Product selection for stomas

The skin barrier is already attached to the pouch. The one-piece is simple to apply — just peel and stick. One-piece products are available in all styles and quite often differing shapes. They can be found in closed, drainable (open-ended) and urostomy, with varying features from manufacturer to manufacturer.

A one-piece pouch generally lies flat against the skin and may show less under clothing. Typically, they are slim and flexible providing great comfort while wearing. If a bulge or hernia happens to appear near the stoma, sometimes a better fit can be found with a one-piece pouch because of its flexibility.

A two-piece system can often be the most versatile. The skin barrier is separate from the pouch. The pieces either snap together with a flange (a part that looks like a plastic ring), or there are adhesive styles which actually stick together. It's easy to remove the pouch and discard it as often as desired without having to remove the adhesive from the skin every change.

The versatility of a two piece system will be appreciated as it's possible to have a quick change and wear different pouches depending on activity level. For example: Changing to a smaller pouch for sports or intimacy. These also are available in closed, drainable (open-ended) and urostomy, with varying features from manufacturer to manufacturer. If the pouch needs changing more frequently than the skin barrier, choose a two-piece system.

Two piece systems might also be preferred if you have delicate or sensitive skin and wish to reduce the frequency of changing barriers.

This type of pouch works best if the stoma output is infrequent and the pouch requires emptying only once or twice a day. Generally, anyone with a colostomy can use a closed pouch (although of course there are exceptions). Closed pouches can be used all the time or some people switch between a closed and drainable pouch. On occasions when say, an episode of diarrhoea happens from something not agreeable, or from a bowel prep for a procedure that requires bowel cleansing, a drainable pouch might be better.

Closed pouches do not have clamps or integrated closures. Basically, they are removed and then thrown away. Most closed pouches have filters to let gas out but not odor.

Some people with a colostomy say they don't wear a pouch or they wear a tiny closed pouch called a stoma cap. Often this is because the person uses a procedure known as irrigation to control their bowels.

Choose this type of pouch if there's discharge frequently throughout the day (such as with an ileostomy). Drainable pouches these days have options of a clamp style closure, which is separate from the pouch, or an integrated closure system, which is already attached. Either way, emptying the pouch is quick and easy. Drainable pouches are available in several lengths, and there are options to choose transparent or opaque.

Filters are available on most drainable pouches. However, there are non-filtered styles available too.

All urostomy pouches have a drain valve/tap at the bottom of the pouch, so urine can be drained quickly, emptying the pouch. Each manufacturer will have a different tap on the bottom of the pouch. Some are like a household sink tap with flow and regulation, and some are like a straight tube with a cap. There are also transparent and opaque options for the pouch and sometimes capacity options depending on the manufacturer.

At night, it's possible to connect the urostomy pouch to a bedside drainage collector. This increases the overall capacity and helps to avoid having to get up during the night to drain the pouch. Each manufacturer's drain valve/tap is different, and it's a good idea to see how they connect with various collectors. An adapter may be needed.

A stoma cap is a small, closed pouch which is generally worn by a person who practices irrigation to manage their colostomy. A stoma cap is not intended to contain stool and is more for mucus and venting of gas but can provide freedom from wearing a standard-sized pouching system. A stoma cap also can be used on a short-term basis during water activities (e.g., swimming, hot tubs) or during intimate moments to increase discretion without compromising security.

Stoma caps are available in both one-piece and two-piece styles. They have an integrated filter to vent gas and an absorbent pad inside the pouch to absorb stoma secretions, such as mucus.

A filter is a feature on most closed and drainable pouching systems that is designed to allow gas to vent from inside the pouch, while removing odor. Filters are usually integrated (i.e., part of the pouching system) but are sometimes added separately. They are generally comprised of a series of membranes and plastics, as well as a deodorising material (usually activated charcoal). Gas flows through the filter materials and is deodorised before exiting through a specially designed exterior vent.

Filters can help prevent the pouch from ballooning (i.e., filling with air) under clothing. They also can help reduce pancaking (i.e., where stool adheres to the stoma and does not fall to the bottom of the pouch) by allowing better gas exchange between the inside and the outside of the pouch.

If a filter becomes wet or blocked with stool, it may stop working. This is why most filters require adhesive stickers on the pouch exterior vent to prevent water from damaging the filter during showering, bathing, or water activities.

Filter construction varies from manufacturer to manufacturer. Many older style filters have performance limitations. Some of the newer filters have liquid protection allowing them to work with more liquid stool. In addition, some have a protective membrane on the exterior vent so stickers are not required during showering, bathing, or water activities. The most technologically advanced, integrated filters, offer the ideal combination. They not only prevent leakage of odorous gases and liquids, but also provide high air flow to prevent ballooning.