Ostomy Tips

Choosing the Right Ostomy Barrier

Choosing the right ostomy barrier can be a challenge for new ostomates. There is so much to learn. Once you’ve mastered the basics, the details are easier to understand! 

If you are lucky enough, you have met with an ostomy nurse. Unfortunately, many areas in the country do not have expertly trained ostomy nurses. Let’s discuss the factors that play a large part in choosing the right barrier.  

Type of ostomy  

What type of ostomy do you have?  

This determines if you need an extended wear barrier or a standard wear barrier. An ileostomy is a stoma created from the small intestine. Because the colon is bypassed, the stool output is loose. It also is more acidic because of digestive enzymes. Those with ileostomies should use an extended wear pouching system. Each brand uses different terms for extended wear:  

• Coloplast – XPRO  
• Hollister – Flextend  
• ConvaTec – Durahesive  

A urostomy is created with a small portion of the small bowel but the ureters from the kidneys are attached. This allows urine to drain into a pouch. Urostomies should also use extended-wear products.  

A colostomy is created from the colon. A stoma in the upper abdomen or on the left side can use standard wear pouching systems: 

• Coloplast – Standard wear  
• Hollister – Flexwear  
• ConvaTec – Stomahesive  

Does your stoma protrude from the skin?  

We use three terms to describe how far the stoma sits above the level of the skin. This feature determines the shape (flat or curved) of the barrier portion of the pouching system. The barrier is what adheres to the skin.  

Convexity refers to the “cupped” shape of the barrier that sits against your skin. It creates a little pressure around the stoma, which in turn helps the stoma to protrude a little more.  

• Does the stoma protrude from the skin (height)  
• Is it flush with the level of the skin – usually, use a barrier with convexity  
• Is it inverted (sits below the skin level)- needs convexity  

What is the shape of the stoma?  

For the first few weeks after surgery, the stoma is edematous or has swelled. This usually resolves after three weeks. As healing occurs, the stoma usually becomes smaller. At about 6 weeks after surgery, the stoma is often stable and will not change in size unless you lose or gain weight.  

Round stable stomas can use precut barriers. Most brands offer standard sizes for the pre-cut options.  

For those with oval or irregular-shaped stomas, cut to fit is best.  

Shape and texture of the abdomen  

Many different factors affect the shape of the abdomen. Mostly, we need to assess the shape surrounding the stoma, looking for scars, skin folds, and indentations that can create an uneven surface.  

Uneven surfaces can be a challenge as the barrier needs to be in contact with the skin to adhere. Some pouching systems are firm, while others are flexible. While assessing the abdomen, the nurse will evaluate for:  

• A flat, firm abdomen  
• Round and soft  
• Is there a hernia at the stoma site (parastomal hernia)  
• Does the stoma sit in or near a fold  
• Does the stoma retract into a deep valley when sitting or standing?  

Typically, the ostomate with a flat, firm abdomen may do well with a flexible pouching system such as Coloplast Mio Flex, 1 or 2-piece. It is available in a flat if the stoma protrudes or convex if the stoma is flush or inverted.  

These flexible systems are great for abdomens with deep folds around the stoma. ConvaTec offers the Esteem Synergy line that is very flexible and available in 1- or 2-piece systems.  

Coloplast’s Sensura line is firm and available with convexity or as a flat barrier as needed based on the height of the stoma. This pouching system generally is better for those with a soft abdomen.  

Abdomens with folds near the stoma or a deep divot when retracted, should try Coloplast Mio Click with convexity. This barrier folds with the skin. It is offered with convexity for those with a divot.  

A parastomal hernia is common for those with ostomies. The muscle has been cut to allow the intestine or stoma to be pulled through, causing a defect or weakness at that site. Certain activities create pressure that pushes against the defect. These activities include:  

• Coughing and sneezing  
• Lifting heavy objects  
• Some exercises such as sit-ups  

For those ostomates that have a parastomal hernia, finding the right fit can be a challenge. As the hernia becomes larger, often the stoma stretches out and will have a larger diameter but it flattens in height. For this reason, many choose a pouching system with convexity.  

However, Coloplast looked at this problem and created a pouching system called the Convex Flip. This barrier is flower shaped, flat in the middle, and curved toward the edges. Once placed around the stoma, the edges need to be flipped toward the skin. This creates a barrier that “hugs” the parastomal hernia. The barrier is soft. It is available in 1- or 2-piece pouching systems and offers a click-lock mechanism for the 2-piece pouch or an adherent pouching mechanism. Also offered are drainable, closed-end, and high-output pouches.  

Sensitive skin or allergies 

Some ostomates can have an allergy or sensitivity to the adhesive or tape border of a barrier.  

ConvaTec and Hollister offer barriers without the tape border. Others will complain of itching under the barrier. Hollister has a line with ceramide in the barrier material. This minimizes itching.  

Coloplast’s barriers do not have tape borders. If you are not sure which barrier is right for you, consider calling the manufacturer (Coloplast, Hollister, or ConvaTec) customer service. They have representatives available to answer your questions.  

If you order from Health Products For You, feel free to discuss it with customer service. They will often refer to me, the ostomy specialist. 

 

Author Profile: Christine Kijek, Registered Colorectal Nurse

 

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