People with an ileostomy or a colostomy will need to learn the basics of how to attach, drain, and change their ostomy pouch and care for the stoma and the surrounding skin. Ostomy pouches, or pouching systems, may be one piece or two pieces. They include a barrier, also called a wafer or flange, and a disposable plastic pouch. In a two-piece system, the pouch can be detached or replaced without removing the barrier. For both systems, the barrier attaches to the skin around the stoma and protects it from stool.  

Equipment 

There are different types of colostomy pouches available, depending on the type of stoma.  

Two-piece ostomy system 

The two-piece system consists of a baseplate attached to the skin with a removable ostomy pouch. Although it is very durable and long-lasting, it requires an amount of skill to use and tends to have a weaker adhesive.  

One-piece ostomy system 

The one-piece system consists of a single unit wherein the skin barrier and the pouch are joined. It is simpler to use but must be replaced every 1 to 3 days. The closed pouch system is generally used by people who have a constant elimination pattern and have to be discarded after a single use. 

The open-ended pouches are also commonly used and consist of a single piece attached to the skin around the stoma with a drainable pouch and can be left attached to the skin while removing stomal content.  

Pouches versus plugs 

Generally, in a colostomy, as compared to an ileostomy, a closed pouch must be required, unless the content is excessively fluid, when a drainable pouch may also be used. In an end colostomy, like after a Hartmann procedure, a colostomy plug can also be used. 

Pouch sizes 

Differently sized pouches are available, and they may be used by different people or by the same person at different times during the day or during different activities. For example, a larger sized pouch may be used while sleeping at night, whereas a smaller sized pouch may be used during sexual activity or while exercising. Pediatric sized stoma pouches are also available. 

Caps 

Stoma caps are like lids applied over the stoma. They may be worn by certain people like those with continent ileostomies or those who require stomal irrigation for movement at their discretion, for short intervals during the day. 

Stoma care 

Stoma care starts before the actual surgery 

Stoma care begins when you are diagnosed and informed about the possibility of stoma creation. It requires mental health and guidance counselors to address any concerns you may have about your self-image and societal status.  

It also requires an entero-stomal therapist to discuss with the surgeon the location of the possible creation of the stoma and to go on and mark the colostomy site in the preoperative period. 

Post-surgery stoma care 

When the stoma becomes functional, generally between 2 and 4 days after the surgery, you will need a colostomy pouch or appliance application. In the initial days, it is either done by the nursing staff or in larger hospitals, by an entero-stomal therapist. This is done with a view to teaching you or in case of children, their guardians, how to do it themselves at home. 

You should be informed about the various devices available, about the functioning of these devices, about your own colostomy and the kind of effluent that would be seen about the complications of the stoma and the colostomy pouches. 

The most important person involved in colostomy care is you 

 Once you are discharged from the hospital, you will oversee your own colostomy care. You must regularly change the pouch as required and should visit the provider regularly to assess the stoma in the normal run, or in case of any complications. As a rule, the stoma pouch should be emptied when it is filled up to 1/3^rd to prevent peeling off the baseplate from the skin and leaks. 

Technique 

The colostomy appliance should be changed every 3–7 days, depending on the appliance. You can generally do this yourself or with the help of the primary caregiver, or parent in case of children. If you notice any case of skin breakdown or skin irritation or difference in stomal appearance you should be seen by a healthcare provider. 

Changing the pouch 

Before starting the procedure, all supplies should be arranged, and handwashing and donning of gloves should be done. The used stoma pouch should be first emptied of all content, and then the flange removed by gentle traction on the pouch or flange towards the stoma with counter-traction on the skin. An adhesive remover may also be used.  

The stoma and area around the stoma should be gently cleaned with water, dabbed rather than scrubbed, without using soap. The stoma should be assessed and must be moist, above skin level, and pink to red in color, and the skin around the stoma should be normal. Any deviation from this should be notified to your healthcare provider.  

The skin around the stoma should be dried appropriately to allow good seal formation. Adhesive pastes or powders may also be applied around the stoma. The paper cover on the back of the flange is then removed with the border tape in place. It is then placed around the stoma and held in place for 1 to 2 minutes to create an adequate seal.  

If it is a 2-piece pouch, the pouch is then clipped on to the flange. A belt may be applied around the abdomen and clipped to the sides of the flange to hold it in place. After this, safe disposal of the stoma pouch, handwashing, and documentation of the procedure if needed. 

Mental health matters too in stoma care 

Another integral aspect of colostomy care is mental health support. Poor body image perception, sexual dissatisfaction, and depression are common in those with colostomies. Reassurance, psychiatric, and behavioral counseling may be needed to alleviate these symptoms. 

---

Source: StatPearls