Leaking Pouches - Seeking Advice for Persistent Colostomy Issues

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, with 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 desperate. [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 advice? 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 one-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, one barrier ring should be enough. Also, one brand might adhere better than another brand. I started with Hollister and then tried Coloplast. I had my one 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 without 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.

Getting Support in the Ostomy Community with LeeAnne Hayden | Hollister

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 has helped so much as the soft collar 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 29mm, so I order part number DC29. Good luck. Regards, IGGE
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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 website 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 them 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 the wafer against my leg for a minute to warm it up. Take off the plastic wafer seal protector, fit the wafer over the stoma and ring. Put hands on the wafer, press it against the 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 the wafer firm against my skin. Helps sealing. Save wafer plastic protector, use it as a guide for the next wafer change. I also put on a Nu-Hope support belt for an hour to hold the 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 the wafer, nothing remaining on my skin, no leaks.

I use the 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 the 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. The 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 website 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 the ring out of the plastic container. Leave plastic strips on. Put under the arm for a minute to warm the ring up. Remove 2 plastic strips. Use ostomy scissors to cut through one side of the ring. Spread the 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 the 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 a mirror. Starting at the stoma bottom, fit the middle section of the ring right against the 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 overlapping. When the ring is placed to your liking, lightly press the ring down against the 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 them.

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

Good luck

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

Thanks, Iggie! Very helpful.

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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 holds it together. I have upgraded to gold.
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Regards, IGGIE

Thanks, Iggie. A picture tells a thousand words.

I use your invention every day. Easy and effective.

Do you use any skin prep 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 the 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 causes me problems, but I've never had a leak. Hope that helps.

Thanks, Iggie! I appreciate your re-sharing the picture of your "invention," because 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 around 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 durable one since what I was using tended to break down when exposed to 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 remains more on the liquid 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 leaks are problematic for an ostomate. Unfortunately, they can happen, but with a fiber-rich diet, 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.

I go along with Axl on going back to Hollister products. I have tried others and they just do not seem as effective. So, if it ain't broke, don't fix it, as they say. Also, I use 2 Hollister 7805 barrier rings: one on the bottom of the flange (I use 14803) and one on the inside around the stoma. Then, before I put the bag on, I have the center of a 6x6 Brava 032155 sheet cut out to just fit around the ring of the flange where the bag goes on, to help keep the pressure off the flange. This way, I do not need to wear one of those skinny support belts that clip to the flange. Then, on the outer edge of the 6x6, I use 3 Coloplast 120700 seal strips to help the sheet edges. And if the barrier rings break down, as they will from the stool, and things do leak out under there, it gets contained enough so that the sheets and/or clothing doesn't get soiled. Sometimes I get up to 8 days of use on the flange system this way, depending on how much this old fat man sweats! Hahaha. Seriously though, do not get discouraged. Go back to what was working and find what system works for you. At first, you may have to replace it every 2-3 days until you get it down. Oh, one other tip that makes it better for me: I use a tiny dab of soap to clean the skin around the stoma during a change. And make positive sure that the whole area is dry! Hope this helps.

Hi eagleman.  New ileostomate here.  Just a question for you.  

You put a moldable barrier seal inside and outside your wafer.  Does the one inside tend to break down and expand a lot?  I use one below my wafer and it tends to expand and turtleneck up my stoma.  So if i put a whole ring inside would it expand a lot?

Yes, I put the whole thing on the inside too. And sometimes it will mushroom up. I just try to get it all pushed as flat as I can before putting the new bag on. I have tried less than a full one, but for me it does not last as long. I have a bit of a pot belly that I can not seem to get rid of, so this has been the best option for me. Maybe someone with a flatter stomach would have better luck with just the one. And I do not roll them into a worm shape like my ostomy nurse showed me. I found it works better to just put them on the way they come out of package. Oh, also my stoma tends to stick out a lot most of the time. Maybe a 1/2 inch or more. Maybe that helps me with the using of two seals. Not sure. Keep trying things until you find the best way for you. Good luck

I use Hollister 2 piece with Coloplast mouldable rings. (that’s what they gave me at the hospital after my colostomy and I have stuck with this). My stoma protrudes about an inch.

I normally can go a week before I change the wafer. I remove the wafer and the ring peels off as well. Then clean any crap (literally!) off with toilet paper. Then clean the adhesive off with warm water until nothing feels sticky then dry thoroughly. Drying is important. I put the mouldable ring on the wafer, pressing to help it stick. Carefully put the wafer on my skin, making sure there are no places where stuff could get out. Put on the pouch.

Then I lie down in bed, put a heating pad over the wafer area to soften the ring and help the adhesive to stick better. 10 or 12 minutes reading in bed, and all is well. 
I have only had a leak twice … both times when I was rebuilding a fence and was bending a lot, kneeling a lot, and putting  a strain  on the wafer.

And on those occasions I could smell an unpleasant odour. 
Your mileage may vary, but  careful cleaning of the skin (I don’t use adhesive remover stuff ), drying, and some heat to help set stuff is important.