My name is Jose Caeiro and I have been a nurse since 2003, with a background mainly in urology. I joined Addenbrooke’s Hospital in 2014, where I became a Urology Nurse Specialist and Stoma Care Nurse. In 2022, I became a community Stoma Nurse in Cambridgeshire, working for Hollister.
While at Addenbrooke’s, I had the pleasure of working with the Cambridge Branch of the Urostomy Association (UA). I referred pre-operative patients to the organisation to put them in contact with established urostomy patients and provide them with the opportunity to getting to know the charity and its services for members.
Where possible, I participate in the branch’s monthly meetings to provide support and guidance to members. As leakage is a common concern for urostomates, I hope the following three simple steps will be helpful.
Find the right fit:
The first step is to make sure you have a skin barrier that is the right size and fits well around your stoma. A flat skin barrier might seem like a good idea because it is likely the type of skin barrier on the pouching system you were using when you were discharged from hospital after surgery.
However, if your skin barrier is leaking and/or your stoma is in a skin fold or crease, it can be more difficult to get the skin barrier to fit to the skin to help prevent leaks.
You might need to consider a convex skin barrier (more about which is below). Consult your Stoma Care Nurse about this is a suitable option for you.
Another thing to consider is that your stoma can change in size and shape over time, especially in the first six to eight weeks after surgery. Weight loss or gain can also impact the appearance of your stoma.
It’s ideal to measure your stoma every time you change your skin barrier to ensure the correct size, so that it fits properly and protects your skin from stoma fluid. The skin barrier should fit close to the stoma, without touching it and without any skin showing.
Achieve a secure seal:
The second step is to ensure a good seal around your stoma. Leakage not only occurs when stoma output seeps out from under the edge of the skin barrier, but also when output gets stuck between the skin and skin barrier instead of going into the pouch – this is known as ‘seepage’.
To help prevent this, it’s important to look at where your stoma is located on your abdomen and how far it protrudes from your skin. If your stoma is level with your skin, located in a skin crease or fold, or is still healing after surgery, you may need to use a convex skin barrier to help prevent leakage.
There are different formulations of convex skin barriers to suit your skin type and stoma output. Convex skin barriers may apply downward pressure on the skin surrounding the stoma to help the stoma protrude more and make it easier for output to go into the pouch.
When using a convex skin barrier, you should first try it without a barrier ring. The closer the skin barrier convexity is to the base of the stoma, the better the seal it will create. If a good seal is still not achieved, you can try incorporating a barrier ring.
Remember that less is more:
The final step is to keep your ostomy skincare routine as simple as possible. Some ostomates believe that using baby wipes or applying lotion on the skin around the stoma will help protect it. However, these products may contain oils that can prevent the skin barrier from achieving a good seal.
It is important to follow the instructions for use. For most people with stomas, water is sufficient for cleaning healthy skin. If soap is needed, select a mild bar soap with no added oils, moisturisers or fragrances. Remember to rinse it off completely. In addition, keep in mind that sometimes skin preparation agents and wipes can be mistaken for adhesives because they leave a tacky or sticky residue on the skin.
However, these products are designed to create a film that will prevent the skin from stripping, caused by changing the skin barrier frequently. While useful in certain situations, skin prepping agents can interfere with how the skin barrier adheres, which may cause leaks.
Skin barrier paste can also be mistaken for an adhesive. While the paste is designed to fill uneven skin surfaces near the stoma and improve the fit of the skin barrier, too much paste can prevent a good seal. It may be a better idea to use a barrier ring to fill skin creases and folds.
If you have tried these steps, but are still experiencing ostomy leaks, be sure to reach out to your Stoma Care Nurse.
- This blog first appeared in the Winter 2023 edition of our magazine, The Journal. The article was sponsored by Hollister.
- Learn more about The Journal