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

Get emergency care if bleeding from the stoma will not stop, or if severe belly pain and vomiting come together and nothing at all is passing into the pouch. That combination can mean the bowel is blocked.

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, a fever of 100.4°F (38°C) or higher or chills, vomiting, a stoma that smells bad or is draining pus or bleeding a lot, or blood in your stool. MedlinePlus lists all of these as reasons to contact your provider.

Contact your provider if your stoma has changed colour — it should be pink or red, so purple, black or blue means calling straight away — and also if the skin around your stoma is bulging, if the stoma is getting longer or pulling into your skin, or 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, and three of those steps are the ones people most often rush: measuring the stoma, drying the skin, and pressing the barrier down flat.

That tells you where to look first. Not the brand of the appliance. Not something intrinsically wrong with you. Size, wet skin, wrinkles.

A leak is almost always a technique or fit problem, and technique and fit problems are solvable.

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.

Measure each time rather than assuming last month's size still applies. Stomas change, particularly in the weeks after surgery as swelling goes down. An opening that is too big lets output reach skin. One that is too small presses on the stoma.

And smooth the cut. MedlinePlus tells you to make sure the cut edges are smooth, and a jagged edge from rushing with scissors is a starting point for a leak.

Moisture is the enemy of adhesive, and skin that looks dry often is not.

Where MedlinePlus has you use stoma powder on a wet or open patch, it then tells you to let the area air-dry for 1 to 2 minutes. Give the rest of the skin the same courtesy before the barrier goes on. That feels like a long pause when you are standing in a bathroom half-dressed. It is also the step people most often skip, and it costs them the seal.

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

The holding step is doing real work. Warmth from your hand softens the barrier so it moulds to the contours of your skin instead of bridging over them. Press flat with your palm and count slowly. Do not rush off to get dressed.

A wrinkled barrier makes a channel, and a channel leaks.

Apply from the stoma outwards, smoothing as you go. Stand or lie in the position that gives you the flattest surface around the stoma; for many people that is standing straight or lying down rather than sitting hunched over.

If your abdomen has creases or dips near the stoma, mention it to your ostomy nurse. There are shaped barriers, rings and belts designed for exactly that, and no amount of good technique substitutes for the right product.

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.

Emptying at a third rather than waiting until it is heavy matters more than people expect. Weight pulls on the seal, and a pulled seal fails.

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.

Habits are invisible from the inside. Someone watching for five minutes will often spot the one step that is going wrong, and fix in a single appointment what months of reading cannot.