Certain medical conditions, including cancer, may require treatments that change the way the body eliminates waste. An ostomy is a surgical procedure that creates an opening in the body to redirect urine or stool; depending on the exact surgery, the end of the ureter or small or large bowel will protrude through the abdominal wall (this protrusion is called a stoma). As a consequence of an ostomy, you will need to use a pouch system to collect the waste coming out through the stoma.
A typical ostomy pouch system includes a pouch and a skin barrier or wafer as well as certain accessories to achieve the best fit. The pouch attaches to the abdomen with the skin barrier and is fitted over and around the stoma. The skin barrier is also designed to protect the skin from the stoma output. Urostomy pouches are made specifically for urine collection; others may be described as being for ileostomies and accommodate an opening created from the small intestine (usually at the end of the ileum) or for colostomies, when a portion of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall.
There are two primary types of ostomy systems: one piece in which the pouch and skin barrier come as a single unit and two piece products—the pouch and skin barrier are used together, but come as separate pieces until you attach them.
Pouches can be either open or closed. Open-ended or drainable pouches have a re-sealable end that is used to drain contents in a toilet or other receptacle and need a closing device, such as a clamp or tail clip, and are left on while emptying. A closed pouch is sealed at the bottom and disposed of when full. Many pouches are made with cloth covers on one or both sides for comfort and discretion.
A one-piece system can be simpler to use than a two-piece system, but you'll need to change the entire unit when the pouch is changed. The ActiveLife One-Piece Drainable Pouch With Durahesive Skin Barrier has a one sided comfort panel with a tape collar skin barrier. This pouch is 12 inches and comes with two tail closures and can be cut-to-fit.
With a two-piece system, the wafer is designed to stay on your skin for longer periods, so it doesn't need to be changed as frequently as the pouch. Both components need to be made not just by the same manufacturer, but also chosen from within the same product line. The wafer/barrier is part of a "flange" unit, and the pouches include a closing ring that attaches mechanically to a mating piece on the flange, so the pieces must be made to fit together for the best results. Some are interchangeable. The SUR-FIT Natura Two-Piece Drainable Pouch is a basic 12" ostomy pouch by Sur-Fit for two piece ostomy systems and works with the SUR-FIT Natura Durahesive Moldable Convex Skin Barrier with Flanges. This is a choice for people whose stoma output is mostly liquid. Unlike other skin barriers that can break down around liquid output, this skin barrier is designed swell up or "turtleneck" to better protect the stoma and surrounding skin. A moldable area allows for improved skin protection over traditional barriers and provides ease of use and versatility. It requires no cutting or measuring, which makes it easy to learn how to use.
Manufacturers make sizing easy, using simple codes and colors to match their skin barriers and pouches so that the components lock into place securely. In many cases each color stands for an exact size, so you can match the system by either color or opening dimension.
Ostomy Skin Barriers and Wafers
When choosing a two-piece system, you have a variety of options in skin barriers/wafers. There are moldable skin barriers as well as rigid ones. There are flat as well as convex ones. A convex design is good for people with a retracted or flush stoma. These shaped plastic discs that are inserted inside the flange of certain two-piece systems to create a tighter seal.
Many skin barriers with adhesive backing will need to be removed occasionally. There are also skin barriers without adhesive backing and with and without a perimeter of tape.
Understand the differences among systems and discuss them with your ostomy team. For instance, the CenterPointLock Cut-to-Fit Hollihesive Flat Skin Barrier offers the most gentle skin barrier available from Hollister and is made for people with sensitive skin or limited dexterity. These ostomy skin barriers eliminate pressure on a tender post-operative abdomen with the company's exclusive Floating Flange; the unique CenterPointLock feature prevents unintentional pouch-skin barrier separation. There's also a cut-to-fit opening for uniquely shaped stomas for a customized fit.
If you'd rather have a pre-cut opening, another option is the CenterPointLock Flextend Extended Wear Skin Barrier with Porous Cloth Tape that protects the skin from irritation over extended wearing time and allows it to breathe. The Floating Flange and CenterPointLock are components of this skin barrier.
Ostomy accessories include a wide variety of products to prep and care for skin as well as make the pouch adhered better and more snuggly.
Skin preparation products include wipes, such as Shield Skin Protective Barrier Wipes for use on the skin between skin contact area and ostomy system. Wipes help maintain skin health with a clear and protective waterproof formula that's non-staining, comfortable to wear and gentle to skin with a low alcohol content.
Another helpful product is a skin powder, like Adapt Stoma Powder, to provide a smooth, dry surface that helps the skin barrier adhere better.
Skin paste, like Karaya Paste by Hollister, is a thick cream that can be used to fill in depressions or surface irregularities of the abdominal wall and evens out skin contours under a skin barrier under the wafer to create a better seal—think of as caulking to fill in gaps. While it's not an adhesive, it does protect the skin from stomal discharge.
Moldable adhesive stripes like Stomahesive Strips Moldable Adhesive stripes are double sided for use as a filler to protect or fill in uneven skin surfaces next to an ostomy, fistula or wound and help the skin barrier adhere better.
Tape is another product that can be used to help support the wafer or flange and for waterproofing. It's available in a wide range of materials to meet the needs of different skin types. Megazinc Pink Adhesive Tape is a zinc oxide based, skin friendly and latex-free choice for securing ostomy pouches (as well as wound dressings). Available in 1" x 5-yard and 2" x 5-yard sizes, it's flexible, waterproof and washable with a serrated edge for easy tearing.
When it's time to change the skin barrier and/or one-piece pouch, you might need adhesive remover to clean off any adhesive that lingers on the skin. Adhesive Remover Pads will dissolve unwanted adhesive residue from urinary and ostomy appliances and skin. These pads are free of harsh solvents, lab tested and non-toxic…with a fresh citrus scent.
If you have a reusable pouch, you may want to a deodorizer to freshen your products. Stop-Odor Plus is a powerful ostomy pouch deodorizer in liquid form—you just squeeze a few drops into a new or just emptied ostomy pouch for complete odor elimination. DevKo™ Ostomy Pouch Deodorant Tablets are a pouch deodorant in tablet form to effectively deodorize the contents of your pouch without using a liquid.
Ostomy Irrigation Supplies
Kits are available for draining stoma discharge over an extended period or for nighttime use. Typically, a tube connects to the pouch and drains into a container or basin. ConvaTec Night Drainage Container Set and Tubing has a container cover and universal adapter in addition to the container and tubing. This drainage set is designed for convenient collection of urine over an extended period and features a connector compatible with ConvaTec's urostomy pouches, including SUR-FIT Natura.
Depending on the type of ostomy you have, you may be able to use a technique that enables you to empty your colon on a set schedule and not need a pouch to collect stool. A system like the Visi-Flow Irrigation Starter Set with an irrigator, stoma cone, special lubricant and other essentials allows you to clean stool directly out of the colon through the stoma.
Certain ostomy products help keep the pouch is place so that it doesn't interfere with your daily activities. As an example, the Adjustable Ostomy Belt attaches easily and securely to an ostomy pouch to hold the pouch firmly in place. It's 1-1/8" wide and made of a soft, comfortable high quality elastic material that's washable.
For a more secure feeling, consider the Carefix StomaSafe Classic Ostomy Support Garment, a wrap that helps hold the pouch to the body discreetly. It reduces pouch and content noise and is both convenient and safe for nighttime use. Designed with a fabric that makes it flexible, breathable, comfortable and soft to the skin, it's easy to pull on and can be used with both one-piece and two-piece systems. An inner pocket features a stoma opening and a bottom drainage opening making it easy to use with drainable and closed pouches.