Sally Wright has worked as a Stoma Care Nurse for over 15 years, providing specialist care, education, and support to individuals recovering from stoma surgery within the community. Sally recognises that every patient’s recovery journey is unique, and she has a particular interest in the psychological aspects of adapting to life with a stoma. Her previous role as a Dermatology Sister highlighted the importance of emotional wellbeing whilst coming to terms with changes to our bodies and the impact on self esteem.
What is a stoma appliance?
A stoma appliance is sometimes called a stoma pouch/bag. It is designed to collect output from your stoma.
The type of stoma you have will influence the kind of appliance you may need. The three main types are:
- Colostomy: Created from the large intestine, or colon.
- Ileostomy: Created from the small intestine, or ileum.
- Urostomy: Created to allow urine to leave the body through a stoma.
Although the stoma appliances perform the same basic function, collecting output safely and securely, they are available in many different designs.
Your stoma care nurse will usually help you choose and fit your first appliance. As you become more familiar with your stoma, you may decide to try other options to find the system that suits you best.
Different stoma appliance types
Drainable, closed, or urostomy pouches
The type of pouch you use will usually depend on the type of stoma you have and the consistency or type of output.
- Drainable pouches: Have an opening at the bottom that allows the contents to be emptied. They are commonly used by people with an ileostomy who have a looser output and occasionally by some people with a colostomy. E.g: Drainable Standard Alginate by Unora
- Closed pouches: Do not have an opening for emptying. Instead, the entire pouch is removed and replaced when needed. They are suitable for a more formed to semi-solid output. E.g.: Closed Standard Alginate by Unora
- Urostomy pouches: Are specifically designed to collect urine. They usually have a tap or drainage bung at the bottom and can be connected to a larger drainage bag overnight.
Your stoma care nurse can explain which type is most appropriate for your individual needs.
One-piece or two-piece: what’s the difference?
An important decision is whether to use a one-piece or two-piece system.
- One-piece system: with a one-piece system, the adhesive baseplate (flange) and pouch are joined together as a single unit. The entire appliance is removed and replaced at the same time. Some people prefer one-piece systems because they can be simple to use, flexible, and discreet under clothing.
- Two-piece system: with a two-piece system, the baseplate (flange) attaches to the skin around the stoma, and the pouch connects separately. This allows you to change the pouch without necessarily removing the baseplate (flange) each time. Some people like the flexibility this offers, although the system may feel slightly different or more noticeable depending on the product.
Neither option is automatically better. Your choice may depend on comfort, dexterity, skin sensitivity, lifestyle, and personal preference.
Flat or convex baseplates
You may also hear the terms flat and convex when discussing ostomy appliances.
- A flat baseplate sits relatively flat against the skin and may work well when the stoma protrudes above the skin and the surrounding area is fairly even.
- A convex baseplate has a curved shape designed to apply gentle pressure around the stoma. It may help in certain situations, such as when a stoma sits flush with or below skin level. E.g.: Closed Standard Alginate Soft Convex by Unora
Convexity is not something everyone needs, and there are different depths and styles available. It is best to discuss this with a stoma care nurse, particularly if you are newly diagnosed or experiencing leakage.
Ostomy appliances: How to get the fit right
A good fit is one of the most important parts of choosing and using a stoma appliance.
The opening in the baseplate should fit snuggly around your stoma without pressing against it. If too much skin is exposed, your output can come into contact with the skin and cause irritation. If the opening is too tight, it may rub against or injure the stoma.
In the 6 weeks following surgery, your stoma will change in size and shape as the internal swelling reduces. This means you may need to measure your stoma regularly and adjust the opening of your appliance yourself, with guidance from your stoma care nurse.
When you reach 6-8 weeks the swelling has usually fully reduced and your stoma will usually remain this size. This is a good time to get your stoma measured by your stoma nurse and the opening of your stoma pouch can then be cut to fit for you by your delivery company.
What to consider before you choose your first ostomy appliance
Consider your body shape
Everybody is different, and the area around your stoma can affect how an appliance fits.
Factors that may influence your choice include:
- Skin folds or creases
- Scars
- The position and shape of the stoma
- Whether the stoma protrudes or sits close to skin level
- Changes in body shape when sitting, standing, or moving
An appliance that works well for one person may not work in the same way for another. This is why individual fitting and trying different products can be so important.
Think about your lifestyle
Your ostomy appliance should support your daily life rather than unnecessarily restrict it. When considering different options, think about the activities that matter to you. This might include work, exercise, swimming, travel, sleep, clothing, or caring for children.
- You may want to consider questions such as:
- How easy is the pouch to empty or change?
- Does it feel comfortable when sitting and moving?
- How does it fit under the clothes I usually wear?
- Do I feel confident wearing it during exercise or other activities?
- Is the drain easy for me to open and close?
- Can I manage the appliance comfortably with my level of hand strength or dexterity?
Protect the skin around your stoma
The skin around your stoma, known as the peristomal skin should ideally look and feel similar to the skin elsewhere on your abdomen.
Persistent redness, soreness, broken skin, itching, or discomfort should not simply be accepted as a normal part of living with a stoma. These symptoms may indicate leakage, an issue with fit, sensitivity to a product, or another problem that needs attention.
A well-fitting appliance is an important part of protecting your skin. Additional products such as barrier rings, seals, powders, sprays, or adhesive removers may sometimes be helpful, but not everyone needs every accessory.
Using more products does not necessarily mean better protection. Your stoma care nurse can help you decide what is appropriate for your needs.
Leaks are a sign to review the fit of your stoma appliance
Occasional problems can happen, particularly while you are learning how to manage your ostomy. However, frequent stoma leakage should not be something you simply have to put up with.
Repeated leaks may be related to the fit of the appliance, changes in your stoma or body shape, the condition of the surrounding skin, or the way the appliance is being applied.
If leaks are happening regularly, contact your stoma care nurse for advice. A small adjustment to the fit or a different product may make a significant difference
Trying samples can help
Many ostomy product manufacturers offer samples, giving you the opportunity to try different pouching systems before deciding what works best for you.
When trying a new appliance, consider:
- Comfort on your skin
- Ease of application and removal
- How well the backing plate (flange) secures to your skin
- How the pouch feels as it fills
- Ease of emptying
- How your skin looks when the appliance is removed
- How it performs during normal daily activities
It can be helpful to change one thing at a time. If you try several new products or accessories at once, it may be difficult to know what made a positive or negative difference.
If you'd like to try our new skin-friendly products, order your free sample here!