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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.

A good pouching system should be:

  • Secure, with a good leak-proof seal that lasts for 3 to 7 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

A pouching system is used to collect ileostomy output. 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.

Pouches for one- and two-piece systems are drained through an opening at the bottom. They are made from odor-resistant materials and vary in cost. Pouches are either clear or opaque and come in different lengths.

One-piece drainable pouch with skin barrier, two-piece drainable pouch, flange for two-piece system, and a drainable pouch clip.

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.

Belts and tape

Adjustable belt

Wearing a belt is a personal choice. Some people with ileostomies wear a belt because it makes them feel more secure and it supports the pouching system. Others find a belt awkward and use tape instead. Tape can be put around the outside edge of the skin barrier like a frame.

If you choose to wear a belt, adjust it so that you can get 2 fingers between the belt and your waist. This helps to keep you from getting a deep groove or cut in the skin around the stoma which can cause serious damage to the stoma and pressure ulcers on the nearby skin. Belts should be worn so they do not ride above or below the level of the belt tabs on the pouching system. People in wheelchairs may need a special belt. Supply companies often carry these special belts or an ostomy nurse can talk to you about making one yourself.

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