Contents:

Introduction
The Importance of Finding the Cause of Your Leakage
Potential Solutions
* Flush to the Skin or Inverted Stoma: Convexity
* Poor Fitting Flange/Odd Shaped Stoma: Ostomy Stoma Seals
* Belly Cavity Around the Stoma: Stoma Paste Strips
* Peristomal Hernia: Salts Dermacol (Stoma Collars)
* Pancaking: Opus Healthcare Clear Way (Stoma Bridge)
* Skin Care: Hollister Adapt Powder
For times when leakage does occur:
* Trio Silesse & Niltac
* CliniMed HydroFrame Flange Extenders
Conclusions

Introduction

Leakage is a problem which all ostomates will no doubt encounter at some point during their time with a stoma. For most people it’s a common occurrence in their early weeks of managing an ostomy  when you are still finding your ostomy-feet and working out which products are best for you, and which routine gives the best results. It can cause a heck of a mess, not only to our clothes, but to our self-confidence too.

For most people, however, as time goes by it becomes far less a problem as we slowly learn the complexities of fitting an ostomy appliance in such a way to achieve its peak efficiency for our own bodies and stoma. However, for some ostomates it can be a huge problem lasting years. In these worst cases, and if left unresolved, the fear of leakage can leave people frightened to leave the house in case the pouch should leak causing a big mess to have to clean up in an unfamiliar environment which maybe doesn’t have the best or most appropriate facilities for an ostomates needs, as well as the huge embarrassment for them if anyone were to realise what was happening. Over the years on Ostomyland we’ve had people contact us in utter desperation, and on the verge of harming themselves if their leakage problems could not be controlled.

This editorial, the second in this new feature to the site, is an in depth look into the causes of leakage, and which products are best suited to combat this complex problem – be it a brand new innovation or a trusty favourite in the ostomy supply box.

The Importance of Finding the Cause of Your Leakage

The term leakage is a simplistic yet all-encompassing word when it comes to the definition an ostomy flange or pouch’s adhesion failing sufficiently for the contents to escape. But the truth is that there are many different reasons as to why this could happen. In this editorial I am going to deal with five of the most common reasons for ostomy leakage, and then suggest a product which could be used to try and combat the problem.

When it comes to finding the cause of your leakage, it helps if you put on your deerstalker hat and get into a detective’s frame of mind. (You don’t have to literally go and put on a deerstalker but you are free to do so if you wish. You can send us a photo of it too if you like, and we might even put it on the site! )

Seriously though, if you are at a loss as to the reason for your leakage, check the back of the flange after it’s leaked and you’ve removed it. This holds the biggest clue of all, you will be able to see what path the stool took on its break to freedom. Compare this to your skin and see what problems are present. This is most likely the cause of your leakage. If it is not obvious from this what the problem may be, then it’s possibly one of the following five reasons which covers the vast majority of reasons for leakage discussed on Ostomyland.

1. Condition of the skin. Is it raw, or does it have a rash all over it, or on part of it? If so, you may be allergic to the flange, and it may be interfering with the adhesive properties of the flange. Also, check to see if the area around where the flange leaks is any worse than elsewhere.
2. With leakage, the stool will always follow the path of least resistance. Do you have a belly crease which in turn is creasing the flange and creating a nice little tunnel for your stool to escape?
3. Look at your flange. Was the gap around the stoma too large? Or was it too tight? Or just right? Do you have protruding stitches around your stoma which the flange has trouble moulding around?
4. Do you have a belly cavity near the stoma? Flanges may struggle to adhere to these dips in your belly and lead to leakage.
5. Check your stoma. Is it flat/flush to the skin? Is it inverted / pulled in?

Once you’ve discovered the source of your leakage then you are in a better position to be successful in stopping your leakage in its track, and there are a number of products available on the market which are designed to help reduce opportunities for leakage to occur

Potential Solutions

Some of the Leakage Products Featured In This Article

One thing to bear in mind with all ostomy products is that our bodies are very individual, and because of that, a product which works great for one person may not work anywhere near as successfully for another, and vice versa. Although I will be presenting specific company products in this section it is the type of product I’m suggesting in most cases, and the listed company’s product is presented as a suggested example. Where possible I’ve also listed some other examples from the same product category too. So, if you have no luck with a Coloplast Stoma Ring for example, don’t give up on seals totally; instead try the Dansac Gx-tra, or Eakin Seals, as one of those may work better for you than the others.

Also, leakage can sometimes be caused as a result of a combination of problems. So there is no reason why you cannot use multiple products to help combat it.

In the following section I will list the problem which may possibly cause leakage for an ostomate, along with the type of product which may help you combat it. My hope is that in this section you will discover some new products which you maybe haven’t discovered before, and if it helps eliminate even just a few ostomates leakage then writing this editorial has been a worthwhile project.

Flush to the Skin or Inverted Stoma

Possible Solution: Convexity
Example: Coloplast SenSura

Convexity refers to a pouch system where the adhesive flange has a step outwards in the middle of it (see image below). When the flange is stuck into place, this step helps provide a bit of pressure to the area all around the stoma, which in turn helps it to peek out more and give more of a spout-like stoma. The more the stoma sticks over the flange edge, then the less chance there is of leakage escaping down that gap and eventually out to freedom.

Please note though that you should consult your Stoma Nurse before trying any convexity products. If applied incorrectly they can lead to bruising around the stoma due to the stepped area pushing against the skin.

Other examples of convexity products include:
ConvaTec’s Esteem range
http://www.convatec.com/en/cvtus-productsus/cvt-products/0/proddett/0/399/2374/esteem-synergy-adhesive-coupling-technologytrade-c.html?franchise=46&proddett=2374&prodfamily=53

Hollister FlexTend
http://www.hollister.com/us/products/product_series.asp?id=1&family=10&series=111&ref=

Dansac Nova X3
http://www.dansac.co.uk/default.asp?Action=Details&Item=196

Poor Fitting Flange/Odd Shaped Stoma

Coloplast's Ostomy Seal

Possible Solution: Ostomy Stoma Seals
Example: Eakins Seals

http://www.eakin.eu

Eakins Seals are mouldable and flexible rings of a putty-like substance which is very similar to the hydrocolloid that is used to manufacture the adhesive flange on most current ostomy pouches.  The Eakins Seal is a widely revered product in the Ileostomy member base of Ostomyland’s community forums (http://www.ostomyland.org/ostomyboardipb/), with a number of members regularly saying “God Bless Tom & Jeremy Eakin!” and that is all because of the huge success they have personally had with Eakin Seals controlling their leakage.

To use them you stretch the ring out so that the hole in the centre matches the size of your stoma, and then you fit it into place on to your skin first, smoothing the outer edges outwards a bit to make the join between your skin and the end of the seal flatter. Then you fit the adhesive flange of your pouch system on top.

The seals work best if you make sure that the hole for your stoma in your flange is a snug fit. In an ideal world there should be no more than a 1mm gap between your stoma edge and the edge of the flange’s stoma-hole. If your stoma is not perfectly round or oval, and you have trouble cutting a snug fit into your flange, then you have a couple of options.

1. Get your partner, or a close friend/relative (who you are happy to see your stoma) to help you cut a cardboard template to the shape of your stoma. This is easier with someone helping you, as they can see if the fit is snug all around the stoma from a face-to-stoma angle. Then you can draw around this template hole on to your flange, and then cut the hole out safe in the knowledge that the hole will be near perfect every time.
2. Alternatively, after making your template, send it to one of the many ostomy appliance home delivery companies who will likely offer a service to electronically cut all the flanges in your order to your submitted template, and usually this is a free service. However, it is worth noting that this service is usually only available for two piece flanges.

Other examples of this type of product is the Coloplast Assura Seal
http://bit.ly/sxp8zd

Belly cavity around the stoma

Coloplast Paste Strips and Paste Tube

Possible Solution: Stoma Paste Strips or Stoma Paste Tubes
Example: Coloplast Stoma Paste Strips or ConvaTec Stomahesive Paste

If you have a retracted stoma, chances are that you also have a cavity in your belly from where the stoma has been pulled in and with it being stitched in place then it’s also pulled in the skin around the stoma too.

The ostomy seals mentioned above will be one possible solution to this problem, as the rings can be screwed up into a ball and then moulded. However, you may find Stoma Paste Strips a useful product.

As the name suggests it is just stoma paste, formed into a strip. Personally I find them to be a thicker consistency than normal stoma paste, and this gives it a more putty-like feel to it and because of this I find it easier to mould the strip into a half moon shape to fill in the retracted cavity underneath my stoma.

However, paste is the ultimate in filling in cavities, as you squish the paste into the area, then smooth it over to make a flat surface. However, the paste does not last as long as the strips or seals do. It starts to break down much quicker, and ideally would need changing every 2 days to keep it at peak efficiency – that’s my experience anyway, you might find things different.

Another problem with paste is that if you have a deep cavity then it’s not advisable to fill the whole cavity with paste in one go. You need to create layers of paste – just like you would if you were plastering up a deep hole in a wall surface in your house – then give that a few minutes to harden up a bit, then create another level, and repeat as necessary until the gap is filled. In cases like this you may find it more convenient to make the first layer from a paste strip to give a firmer base from the get go, then make the last layer with paste itself.

One word of caution though: a number of pastes are alcohol based, although the majority of the newer pastes are alcohol free. If you were to squish alcohol-based paste on to raw, broken skin, or a skin rash then you will likely scream the roof off and run a wall of death around your bathroom. But once it’s cooled down after a minute or so you are set.

This is especially so with ConvaTec’s Stomahesive Paste which most people I’ve talked to about the subject consider it to be one of the best on the market today – and it’s been available for many years now. This is because stomahesive is a product feature unique to ConvaTec products which is designed to help heal skin problems. More on this, in a few paragraphs time when we come to deal with skin problems and leakage.

Paste strips are unique to Coloplast; however a number of companies make Stoma Paste, including Coloplast, Dansac and Hollister. A number of them now offer an alcohol free alternative too, enabling you to remove the sting and screams upon application.

Peristomal Hernia

Salts Demacol Stoma Collar

Possible Solution: Stoma Collars
Example: Salts DermaCol

Leakage as a result of Peristomal Hernias can be a very difficult problem to rectify until surgery can be performed to correct the hernia itself. However a stoma collars can be a big help in easing the problem until as such a time as surgery can be performed.

It looks like a thin stoma seal with a plastic funnel rising up from it at the stoma hole which pokes through the stoma hole in the flange. This helps to funnel the stool away from the gap where the flange fits up to the stoma, and into the pouch. I’ve been testing these products myself recently and had good results with them – in fact, their success was the idea behind the writing of this editorial. I found it especially useful when combined with baby oil trick I mentioned in this section too.

Before you can use the product though, you need to know the size of your stoma, as the product comes in many sizes, each differing about 3mm more or less than the last. The idea is that once applied the collar snuggly fits the stoma. It doesn’t matter if your stoma is flat, or oval, or oddly shaped. You can even trim the length of the collar if desired.

It’s such a simple idea, and as always it is those simple ideas which are often the best.

This is a product unique to Salts so I cannot suggest any alternatives at the moment I’m afraid, but I’m sure when other companies see the likely-huge success of DermaCol they will be attempting to bring out their own variations on the idea, presuming no patents restrict them from doing so, that is.

For full instructions on measuring for the size best suited for you, please visit this page:

http://www.saltsstomacare.co.uk/products/dermacol.aspx

Salts is a UK company. If you like outside the UK, please contact the company for details on International availability.

Pancaking

Possible Solution: Stoma Bridge
Manufacturer: Opus Healthcare (Product name: Clear Way) – currently only available in the UK

Pancaking… this is probably responsible for the most problems with leakage that are reported to us in our community forums.

This  is where your stool is usually at a thick whipped cream-like consistency which instead of leaving the stoma and dropping into the bottom of the pouch, it sticks to the pouch as soon as it leaves the stoma and clings to it, usually flattening out across the full width of the pouch (as flat as a pancake – hence the name).  This usually occurs because the two plastic layers of the pouch have stuck together due to static generated during the manufacturing process.

As the stoma outputs the stool, more and more of it sticks to the stoma area and the static seal quickly forces the stool to start looking for weak points in the pouch as it cannot sink into the lower half of it. And for pancaking, this weak point will always be the pouch’s seal to the skin and the gap between the stoma and flange hole’s edge. The stool sneaks between the gap, then whilst the stoma continues to pump out the stool, it slowly moves its way to the outer edge of the flange and making a break for freedom, leaking out all over you. I say slowly, but sometimes if the stoma pumps out a large volume of stool in one go it can give the appearance of the flange being blown off by it!

Pancaking is usually a horrible problem to combat successfully but there are so many possible “tricks n tips” to try in your attempts to combat it. These range from putting baby oil on the pouch plastic where the stoma touches it, so that the output hits it and starts to slide down into the pouch. Or, putting rolled up toilet paper into the pouch bottom, to keep the plastic sides apart and encourage the output down into it. Other tricks include heating the adhesive of your flange with a low heat hairdryer for 30 seconds to make it more malleable to your body curves, and to stick better at the stoma area.

Some of these tricks work for people. Some don’t. But, there is now a product by Opus Healthcare named Clear Way which is very successful in combating pancaking. They describe it as a stoma bridge which I personally have found to be very effective.

The Opus Healthcare Stoma Bridge is another simple idea that leaves you wondering how you didnt think of it first! Basically it is a cube of a foam like material (imagine a sugar lump and you’ve got the idea) which has an adhesive layer on one of the sides. You then take this sticky side and place it inside your pouch, above where the stoma will be, or place two either side of the stoma area. This cube then keeps the plastic film sides of the pouch apart, enabling the stool to drop into the bottom of the pouch, yet it wont make the pouch show through your clothes as the foam compresses quite a lot whilst still keeping that crucial gap between the two plastic layers of the pouch. It’s incredibly effective, and certainly more reliable than the old idea of screwing up a couple of sheets of toilet tissue and putting it inside the pouch as that tends to sink into the bottom of the pouch and holds the film sides apart in the wrong area.

Sadly, I don’t have a photo of the items yet, and they are currently only available in the UK, but if you can get your hands on some then I can highly recommend giving them a try. For those Ostomates who live outside of the UK, then may I also suggest the Salts DermaCol stoma collar product, which I talked about in the hernia section above this Pancaking area, as they too are an effective solution to pancaking and available internationally.

http://www.opus-healthcare.co.uk/

Skin Care: Skin Rash from Hydrocolloid Reaction or Shaving Rash

Possible Solution: Stoma Powder
Example: Hollister Karaya Powder
http://www.hollister.com/us/products/product_series.asp?id=1&family=1&series=89

To the best of my non-medically-trained knowledge, karaya powder is nothing new to the skin care world, and it is not an ostomy-specific product either. But it is a great product!

Karaya powder is puffed on to the rash on the skin, and it forms a gel like surface, which is suitable for the ostomy products flange adhesive to stick to. This helps it stick better, whilst at the same time helping to heal the rash underneath.

Whilst this product will help ease the rash, it is still a better idea to find the cause of the rash and treat that in the long run. Skin rashes could be caused by leakage itself, as stool can burn the skin if left in contact too long. In this case you would treat the leakage itself to help heal the skin. But if your skin has a rash for other reasons such as allergic reactions to adhesives then it is important you find a way to resolve that as well, because this will likely be the single biggest step you could take to helping ease or totally eradicate your leakage.

If you are experiencing allergic reactions to flange adhesives, then its best to enlist the help of your stoma care nurse (aka ET Nurse, WOCN etc) to perform a skin allergy test. This involves cutting small 1cm x 1cm squares of flange pieces off lots of different company’s products, then sticking them on the skin and numbering them. This is usually done on the back to reduce the chance of the square being rubbed off. Each square might also have some medical tape stuck over them. The nurse will give you a sheet of paper with the numbers of each product on it, and after 5 days or so, you’ll remove them and note which ones have caused problems. It’s then best to avoid those products if you can to help reduce the chance of your skin getting another rash in the future. You might also want to look into using skin protection wipes which I’ll be covering in the next section.

If you have a razor rash from shaving around the stoma (this one is for the hairy bears, like me LOL ) then you can’t very well stop shaving as the hair will ultimately get in the way of the flange sticking effectively, not to mention it would be very uncomfortable when you come to remove the flange! One alternative though is laser hair removal. The machines themselves are getting much cheaper to buy now. For example, you can get a 1cm x 1cm area hair removal laser machine for approximately £100 in the UK on a satellite shopping channel. However, you may also wish to look into beauty clinics hair removal services. These are not cheap though, as the whole process could take 6 months so it could end up being more cost effective to the buy the machine and do it yourself.

I’ve not had this done myself, but I understand that you need to laser the area of skin you want to be hair-free, once a month for 6 month. This guarantees that each hair follicle will be treated at the best possible time of its growth cycle – a growth cycle which last six months, hence needing to do the procedure once a month for six months. It’s a painless process, and shouldn’t take more than half an hour a month to hit a flange sized area of your skin.

However – big warning time! The hair will never, ever grow back. So if your ostomy is temporary you may wish to think twice, or even three times before going down this route.

For times when leakage does occur:

Sometimes, no matter how much we try, we cannot control the leakage problem, and although that is incredibly rare, it is still nevertheless best to have some preventative products included in your pouch changing routine. Its also worthwhile having a particular product in your coat pocket or handbag just in case you get a leak in public and need to quash it without doing a full change until you get home.

Trio's Silesse and Niltac Products

Product: Trio Silesse & Niltac (Second Skin Wipes and Medical Adhesive Removers)
Trio’s skin care products are in my personal opinion excellent. I’ve suffered with skin rashes from shaving around the stoma for over 14 years now, and thanks to Silesse and Niltac, I managed to get rid of the majority of the rash in only a few weeks. I was so impressed with the products I wrote an editorial specifically covering my trial of them, and the improvement in the skin condition which I experienced. You can read that editorial here:

http://ostomyland.com/mainsite/2011/07/oland-editorial-1-trio-silesse-niltac/

Clinimed Hydroframe

Product: CliniMed HydroFrame (Flange Extenders)
Sometimes leaks can happen at the most inopportune times; for example when you are out of the house and you do not have access to a decent bathroom or maybe no bathroom at all! At those times you wish you could just get your flange to last a little while longer until you got home so that you could change your kit in your safe, comfy bathroom.

But if you do have a leak at those bad times what can you do to manage the leak until you get home? Poke some toilet paper in the leaking area at the side of the flange? That might hold the content back for a few minutes if you are unlucky, or maybe half an hour if you are very lucky (depending on your stool consistency). But that wouldn’t be a 100% seal. Alternatively, maybe you could take a tube of stoma paste and squirt it into the leaking area. It can be done, but what can you do if it’s a small crease/gap which is leaking, or for that matter a large gap beyond the size of the paste tube’s delivery end?

There is a better option to both of those quick-fixes now though, and they are called “Flange Extenders”. For example, I’ve been testing the CliniMed HydroFrame Flange Extender. This is a quarter-moon shaped piece of hydrocolloid (the stuff your pouch flanges are made from) which has a sticky side which you stick over/onto the leaking area of your flange so that half of the HydroFrame is overlapping onto the flange edge, and the other half is stuck to your skin. For best results you need to clean that patch of skin before you adhere the flange extension otherwise it too could lift quite quickly too and leak as well.

Again, it is such a simple idea and it works great; best of all though the adhesion is just as secure as your flange can be at its peak performance. It has saved me personally from leakage trouble whilst outside of the house on two occasions, and although I got home within an hour in each case, I was convinced that the “fix” might even have lasted as long as overnight if the stoma had stopped pumping out, maybe even longer!

If you are not in the UK then you can get the CliniMed Flange Extenders via Welland Medical, distributed under the Welland company name. Other examples of this type of product are the Ostomart flange extenders OstoFIX 40 and/or OstoFIX 80 and a few more companies do equivalents too.
http://www.clinimed.co.uk | http://www.wellandmedical.com | http://www.ostomart.co.uk

Conclusions

For many people leakage is an occasional inconvenience best combated by learning how to properly fit your appliances so that they can work to their maximum efficiency. For some other ostomates though, it can be devastating. I sincerely hope that this editorial has given any ostomates faced with leakage some fresh ideas on how to combat the problems they might be experiencing, as well as given some hope for the folks who suffer severe leakage that is causing them to be house bound and likely very depressed.

For more leakage support, please feel free to visit our community forums, where you can ask all the questions you like and I’m sure our wonderful members will welcome you with open arms and offer help in any way they can from their own personal experiences.

http://www.ostomyland.com/ostomyboardipb/

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