An Ostomy Product Guide for New Ostomates

Over the past two decades, ostomy product technology has improved significantly. With so many brands and types of products to choose from, knowing where to start can be overwhelming. Below is a general overview of the many types of products available to help manage your ostomy.

Ostomy Pouching System

Before we start: what is an ostomy pouching system? An ostomy pouching system is an ostomy pouch that collects and contains output from the stoma, and a skin barrier (adhesive) that attaches to the skin around the stoma. Sometimes the pouch and barrier are attached (a one-piece pouching system), and sometimes the pouch and barrier are separate (a two-piece pouching system). There are benefits and drawbacks to both systems, which we will cover in more detail below.

The pouching system collects output (stool) from an ileostomy or a colostomy bag. The skin barrier protects the peristomal skin from corrosive output while simultaneously keeping the bag sealed to the skin. Sometimes the pouch has an opening, or tail, which can be opened to drain collected stool, and sometimes the pouch is completely sealed. Just like the types of pouching systems, the types of pouches vary depending on your need.

Just as a side note: the pouching system should be emptied when it is about one-third full, and changed every three to four days.

Skin Barriers

Barriers, or wafers, are the part of the pouching system that apply directly on your skin like a sticker or a Band-Aid. Generally, a barrier is composed of a hydrocolloid material. Hydrocolloid ingredients are optimal for ostomy care because they are gentle, flexible, and water-resistant. Hydrocolloid materials can also absorb discharge, protect the skin from irritating output, and adhere to the skin for long periods of time. When warmed to body temperature, the material in the wafer softens like wax and creates a tight seal on the skin. Manufacturers offer many different types of barriers to suit your individual needs.

Types of barriers include:

• Cut-to-fit barrier – This barrier comes with measurements on the back that allow you to measure and cut the wafer opening to your exact stoma size. This is useful for people who have oblong stomas or whose stomas continue to change size (generally the first 8 weeks after surgery).
• Precut barrier – This barrier comes with a pre-cut hole for your stoma. If your stoma doesn’t change size, is round, and is close enough to one of the precut measurements, this can be a good way to skip a step during your ostomy changes.
• Flat barrier – Flat barriers are meant to be used on flat abdomens. They are also useful when your stoma protrudes from your skin, and the opening in your stoma - the lumen - is not near the skin.
• Convex barrier – Convex barriers are best for people who have recessed stomas, extra skin around the stoma, or have the lumen(s) of their stoma(s) close to their skin. A convex wafer helps to gently push your stoma further from your skin to create a more secure seal.
• Standard Wear barrier – Standard wear barriers are recommended for people who have thicker output. These types of barriers are appropriate for some end ileostomies or colostomies.
• Extended Wear barrier – Long wear or extended wear barriers are recommended for people who have thinner output, such as people with active ileostomies and urostomies.
• Barriers with Tape – Some barriers come with tape along the edges of the hydrocolloid wafer. This tape is not there as a seal; it is used to stabilize the skin around the wafer. Preventing large skin movements around the stoma can help to increase wear-time.

Pouches

A pouch is a containment device for the ostomy output. Like barriers, there are many types of pouches available. Here are some configurations:

• One-Piece System – In a one-piece system, the ostomy pouch and barrier are a single, inseparable unit. The ostomy pouch is permanently attached to the barrier.A one-piece system can feel more flexible on the body than a two-piece system, and they are more low-profile than a two-piece system. If you have a bulge or hernia near your stoma, you may get a better fit with a one-piece pouch. And if you have arthritis, poor eyesight, or other challenges, a one-piece system can be easier to use. If costs are an issue, one-piece systems also tent to be more affordable. On the downside, when changing a one-piece pouching system you must remove both pouch and barrier together. This means you’ll want to avoid frequent changes to protect delicate peristomal skin. One-piece pouches can be a good option for people who meet the criteria above; who are not extremely active; or who may change or drain pouches less frequently, such as colostomates with more formed stool. One-piece systems are available in both closed end and drainable pouch styles (see below).

• Two-Piece System – In a two-piece system, the ostomy pouch and barrier are two separate units. The barrier and pouch are both designed with a flange, or plastic ring, that snap together – making it easy to unsnap and discard the pouch. This system is the most versatile, allowing you to change your pouch while the skin barrier stays in place on your body, and protecting your delicate peristomal skin from too many changes. You can swap out for different pouches depending on your activity level and type, such as changing to a smaller pouch for sports or for intimacy. A two-piece system may also be a good choice if you require more frequent pouch changes, such as ileostomates who manage more liquid output. On the downside, a two-piece system can be more costly and can have a higher profile under clothing. The pouches in a two-piece system are also available in both closed end and drainable styles.

• Closed Pouch – A closed end pouch is a pouch with no opening other than the hole that goes over the stoma.Designed for one-time use, closed end pouches are removed and discarded when about 1/3 - 1/2 full. These are a popular choice for individuals with formed stool, such as colostomates. Closed end pouches are not recommended for people with a urostomy or ileostomy.
• Drainable Pouch – A drainable pouch has an opening at the bottom to allow pouch contents to be drained, usually when 1/3 full. Drainable pouches can have a wide range of closure options (see below). Drainable pouches can also be rinsed and reused, if necessary. People with liquid output who may require frequent changes, such as an ileostomate or urostomate, may require or benefit from a drainable pouch.
• Closure options – There are several different types of systems to close pouches, including:
  • Clamp closure
  • Integrated closure with Velcro
  • Integrated closure with an interlocking end
  • Paper-wrapped wire (similar to a twist tie on a bread bag)

Accessories

There are a wide range of ostomy accessories to help make ostomy wear more comfortable. See below for a breakdown of the different products.

• Stoma Powder – Stoma Powder is used to absorb moisture from the skin. Barriers adhere best to the skin when it is clean and dry, making stoma powder helpful if your skin is moist or weeping. Apply the stoma powder to any moist or weeping skin and brush off the excess powder. The powder will stick to the moist areas and brush off of dry, intact skin. Is your peristomal skin irritated? Pairing stoma powder with barrier wipes can help to “crust over” damaged skin. You can learn more about crusting here.
• Antifungal Powder – Some individuals with stomas can develop fungal infections underneath their ostomy barriers. This is fairly common and is caused by a wet and warm environment. Generally fungal infections are itchy and can appear as little red bumps on reddened skin. Apply antifungal powder to the irritated areas and brush off any excess powder.
• Deodorant Drops – Ostomy deodorant neutralizes odors in ostomy pouches. Just adding a few drops of deodorant to a clean ostomy pouch can help eliminate odor from stoma output, even when emptying the pouch. You can add drops every time you empty your pouch to continually have odor-free output.
• Lubricating Deodorant – Similar to deodorant drops, lubricating deodorant eliminates odor from stoma output. As a bonus, the lubricating deodorant coats the inside of the ostomy pouch and makes emptying any sticky output much easier.
• Ostomy Belt – An ostomy belt hooks onto your ostomy barrier and presses the barrier more snugly against your abdomen. This is helpful if you want added security while you are exercising or being active. Make sure that the belt is comfortable and not too tight.
• Adhesive Remover – Adhesive remover can come in the form of a spray or a towelette. In either form, this handy product helps ensure a pain-free removal of the ostomy when it is time to change your pouching system. Adhesive remover helps keep the skin healthy and trauma-free.
• Paste – Contrary to the name, paste is not an adhesive. It is a semi-solid substance that’s used to fill or caulk uneven skin contours near the stoma to create a flatter surface. Patients with liquid output often use past on top of the skin barrier around the stoma for a more secure seal.
• Barrier Strips and Rings – A bendable, stretchable, sting-free alternative to paste. Use to fill in or caulk uneven skin contours. Strips and rings come with a putty-like consistency and are malleable. You can also break off pieces of strips or rings to fill any divots in your skin to allow your pouching system to sit more flatly on your abdomen. People with chronic leakage and fitting problems may find it beneficial to use these accessories.
• Skin Barrier Wipes – Barrier wipes form a protective “second” skin that helps protect the skin from output. These wipes deposit a thin wet film that dries as a clear protective layer over the skin. Pair this product with stoma powder to “crust.” This product is fantastic for protecting further damage to skin. It is not needed if skin is healthy.

Although the list of available ostomy products can be daunting, over time you will find the products that work best with your body. If you’re uncertain about a product, please consult with your doctor or WOCN.