Chapter 18: Leakage and Skin Problems
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Even with today’s advances in stoma care products all ostomists will admit that leakages happen occasionally. They’re a huge source of irritation; not only to the ostomists pride, but more importantly to their skin.
If leakage is constant your skin will get burnt away with all the motion forcing it’s way past the adhesive and sticking to the skin.
The aim of this section is to ask a serious of questions, so that with vigilance and care you can stop most skin and stoma problems before they happen. It is better in the long run to quash the cause of the skin irritation at source rather than rely on barrier creams or splurting on layer after layer of stoma paste to prevent leakage.
What follows is a list of questions which you should ask yourself when ever you experience a leak or have sore, problematic skin under the flange. Advice given here is not necessarily what will work for you, but is intended as a guide. As always if you are in any doubt whatsoever over your stoma or skin you should seek medical advice.
When does the leakage occur?
If the answer is ‘any time’, or when you are bending or stretching and finding yourself creasing the flange or making it’s security questionable you may benefit from wearing a small security belt. The major ostomy manufacturers all produce a stoma belt and/or cap. Wear the cap over the pouch, and secure it in place with the belt.
Has the nature of the stoma output changed?
Diarrhoea can create major problems by seeping underneath a weak flange or pouch, then forcing it’s way out of the side and down your belly. Try to work out which foods cause this effect in you, and avoid them or eat in moderation. However once you know which foods do what you can eat whatever you want so long as you are prepared for it.
Are you using any lotions or creams on the skin around the stoma?
These creams can do more harm than good. You should make sure than any creams or lotions you apply to the skin are especially for ostomy requirements (so that they do not stop adhesion to the skin), also make sure that the cream has all been absorbed by the skin. Your skin must be clean and 100% dry before you stick the flange on otherwise the security of the flange will be compromised and you’ll have leakage.
Has the stool “pancaked” around the stoma rather than collecting in the pouch?
This is caused by there being no air being in the bag, or the stool being too sticky. A handy tip here is to screw up a couple of pieces of toilet tissue and put this in the bottom of the pouch; this helps to prevent pancaking but isn’t a guaranteed cure. I personally feel this is one area where we are let down by the ostomy manufacturers.
Have you gained or lost weight recently?
Both instances can cause the layout of a stoma to change by creating creases in the skin where the less flexible adhesives struggle to stick. Whenever possible try sucking your belly in before adhering the flange, we all like to think we’ve got a flat tummy but in an ostomist’s case very few can claim they have a leak-proof/flat tummy. Sucking your tummy in before adhering helps prevent the flange creasing when you sit down. I personally had major problems with this when I went back to work with sitting down all day. In the end all I needed to do was suck my beer gut in :o)
This is the most common problem ostomists face, and more often than not it is caused by leakage.
Are you removing the pouch/flange an excessive number of times?
Any more than three times in 24 hours is asking for trouble. Try to avoid it if you can.
Does the soreness match the shape of the tracking on the back of the flange?
This is a positive sign of leakage.
Does the soreness match the shape of the flange backing?
If yes, you are allergic to the adhesive on the flange, try another make or manufacturer’s products. Seek the advice of your Stoma Care Nurse as he/she will be able to advise which products are similar or different.
Is the affected area around the edge of the stoma?
This is caused by a badly fitting flange. Try getting your stoma nurse to create a paper template for you, which you can use when you cut future flanges. Weight gain or loss can also affect the size of a stoma.
Bleeding from the stoma?
In most cases caused by the flange fitting too tightly, or you are cleaning the stoma too vigorously. You need only wipe the stoma gently because you need only look at the stoma and it’ll start bleeding due to it having a rich blood source to it’s surface. If you find you have a bag full of blood inside your bag which has come from inside the body and not from the stoma you should seek medical advice immediately.
Are you currently undergoing a course of chemo- or radiotherapy?
These treatments make the stoma very fragile. If bleeding should occur apply gentle pressure on the stoma, using a lint-free wipe.
This is not a skin complaint but can be a cause of leakage. A prolapsed stoma looks hideous and you’ll know if you have one by the look of the stoma, and the amount of pain you’ll be enduring. Look for a change of colour in the stoma, with it getting a grey or darkish tinge to it. If you are unlucky enough to experience this you should seek immediate medical attention. Surgery may not be needed but I should think that in most cases it is, and it is only a minor job.
Source Material Biblography:
Charter #4: This is a magazine produced by Coloplast UK, which features rather interesting pictures of the above mentioned problems. Sadly I was not allowed to include the pictures on this website. If you wish to receive a copy of Charter please phone Coloplast UK on 0800 132787.