Leakage

 

Pouch or stoma leakage and odor is a major concern of ostomy patients and can significantly affect their adjustment to life with an ostomy and their quality of life. Patients can be instructed to change their pouches when they are half full or less to reduce problems with loosened seals.

 

Several strategies and products can be used to prevent leakage. For instance, in malnourished patients, or patients with retracted stomas, or stomas located in a skin fold, convex pouches can be used. These pouches have a raised area that allows the stoma to protrude to the pouch opening. Seals can be used around the stoma to prevent leakage under the connection. Two-piece pouches can include convex inserts to improve support. For patients with unusually-shaped stomas, pouches can also be tailor-made using a molding kit that allows custom-made pouches to be manufactured. Other special features to consider are tail closures or clips for drainable pouches, some of which make it easier for arthritis patients. Some leakage problems are due to high output or less frequent drainage. Where this is a problem, some high-output pouches are available. It is important to note that because of the variations in pouching systems, manufacturer instructions vary and should be carefully read and followed.

 

Specialty products include seals made for hard-to-fit stomas and filling or absorbent agents for irregular skin. These products may provide protection to promote healing and prevent further problems by reducing undermining or sticking of the outside of the pouch to the skin. Skin barriers include pastes, powders, strips, rings, and wafers that may contain karaya or pectin, gelatin, or hydrocolloid materials. Sealants may include gels and liquids in wipes, sprays, and roll-on forms. Skin adhesives are commonly silicone or latex-based. These should be used according to the manufacturer’s instructions because some sealants can interact with pouches and faceplates causing breakdown.

 

Ostomy belts can help to keep pouches in place. These can be especially useful during more physically active times. There are several types of belts that are made for use with particular pouches. Hernia belts are also available to maintain the herniated stoma until surgical correction is possible. Prolapse belts are available to assist the maintenance of prolapsed ostomies.