Why an ostomy bag leaks, and how to fix the seal

This page is for people with an ostomy whose pouch keeps leaking. It covers the warning signs to act on first, then the steps that most often cause a seal to fail and how to fix them.

• Call 911 or go to the nearest emergency department if bleeding from the stoma will not stop or is heavy, or if severe belly pain and vomiting come together and nothing at all is passing into the pouch. MedlinePlus says to get medical help right away when bleeding cannot be controlled. Severe pain, vomiting and nothing passing can mean the bowel is blocked.
• Call your care team right away, day or night, for chills, a temperature of 100.4°F (38°C) or higher, a stoma that smells bad or is draining pus, or any other sign of infection. MedlinePlus lists these as reasons to contact your provider. If you are on chemotherapy, a normal reading is not permission to wait.
• Contact your provider the same day if you have had no gas or stool for 4 hours, a lot of pain or bloating in your belly, vomiting, blood in your stool, or a big increase in the stool collecting in your pouch. MedlinePlus lists these as reasons to contact your provider. If you are on chemotherapy, do not wait for the same day. Call right away, day or night.
• Call your provider right away if your stoma changes color or shape. MedlinePlus says to call if your stoma is a different color, is getting longer, or is pulling into your skin. It says the skin around the stoma should be pink or red, and to call if that skin is purple, black or blue or is bulging. Call too if your stools are looser than normal.

MedlinePlus does not publish a list of reasons seals fail. What it does publish is a step-by-step method for changing the pouch. The steps that bear on the seal are measuring the stoma, drying the skin, and holding the seal in place.

So compare your routine with each step. Ask your ostomy nurse to watch you do a change if leaks keep happening.

MedlinePlus's method: use your measuring card to find the circle size that matches the size of your stoma, without touching the card to your skin. If you have a two-piece system, trace that circle size onto the back of the ring seal and cut it out. Make sure the cut edges are smooth.

Two details matter here.

First, the size of the stoma can change. MedlinePlus says that after surgery the stoma is swollen and shrinks over the next several weeks. Ask your ostomy nurse how often to re-measure.

Second, smooth the cut. MedlinePlus tells you to make sure the cut edges are smooth.

MedlinePlus says to clean the skin around the stoma with warm soap and water and pat it dry. If there is a wet spot, use stoma powder on it. Then let the area air-dry for 1 to 2 minutes before the seal goes on.

Do the waiting. Use the time to get the next items ready.

MedlinePlus offers several things that improve adhesion:

• Apply stoma paste around the seal opening.
• Place the seal evenly around the stoma and hold it in place for a few minutes.
• Use a warm washcloth to enhance adhesion.

Do not rush off to get dressed. Give the seal its few minutes.

MedlinePlus says to use stoma powder only on wet or open areas. It is not a general dusting to help things stick.

It also mentions placing cotton balls or gel packs in the pouch to help prevent leaking, which some people find useful overnight.

MedlinePlus's guidance is to empty the pouch when it is about 1/3 full, and to change it about every 2 to 4 days, or as often as your nurse tells you.

If leaks keep happening despite doing everything above, the most valuable thing you can arrange is an ostomy nurse observing you do a full change.

Someone watching you do a change can check each step against the method above. Ask whether your current pouch system suits your stoma, and whether paste, a ring or powder is right for you.

• MedlinePlus — Changing your ostomy pouch
• MedlinePlus — Ileostomy: caring for your stoma
• MedlinePlus — Bleeding
• CDC — Signs and Symptoms of Infection During Chemotherapy