Management of Leaking Colostomy
For a leaking colostomy, immediately implement conservative measures using convex appliances with ostomy belts, paste/barrier rings, and meticulous skin preparation—these interventions resolve most cases without surgical intervention. 1
Immediate Assessment and Conservative Management
First-Line Interventions
- Apply a convex appliance to create outward pressure on the retracted stoma and improve the seal between appliance and peristomal skin 1
- Use an ostomy belt in conjunction with the convex appliance to maintain consistent pressure and prevent ongoing leakage 1
- Apply paste or barrier rings around the stoma base to fill gaps and create a level surface for appliance adhesion 1
- Ensure complete dryness of peristomal skin before applying any pouching system—this is critical for adhesion 1
- Apply stomal powder followed by skin sealant on any damaged peristomal skin before appliance placement to protect compromised tissue 1
Application Technique Optimization
- Heat the appliance with a hair dryer before application and have the patient lie flat for several minutes after application to improve adhesion 1
- Cut the appliance opening one-eighth inch larger than the stoma to prevent mucosal irritation while minimizing skin exposure to effluent 1
- Measure stoma size at each appliance change for the first 8 weeks, as the stoma continues to change during this period 1
Identify and Address Underlying Causes
Rule Out Stoma Retraction
Stoma retraction is the most common cause of persistent leakage and requires specific management beyond simple appliance changes. 1
Assess for High Output
- Monitor for output greater than fluid intake, which rapidly leads to dehydration and electrolyte imbalances 2, 3
- Initiate aggressive intravenous hydration if high output is present to prevent renal failure—this typically requires hospital admission 2
- Monitor serum electrolytes regularly (sodium, potassium, magnesium) due to significant losses through high-output ostomies 2, 3
Evaluate for Downstream Complications
- Obtain CT imaging if clinical deterioration occurs or if conservative measures fail, as anastomotic complications or stenosis may perpetuate leakage 2
- Do not delay CT imaging when complications are suspected—ultrasound alone is insufficient 2
Ongoing Monitoring and Skin Protection
- Monitor for peristomal skin breakdown from leakage, which represents a secondary complication requiring immediate intervention 1
- Apply foam dressing rather than gauze to reduce local skin irritation—foam lifts drainage away from skin while gauze traps it 4
- Treat local fungal infections with topical antifungal agents if they develop in association with leakage 4
- Consult wound ostomy and continence (WOC) specialists as they are invaluable resources in managing leaking ostomy sites and often serve as primary managers 4
When Conservative Measures Fail
Indications for Surgical Intervention
- Consider surgical revision when persistent leakage causes significant financial hardship from frequent appliance changes and progressive skin damage despite optimal conservative management 1
- Avoid moving the stoma to a new location during revision, as this creates significant risk of complications at the new site 1
Critical Pitfall to Avoid
Do not attempt to replace the ostomy tube with a larger-diameter one—this is usually ineffective and can result in continued leakage around an even larger stoma 4. If conservative measures fail completely, the ostomy tube must be removed for several days to allow the stoma to approximate more closely, and occasionally requires placement at a new site 4.