Colostomy: A Guide

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Choosing a pouching system

Deciding what pouching system or appliance is best for you is a very personal matter. When you are trying out your first pouching system, it is 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 are getting ready to leave the hospital, be sure you are referred to an ostomy nurse, a clinic, or a chapter of the United Ostomy Associations of America. Even if you must go out of town to get such help, it is 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 "Getting 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.

You may not need to wear a pouch, but many people with colostomies do. For example, those who have a transverse colostomy, those who do not want to irrigate, and those who have some return between irrigations may wear pouches. (More information on irrigation is coming up.)

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 when covered with clothing
  • Easy to put on and take off

Types of pouching systems

Pouches come in many styles and sizes, but they all do the same job – they collect stool drainage that comes out of the stoma. Some can be opened at the bottom for easy emptying. Others are closed and taken off when they are full. Still others allow the adhesive skin barrier, also called the face plate or flange, to stay on the body while the pouch may be taken off, washed out, and reused.

Figures 8 through 15 show you some types of ostomy supplies. Along with the different kinds of pouches, other supplies that may be needed, such as flanges, clips, and belts are shown. Pouches are made from odor-resistant materials and vary in cost. Pouches are either clear or opaque and come in different lengths.

There are 2 main types of systems available. Both kinds include an adhesive part that sticks to your skin (called a faceplate, flange, skin barrier, or wafer) and a collection pouch.

  • 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

The skin barrier or faceplate of the pouch may need a hole cut out for the stoma, or it may be sized and pre-cut. It is designed to protect the skin from the stoma output and to be as gentle to the skin as possible.

After surgery, the 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. The opening on the skin barrier should be no more than 1/8 inch larger than the stoma.

Stoma covers

A gauze or tissue can be folded neatly, dabbed with a small amount of water-soluble lubricant, placed over the stoma, and covered with a piece of plastic wrap. Such a dressing may be held on with medical tape, underclothing, or an elastic garment. Plastic, ready-made stoma caps (Figure 16) are also available. Stoma covers may be used for colostomies that put out stool at regular, expected times.

Last Medical Review: 03/17/2011
Last Revised: 03/17/2011