN, I actually saw the little bugger (i.e., my stoma) squirming -- moving round and retracting a little. I could imagine that could be at least part of the problem. The next day when I went back to my WOC nurse, we decided (since what I was doing certainly was not working) to try a slightly convex barrier/appliance (still Coloplast). She made the hole bigger than my stoma: 32mm vs 25mm (the rationale of which totally escapes me). We used a moldable ring (a more dureable one since what I was using tended to break down when exposed o stool), and a belt. She (the nurse) uses a disposable heating pack, to really heat everything up, and then pokes and pinches the appliance against the stoma. It has been almost 48 hours with NO LEAKING!!   [I looked into the Salts Collar Seal, and ordered something similar from a domestic company.]   Now I don't want to take the bag off -- on the chance that this is a one-off success.  :)

I have found that 3M Cavilon Barrier Film works the best for me to protect my skin against any leakage.  If there is a little leakage around the stoma, I used to get red, irritated spots.  The Cavilon Barrier stopped that I've had no more sore spots.

 

I have suffered through a handful of leaks. The cause of the problem was the consistency of the bowel. The leak occurred when my output was getting  thick. Instead of "dropping down into the bag" it stayed near the stoma and put pressure on the ring, and so it gave way. Miralax has solved that problem. I take it regularly, and my stool remain more on the liquidly side. 

I have found that 2-piece systems, combined with a nu-hope cool comfort belt are my best options for preventing leakage.  The 2 piece wafer has a plastic ring built into it that keeps the wafer from flexing too much.  The belt keeps steady pressure on the wafer's adhesive, so it doesn't lift up.  I also use the Cavilon barrier film, and it seems to help with minor skin irritation.  I am really curious about the barrier rings though... I have never tried them, but might have to now.

Pouch leakes are problematic for an ostomate. Unfortunately they can happen but with a fiber rich died they become seldom. I recommend using 3m micropore tape. It's like scotch tape and is designed for medical purposes. I use 1". A box of it will last a year and only costs about $12