Choosing an ileostomy 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 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 5 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

A pouching system is needed to collect ileostomy output. 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

Depending on the design of the skin barrier or wafer of the pouch, you may need to cut a hole out for your stoma, or it may be sized and pre-cut. It’s designed to protect the skin from the stoma output and 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.

illustration showing a one-piece drainable pouch with skin barrier, two-piece drainable pouch, flange for two-piece system and 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

Wearing a belt to help hold the pouch in place 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 sores (pressure ulcers) on the nearby skin. If a belt is used, it shouldn’t ride above or below the level of the belt tabs on the pouching system. People in wheelchairs may need special belts. Supply companies often carry these special belts or an ostomy nurse can talk to you about making one yourself.

In its original form this document was written by the United Ostomy Association, Inc. (1962-2005) and reviewed by Jan Clark, RNET, CWOCN and Peg Grover, RNET. It has since been modified and updated by:

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: December 2, 2014 Last Revised: December 2, 2014

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