Choosing a pouching system

A pouching system is needed to collect urine that comes out of the stoma. It must have a skin barrier that protects the surrounding skin.

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 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 a few things to think about when trying to find the pouching system that will work best for you. The size 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 under clothing
  • Easy to put on and take off

Types of pouching systems

Pouches come in many styles and sizes, but they all include an adhesive part that sticks to your skin (called a flange, skin barrier, or wafer) and a collection pouch. 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

While you are in the hospital after your surgery, an ostomy nurse will talk to you about your personal needs and help you pick a pouching system. For some, this pouch is the type worn for a lifetime. Others will need to change to a new or different type of pouching system later on if they gain weight, grow (in the case of a child), or for other reasons. Do not keep using a recommended pouch if it’s not working the way you need it to. Try different types until you find one that feels good, works well, and is easy to use.

Fitting the skin barrier

The constant flow of urine from the stoma can irritate the nearby skin. The pouching system’s skin barrier is designed to protect the skin from urine and be as gentle to the skin as possible. Depending on the design, you may need to cut a hole out for your stoma, or it may be sized and pre-cut.

Right after surgery the stoma is swollen, but it will shrink over the next 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 skin barriers, or you can make your own template that matches your stoma shape. The opening on the skin barrier should be no more than 1/8-inch larger than the stoma size to keep urine off the skin.

Using an ostomy belt or tape

Illustration of an adjustable ostomy belt

Wearing an ostomy belt to help hold the pouch in place is a personal choice. The belt attaches to the pouching system and wraps around your waist. Some people with urostomies wear a belt because it makes them feel more secure and it supports the pouching system, which can get heavy as it fills with urine. Others find a belt awkward and use tape instead. Tape can be put around the outside edge of the skin barrier like a frame, to help hold it in place.

If you choose to wear an ostomy belt, adjust it so that you can get 2 fingers between the belt and your waist. This helps 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 you use an ostomy belt, it shouldn’t ride above or below the level of the belt tabs on the pouching system. People who are in wheelchairs may need special ostomy belts. Supply companies often carry 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

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.