The affect of stress on an ostomy appliance

July 2017

Question:

Does stress cause an ostomy to leak or affect the adhesiveness of the bag opening?

Response:

There are times when all ostomates encounter appliances that just won’t stick, and this is frustrating to deal with. We have all shared these experiences. There is always a cause for adhesives failing, and once you find that cause, your life will become infinitely more enjoyable. Following are a list of potential appliance failure causes and solution hints that may help. I would also advise you to seek guidance from an  Enterostomal Nurse (ET Nurse -WOCN stoma nurse) for further assessment of your situation and recommendations.

Perspiration

Problem: Although stress alone may not affect the adhesiveness of appliances, the potential of excessive sweating for example during a particularly stressful time is possible. We all sweat, but sweat under our wafer can cause a lot of issues with the adhesive. For ostomates living in hot, humid climates, this can be an ongoing issue that needs to be dealt with continually.

Possible Solutions:

  • Try using an extended wear wafer, or one that’s suited to excessive moisture. You may find that some brands are better than others, so sample, sample, sample when you can!
  • Change your appliance more often. If you’re only sweating during certain times (i.e. after a strenuous workout), it might help to change your appliance after those activities. If you live in a constantly hot and humid environment, change your appliance a day earlier to see if it helps.

Skin Care Products

Problem: The ingredients in many soaps, moisturizers, shampoo/conditioners, baby wipes and creams often contain ingredients that interfere with the adhesives in our wafers. Oils in particular can cause issues, but even if your skin doesn’t feel oily after using these products, it can still create problems.

Possible Solution:

  • If possible, avoid the use of these products, or at least avoid using them near your stoma.
  • Try another brand of soap that doesn’t have extra moisturizer. Mild soaps are likely to work better.

Body Hair

Problem: Body hair, especially on men, can create a unique challenge for ostomates. When hair gets too long on the skin and your wafer is on top, it can impact the adhesive and create tunnels for output to leak through.

Possible Solutions:

  • Shave the area around your stoma before putting on your appliance.
  • Change your appliance more often if you find that hair grows back quickly.

Applying Wafer onto Wet Skin

Problem: Wet skin is a big no-no when it comes to adhesives; ostomy wafers and other supplies like barrier rings, need to be applied to dry skin.

Possible Solutions:

  • Be sure to dry your skin before applying anything to your skin; some ostomates let their skin air-dry.
  • If you like to have showers before an appliance change, make sure that you’ve gotten rid of as much humidity from the bathroom as possible: open a window, open a door, or use a ceiling vent.
  • If you live somewhere that’s always humid, you may want to invest in a dehumidifier to help with appliance changes.

Not Using Enough Pressure or Heat on Your Wafer

Problem: Some wafers require heat and/or pressure in order to properly activate the adhesive. You’ll want to do this before and during your appliance change.

Possible Solutions:

  • Gently heat your wafer before applying it to your skin. This can be done by putting it under your arm, or rubbing it between the palms of your hands.
  • After applying your wafer, use the palm of your hand to apply gentle pressure to your wafer (for a minute or two).

Skin Issues

Problem: If you’ve got damaged skin, weepy skin, irritated skin, fungal/yeast infection, psoriasis or eczema near your stoma, you will likely have a lot of difficulties getting your wafer to stick.

Possible Solutions:

Because each case is unique, and may require special attention, I HIGHLY RECOMMEND you seek medical advice in these situations. Skin problems around your stoma don’t tend to just go away, and often get worse, but treating it quickly and effectively is the key.

  • Have an Enterostomal Nurse (ET Nurse – WOCN stoma nurse), dermatologist or family doctor have a look at your skin. You may need to be prescribed medication or special topical drugs to heal your skin.
  • Rule out allergic reactions to the adhesive by testing the wafer on another part of your body to see if it causes the same issue.
  • There are non-adhesive wafers available, but they are not common and your ET Nurse should be the one to recommend their use.
  • The use of a protective barrier between your skin and wafer may help if your skin is damaged or weepy.
  • Use barrier wipes to help protect your skin from damage caused by tape or wafers.

Flush or Recessed Stoma

Problem: If you have a stoma that retracts or is flush with your skin, you may get leaks under your wafer, preventing it from sticking properly.

Possible Solutions:

  • Using a convex wafer is often the recommendation for these types of stomas. Because convex wafers increase the risk of pressure ulcers around the stoma, it’s highly advisable that you seek help from your ET Nurse, who can assess if a convex wafer is right for you.
  • In extreme cases, you may need to have your stoma revised. Your surgeon would be the only person qualified to assess and recommend this to you.

                        “Ballooning”

Problem: “Ballooning” happens when gas is stuck in your pouch, and gets to the point where it literally looks like you’ve got a balloon stuck to your abdomen. Ballooning can put a lot of pressure on your wafer, and can often result in a leak or full appliance failure.

Possible Solutions:

  • Experiment with different filtered pouches to see which one works best at releasing gas from your pouch.
  • Modify your diet to reduce gas output.
  • Keep your pouch as empty as possible (of both stool and gas).

                        Using Expired Products / Improper Storage

Problem: Expired products may lose their ability to stick properly; not storing your supplies properly may also cause this problem, regardless of whether or not they are expired.

Possible Solutions:

  • Keep an eye on the expiry date on supplies and use them before they expire.
  • Store your products according to the instructions found on either the box and/or product insert.

                        Adhesive Remover Residue

Problem: If you use an adhesive remover to help get your wafer or medical tape off your skin, you may not be aware that it can leave a residue that makes it hard for the next wafer to stick properly.

Some products, leave an oily film on the skin, and must be cleaned off before applying your wafer.

Possible Solutions:

  • Avoid using adhesive removers if you don’t need them.
  • Use only enough adhesive remover product as necessary (don’t spray half a can onto your skin if you don’t have to).

Regular Wear Appliances

Problem: Regular wear wafers are meant to be changed more often, and don’t usually last for more than 3 -5 days. They contain adhesives that are more prone to breaking down, but allow for easier removal from the skin. These products may begin to peel prematurely, and so the appliance may not stick as well as you’d like.

Possible Solutions:

  • If you change your appliance often, and prefer to use regular wear wafers, consider looking at other brands to see if they offer a better fit without peeling.
  • You can use a wafer extender or medical tape on the edges of your wafer to keep it from peeling.
  • Consider using an adhesive product.

                        Your Skin and Wafer Don’t Get Along

Problem: Our skin chemistry is different from person to person, and some people may have oily skin, while others have dry skin. Sometimes, our unique skin simply isn’t compatible with the adhesives in certain wafers, and they either don’t stick well or fail completely.

Possible Solutions:

  • Sample as many products as you can so that you can find one that works best on your skin. Many manufacturers and suppliers offer free samples – just ask!
  • You can consider using additional adhesive products, protective sheets or tape to keep your appliance on better. These are more like band-aid fixes though, rather than complete solutions, but it can help while you find a product that works best for you.
  • Keep an eye on what you’re eating, if you find that it contributes to oily skin.

Leaks

Problem: A properly fitted ostomy appliance should keep your stool or urine in the bag without breaking the seal between your wafer and stoma. Due to many factors, leaks can happen and they inevitably cause your wafer to fail completely.

Possible Solutions:

  • Be sure to keep your skin clean and dry before applying a new appliance.
  • Make sure that you know how to properly cut the hole for your stoma into your wafer.
  • Prevention is key when it comes to leaks, but if you do find yourself with one, a wafer extender or medical tape might be able to buy you some time before you can do a full appliance change.

                        Lack of Pouch Support

Problem: When your bag fills, it can cause tugging on your wafer. This can not only cause leaks, but may also cause your entire appliance to come off.

Possible Solutions:

  • Empty your pouch before it gets 1/3 to 1/2 full. This will make sure that it’s not getting too heavy.
  • Use a support garment, wrap or accessory belt for added support.
  • Wear a smaller pouch to prevent it from getting too heavy. You will need to empty it more often though.
  • Try a larger wafer. A larger wafer sticks onto more surface area, so it may be able to hold up better than a smaller one.
  • Try a different style or brand of wafer that gives less pull on your skin.

Water from Showers, Pools, Beaches, Etc.

Problem: While wafers are designed to be waterproof, some ostomates may still experience peeling edges or worse when theirs gets wet for prolonged periods of time.

Possible Solutions:

  • Wafer extenders can help to keep the edges of your wafer protected from water.
  • If you don’t have wafer extenders, you could also use medical tape in a pinch.
  • If you don’t swim, but would like to protect your wafer during showers, you could try using a shower guard.
  • Many ostomates who swim will change their appliance after getting out from the water.
  • Salt water will apparently degrade wafers very quickly, so use a wafer extender at the very least when dealing with salt water (from oceans or swimming pools).

Comments 1

  1. 99% of the leaks that I experience with my appliance (for an ileostomy) stem from diet. Certain foods seem to react with the output resulting in a corrosive effect to my wafer and flange. They include garlic, garlic oil found in dips and dressings and very spicy, hot sauces. Since I have been monitoring my diet, leaks have been reduced to less than 2 or 3 per year, and noticed before a drastic result.

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