Pouching Systems
Introduction
Ileostomy or colostomy creation may be required temporarily or permanently for the management of a variety of pathologic conditions, including congenital anomalies, colon obstruction, inflammatory bowel disease, intestinal bowel disease, intestinal trauma or gastrointestinal malignancy.
After a colostomy or ileostomy, stool no longer comes out of body through the rectum, but through a new opening in the abdomen called the stoma. Ideally, a stoma should appear red or pink, moist and slightly elevated from the surrounding skin.
As the stoma has no control muscle (sphincter muscle), one cannot control the stool from coming out of the stoma.
Pouching Systems
The main functions of ostomy pouches are to contain the ostomy effluent, contain odour and protect the peristomal skin. Many pouching systems are available, as either one- or two-piece systems.
Skin Barrier
The skin barrier is the piece of pouching system that sticks to your body. It holds the pouch in place and should protect the skin around your stoma from stool. It is designed to fit snugly around the stoma and comes in 3 alternative formats:
- A mouldable option where the opening is moulded with the fingers to the size and shape of your stoma.
- A cut-to-fit option where you use scissors to cut the opening to your measured stoma specifications.
- A pre-cut option that cannot be further sized.
NOTE: Should leave a one-eighth inch opening around the stoma when using cut-to-fit or pre-cut options.
The skin barrier is also available in a convex format. Convex skin barriers may be appropriate if you have a flush (flat or even with the skin) or retracted (below skin levels) stoma. A convex barrier is shaped so that when you apply it, it presses down on the skin around your stoma. As a result, your stoma will stick out more, which can help prevent leakage around the stoma.
The Pouch
The pouch attaches to the skin to collect the stool that comes out of your stoma.
- Can be clear or opaque (tan coloured-pouch) and is odour-proof.
- Is available with or without a filter.
- A filter helps release and deodorize gas.
- If you have a pouch with a filter, you will need to cover the filter while swimming or showering.
- Comes in drainable and closed-ends options.
- Drainable pouches allow the stool to be drained from the pouch periodically through the day. This option is recommended for patients who have loose, liquid stool or semi-formed stool that can be unpredictable.
- You cannot drain closed-end pouches. Instead, these pouches are simply removed, placed in sealable plastic bag and discarded after use. This option is recommended only for patients who have thick, formed stool that is more predictable.
NOTE: Pouch should be emptied (or changed if you have selected a closed-end pouch) when one-third to one-half full. A full pouch can pull away from the barrier or skin due to the added weight. It can also cause bulging under your clothes.
Pouching System Application
NOTES:
- After surgery, stoma will be swollen. The swelling will subside, and stoma will change in size and possibly shape. It is therefore important to measure stoma after every pouching solution for the first 8 weeks, and periodically thereafter, to ensure your pouching solution is the correct size.
- Clean the skin around stoma with warm water. Avoid oils, creams, baby wipes and moisturizers.
- There are skin care accessories, including barrier wipes and adhesive removers.
- Patient can shower, bathe, swim or get in a hot tub with pouching system on. It is recommended to empty the pouch first.
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