Colostomy: A Guide

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Choosing a colostomy pouching system

Deciding what pouching system or appliance is best for you is a very personal matter. When you’re trying out your first pouching system, it’s best to talk with an ostomy nurse or someone who has experience in this area. There should be someone in the hospital who can get you started with equipment and instructions after surgery.

As you’re getting ready to leave the hospital, be sure you are referred to a Wound Ostomy Continence nurse (WOCN or WOC nurse, also called an ostomy nurse), a clinic, an ostomy manufacturer, or a chapter of the United Ostomy Associations of America. Even if you must go out of town to get such help, it’s worthwhile, as you want to get a good start and avoid mistakes. Even with help, you may have to try different types or brands of pouching systems to find the one that best suits you. (See the section called “Getting colostomy help, information, and support.”)

There are many things to think about when trying to find the pouching system that will work best for you. The length of the stoma, abdominal firmness and shape, the location of the stoma, scars and folds near the stoma, and your height and weight all must be considered. Special changes may have to be made for stomas near the hipbone, waistline, groin, or scars. Some companies have custom-made products to fit unusual situations.

A good pouching system should be:

  • Secure, with a good leak-proof seal that lasts for up to 3 days
  • Odor-resistant
  • Protective of the skin around the stoma
  • Nearly invisible under clothing
  • Easy to put on and take off

Types of pouching systems

Pouches come in many styles and sizes, but they all have a collection pouch to collect stool drainage that comes out of the stoma and an adhesive part (called a flange, skin barrier, or wafer) that protects the surrounding skin. There are 2 main types of systems available:

  • One-piece pouches are attached to the skin barrier
  • Two-piece systems are made up of a skin barrier and a pouch that can be taken off and put back on the barrier

Some pouching systems can be opened at the bottom for easy emptying. Others are closed and are taken off when they are full. Still others allow the adhesive skin barrier to stay on the body while the pouch may be taken off, washed out, and reused. Pouches are made from odor-resistant materials and vary in cost. They can be either clear or opaque and come in different lengths.

Figures 8 through 15 show some of the different kinds of pouches, plus other supplies that may be needed, such as flanges, clips, and belts (to help hold the pouch in place).

The opening of the skin barrier or wafer of the pouch needs to fit your stoma. The opening should be no more than 1/8 inch larger than the stoma. Depending on the pouch design, you may need to cut a hole out for your stoma, or the wafer may be sized and pre-cut. The size of the hole is important because the wafer is designed to protect the nearby skin from the stoma output and be as gentle to the skin as possible.

After surgery, your stoma may be swollen for about 6 to 8 weeks. During this time the stoma should be measured about once a week. A measuring card may be included in boxes of pouches, or you can make your own template to match your stoma shape and get the best fit.

Stoma covers

If your colostomy puts out stool at regular, expected times, you may be able to use a stoma cover instead of always wearing a pouch. You can place neatly-folded gauze or tissue, dabbed with a small amount of water-soluble lubricant over the stoma, and cover it with a piece of plastic wrap. This can be held in place with medical tape, underclothes, or an elastic garment. Plastic, ready-made stoma caps (Figure 16) are also available.

Last Medical Review: 12/02/2014
Last Revised: 12/02/2014