Ostomy Guide

Stoma Pouches: The Right Fit

Getting the right fit for pouching your stoma is not always easy. Using a systematic approach to the characteristics of your body shape and stoma is very helpful. During a fit session, the stoma nurse will look at the shape of your abdomen while standing, sitting, and lying to assess any changes in the needs with each position.

What are the different types of Stoma

1. Ileostomy

An ileostomy is a stoma created from the small intestine. Because the colon is bypassed, the stool output is loose. It is also 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

2. Urostomy

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.

3. Colostomy

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

We use three terms to describe how far the stoma sits above the level of the skin. This feature determines the shape (whether 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)- convexity

What are the factors that affect the shape 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 if the abdomen

• Is flat and firm
• Is round and soft
• Has a hernia at the stoma site (parastomal hernia)

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

Typically, the ostomate with a flat firm abdomen does well with a flexible pouching system such as Coloplast Mio Flex, 1 or 2 pieces. It is available 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 is better for those with a soft abdomen.

For ostomates with a parastomal hernia, finding the right fit can be a challenge. As the hernia becomes larger, the stoma will often stretch out and 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 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.

Accessories to Support Fit

Many accessories are available to improve fit and wear time. Caulking agents such as stoma paste, moldable rings, Eakin seals, Brava barrier strip paste, and Brava protective barrier rings can be used right around the stoma to improve the seal. They also fill in small gaps if the surface is uneven.

Those like Coloplast’s Brava elastic barrier strips or Hollister’s barrier extenders add to the surface of adhesion of the wafer or barrier. These are placed around the outer edges of the barrier.

Importance of Ostomy Belt

An ostomy belt is great for support as well. If the stoma sits where there is a fold while sitting, a belt is recommended. The belt is meant to fit snug but not cause discomfort. If a parastomal hernia is present, Nu-Hope offers a large selection of hernia support belts made for ostomates. Coloplast has a support belt as well.

Products for managing ostomies have made great strides in meeting the community’s needs. New products are released often and the pouching systems improve each time.

If your pouch fit is no longer working, consider seeing a stoma nurse or all the manufacturer's customer support team. They can recommend products based on your individual needs.

Where to buy Ostomy Supplies?

Health Products For You ensures people with ostomies lead a normal and healthy life and presents a vast catalog of ostomy products at affordable prices. HPFY takes pride in being a customer-centric medical supplies store that aims to make health and wellness accessible for everyone. Shop with us and get exclusive discounts on each buy. Order today!

 

Author Profile: Christine Kijek, Registered Colorectal Nurse

 

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