Stoma leakage issues sometimes occur because wafers do not completely adhere to the patient’s stoma. If this is the case, you might need to use stoma paste.
What is Stoma Paste?
“A gummy type of skin barrier material that comes in a tube that may be used to fill skin indentations and to protect the skin at the edge of the cut opening of the pouch skin barrier. (Note: Not to be used as ‘glue’ to hold on a pouch).”1
A stoma paste is a product that fills in rough skin surfaces, imperfections, scars or gaps around the stoma to form a more attachable wafer that, in turn, will prevent stoma leakage. “Leakage from stomal equipment causes much distress to patients, diminishing their confidence in both the equipment and the possibility of a leak-free future life. Generally, the volume of effluent should not exceed half an appliance capacity and it is prudent to check and empty bags regularly and before changing a patient’s position. If an appliance is more than half full it leaves insufficient room for flatus (which also takes up space) to be accommodated without pressure on the bag seams, the seal between flange and bag in two-piece equipment, and the seal between the bag adhesive and the patient’s body. The weight of an overfull bag also drags on the body-bag adhesion seal, thereby reducing its efficiency as well as being uncomfortable for patients.”2
It is not an adhesive element but a sealing factor that prevents undesired liquids from coming out of the stoma. “Stomal leaks can be associated with significant social, psychological and physical morbidity for ostomy patients. Poor fitting of the stoma appliance due to irregularities of skin contours is one cause of stoma leaks which commonly result in secondary irritant dermatitis prompting presentation to a dermatologist. In addition to skin-directed topical therapy and review of stoma appliances, correction of contour defects with intradermal injections of filler materials is one possible treatment to improve adhesion and reduce leaks.”3
Benefits of Using Stoma Paste
The main benefit of stoma paste is the avoidance of liquid drainage from the stoma and the subsequent comfort and relief this offers. An optimum sealing of skin imperfections helps the stoma bag to work properly.
“The paste facilitates seal and protects the skin. The correct size of the pouch opening keeps drainage off the skin and lessens the risk of damage to stoma during peristalsis or activity. Pouch and skin barrier are changed whenever leaking. It can also be charged before or after a tub bath or shower. The stool is alkaline and this irritates the skin; fecal bacteria can colonize on the skin and increase risk of infection. Change when the patient is comfortable; before a meal is better; because this avoids increased peristalsis and chance of evacuation during the pouch change.”4
Presentation on the Market
They are available as squeezable cylinders/tubes or non-adhesive strips. All instructions require careful reading and following. When using stoma pastes, consider that you can apply it directly to the patient’s wafer or in every external side of the stoma. Using the cylinder type, it requires more settling and drying time, in contrast to the strip paste.
Indications and Adverse Effects
Do not apply stoma paste in excess; otherwise, it can transform a solution into a new problem.
Some cylinder pastes may contain alcohol, which can cause skin burning sensations to sensitive patients, but not all commercial brands have alcohol in their products. Strips stoma pastes are usually alcohol-free.
“Moldable strip, rings, alcohol-free stoma paste, Stomahesive powder and skin barriers can be applied directly to injured skin. If there is no alcohol-free paste available, glycerol 85% and Stomahesive powder can be mixed together to form a paste. Stomahesive powder turns to gel on contact with wound exudate forming a hydrocolloid mass and thereby binding moisture. A baseplate can be glued to a thin layer of the fanned powder where any resulting moisture causes the powder to swell and turn to gel, thus creating a leak-tight layer between the skin and the baseplate.”5
Another consideration when using stoma paste is its adverse effects on useful wear time of wafers so remember that if the patient certainly requires to use the product.
“Peristomal skin is constantly exposed to a number of substances including urine, feces, medicaments, ostomy pouch systems, and stoma skin care products such as barrier films and adhesive paste/removers. The above can result in a variety of peristomal events, including physical skin abrasion and/or infections, dermatologic conditions (pyoderma gangrenosum, psoriasis etc), and contact dermatitis. Bodily fluids are known to be an important cause of peristomal dermatitis. To protect the peristomal skin, medical professionals recommend applying stoma skin care products designed to prevent peristomal irritation. Because of the presence of known allergens/irritants in peristomal skin products (e.g., fragrances, colophonium), we reasoned that stoma skin care products may represent a previously unappreciated cause of peristomal dermatitis. Allergic contact dermatitis (ACD) has been infrequently reported (0.5–4.7%), but, when present, stoma skin care products are often the cause. The role of these products as irritants is also poorly understood. Most of the evidence in the literature is in the form of case reports and case-series, with no large-scale studies reporting on these events. Herein, we evaluate irritant and allergic etiologies for peristomal dermatitis and identify commonly used products as culprits.”6
Adhesive Agents can cause skin damage
“Adhesive agents, such as ostomy paste, can result in damage to the epidermis during removal of the appliance, particularly on a child with fragile skin or one requiring frequent pouch changes. Once the skin is denuded, pouch adhesion is difficult to achieve., predisposing to undermining and compounding skin breakdown. Adhesive agents should be reserved for those instances in which pouch wear time for a child is unacceptably short with the use of basic pouching techniques. On premature infants, de decision to use ostomy paste should be made on an individual basis, but in any case, it should be used with extreme caution, because of the risk of epidermal stripping and percutaneous absorption of ingredients.
Chemical or irritant dermatitis results from exposure of the skin either to chemicals or to effluent. Ostomy products containing chemicals include adhesive remover, skin sealant, ostomy paste, and soap. These products should be used on an ‘as needed’ basis. Products used for dissolving adhesives or cleaning the skin should be thoroughly removed from the skin before pouching.”7
How do you use Stoma Paste?
Once you decide to use stoma paste, follow a few steps to apply it:
- Wash the peristomal skin and carefully dry it, leaving no moisture or residues of any kind. Any moisture or residue will affect the process.
- Place stoma paste directly on the external side of the stoma or in the wafer, whatever suits your particular needs. Allow it to sit for one or two minutes so that it dries off completely.
- If you are applying the paste to the wafer, place it as usual and press it against the abdomen for about one minute to ensure a proper sealing process. “If the wafer is not self-adhesive, apply adhesive stoma paste to the skin around the stoma. Some pastes must dry a few minutes; follow manufacturer’s instructions. Peel the paper backing from the wafer. Position the wafer, adhesive side down, over the adhesive paste.”8
- Once you discard the pouch, you can remove the stoma paste. Once it is ready for removal, ensure to use warm water and a towel. Take off the paste smoothly and do not irritate the skin applying excessive pressure.
“PSCs (Peristomal complications) is a common postoperative complication. It affects the patient physically and psychologically, ultimately prolonging rehabilitation and adaptation to the stoma. Furthermore, PSCs significantly increase the cost both for society but also for the individual living with a stoma. Ideally, PSCs should be prevented and awareness of the data presented here is important to disclose to surgeons creating a stoma and to other stoma care professionals (e.g dermatologists) as the quality of stoma construction and management may have a lifelong direct impact for the patient’s well-being and major financial implications for the health care system. […]
PSCs are common and both frequency and severity are under-recognized and under-reported. A key causative factor is undoubtedly peristomal leakage and individuals with an ileostomy are most at risk from a combination of the higher output and irritant nature of the effluent as compared with those people with a colostomy. The consequences of PSCs are substantial, both from the patient and the health economy viewpoint. The extent of the problem warrants a major focus on methods to minimize the risk, detect PSCs at an early stage and institute optimal treatment to prevent the long-term, debilitating and expensive complications.”9
Each patient dealing with stoma leakage and stoma paste problems may also have different skin types that might predict the usefulness of the product. So, if you are currently having stoma leakage, ask your nurse or doctor if a stoma paste is appropriate for you.
(1) Zulkowski, K. (2015). Ostomy terms and definitions-continued. World Council of Enterostomal Therapists Journal, 35(3), 48. Available online at https://www.wcetn.org/assets/Journal/WCET_Terms/wcet20wound20terms2020definitions203.pdf
(2) Breckman, B. (Ed.). (2005). Stoma care and rehabilitation. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?hl=es&lr=&id=F7NE_iXpEvgC&oi=fnd&pg=PR13&dq=Stoma+Care+and+Rehabilitation+Brigid+Breckman&ots=CQq3akD2hj&sig=MCEsXMYhaES_AgMq4AuuM-ZcGEI&redir_esc=y#v=onepage&q=Leakage%20from%20stomal%20equipment&f=false
(3) Weidmann, A. K., Al-Niaimi, F., & Lyon, C. C. (2014). Correction of skin contour defects in leaking stomas by filler injection: a novel approach for a difficult clinical problem. Dermatology and therapy, 4(2), 271-279. Available online at https://link.springer.com/article/10.1007/s13555-014-0058-x
(4) Rebeiro, G., Jack, L., Scully, N., & Wilson, D. (2014). Fundamentals of nursing: Clinical skills workbook. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?hl=es&lr=&id=uQlPAgAAQBAJ&oi=fnd&pg=PP1&dq=Fundamentals+of+Nursing:+Clinical+Skills+Workbook+Geraldine+Rebeiro,+Leanne+Jack,+Natashia+Scully,+Damian+Wilson&ots=Se1Y7hj_TP&sig=ZrOEncTJJhsfyFzuPdzvKT0k0DY&redir_esc=y#v=onepage&q=The%20paste%20facilitates%20seal%20and%20protects%20skin&f=false
(5) Sturm, A., & White, L. (Eds.). (2019). Inflammatory Bowel Disease Nursing Manual. Springer. Available online at https://books.google.co.ve/books?id=WfaEDwAAQBAJ&pg=PA288&lpg=PA288&dq=Moldable+strip,+rings,+alcohol-free+stoma+paste&source=bl&ots=-rR6l7HhSg&sig=ACfU3U18Kgc5HyDKRc8j3WxfwPzAopdTog&hl=es-419&sa=X&ved=2ahUKEwjJsLH_kcTiAhXQuVkKHWWRCjcQ6AEwCnoECAgQAQ#v=onepage&q=Moldable%20strip%2C%20rings%2C%20alcohol-free%20stoma%20paste&f=false
(6) Cressey, B. D., Belum, V. R., Scheinman, P., Silvestri, D., McEntee, N., Livingston, V., … & Zippin, J. H. (2017). Stoma care products represent a common and previously underreported source of peristomal contact dermatitis. Contact dermatitis, 76(1), 27-33. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523875/
(7) Browne, N. T., Flanigan, L. M., McComiskey, C. A., & Pieper, P. (2008). Nursing care of the pediatric surgical patient. Jones & Bartlett Publishers. Available online at https://books.google.co.ve/books?hl=es&lr=&id=wRqGwrdmxCcC&oi=fnd&pg=PR3&dq=Nursing+Care+of+the+Pediatric+Surgical+Patient+Nancy+Tkacz+Browne,+Laura+M.+Flanigan,+Carmel+A.+McComiskey,+Pam+Pieper&ots=eE1lC4BdJS&sig=9omDoPPHT9R5OJPxgfq85UGWTfA&redir_esc=y#v=snippet&q=Adhesive%20agents&f=false
(8) Simmers, L. M., Simmers-Nartker, K., & Simmers-Kobelak, S. (2013). DHO: Health Science. Cengage Learning. Available online at https://books.google.co.ve/books?id=vs5XCQAAQBAJ&pg=PA823&lpg=PA823&dq=If+the+wafer+is+not+self-adhesive,+apply+adhesive+stoma+paste+to+the+skin+around+the+stoma&source=bl&ots=i1wJnzSw3K&sig=ACfU3U1DiRIHeFKBUGCPJX_ui52XAto3Uw&hl=es-419&sa=X&ved=2ahUKEwiK3cuWkMTiAhUow1kKHcXvBroQ6AEwFXoECAcQAQ#v=onepage&q=If%20the%20wafer%20is%20not%20self-adhesive%2C%20apply%20adhesive%20stoma%20paste%20to%20the%20skin%20around%20the%20stoma&f=false
(9) Meisner, S., Lehur, P. A., Moran, B., Martins, L., & Jemec, G. B. E. (2012). Peristomal skin complications are common, expensive, and difficult to manage: a population-based cost modeling study. PLoS One, 7(5), e37813. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359986/