Ostomy Appliances

Choosing the right ostomy appliance.

An Introduction to Ostomy Appliances

This section is not meant to replace the expert advice from your caregiver – NSWOC, doctor, etc. and yet can serve as a guide.

You may have already heard different terms and are confused about just what exactly they refer to. To clarify the terminology, a ‘bag’ or ‘pouch’ refers to the part that collects waste. ‘Flange,’ ‘barrier,’ ‘wafer,’ or ‘faceplate’ all refer to the part that sticks to your body. The general term ‘pouching system’ refers to the entire system (one or two-piece). The general term ‘appliance’ is also sometimes used.

Pouches (or bags) are one or two-piece, can also come in ‘closed end’ or ‘drainable’ models. A drainable pouch has an open end to release waste and closes via a clip or Velcro closure. A closed-end pouch has no opening and is removed and discarded instead of emptied. Many pouches are now made with filters near the top, allowing gas to escape without odour.

Barriers (or flanges) are available in various types of materials. Some are called standard wear, and others are extended wear. In general, a standard wear barrier is used when stool is semi-formed or formed. An extended wear barrier is usually used when a stoma drains urine or stool that is loose or liquid. The extended wear barrier does not break down like a standard wear barrier when it comes in contact with liquid waste.

Most hospitals employ one or more Ostomy Nurses, also referred to as NSWOC’s (Nurses Specializing in Wound and Continence). These are nurses who have taken specialized training in ostomy care. When you are discharged you will receive a supply of ostomy products recommended by your Ostomy Nurse to get you started. But where do you start and what to buy? How does one choose two-piece, one-piece, closed, drainable, different sizes, different brands? You may find that the product introduced to you by your hospital works well, and yet we encourage patients to learn different brands and new appliances. Your local Chapter or Support group is also a great source for nonmedical advice.

The Ostomy Canada Society Inc. does not endorse one brand or type over another – all have merit. What works well for one patient may not suit another, and what one person swears by others don’t like. Everyone has different needs and preferences. The most prevalent brands in Canada are Coloplast, ConvaTec, Hollister, Marlen, SALTS, Nu-Hope and CyMed. Your Ostomy Nurse is the best source to ask to try different product samples. They will know your ostomy and skin characteristics. If this isn’t possible, you can contact the manufacturers directly. All have websites and toll free numbers for information.

Two-Piece vs One-Piece Pouching Systems

A two-piece appliance is composed of two parts: the flange, which sticks to your skin, and the pouch, which snaps or attaches onto the flange. A one-piece appliance has the flange combined with the pouch. There are advantages and disadvantages to both:

Two-piece advantages:

most are more effortless to ‘burp,’ that is, allow gas to escape.
a smaller or larger pouch can be substituted without having to change the entire flange
Some have a ‘floating flange,’ a type of flange with an extra flexible join at the circular ring. It can be an advantage for those with poorer hand dexterity who have difficulty snapping a pouch onto a flange. It’s also helpful for those whose abdomen is very tender and pressing down to attach a pouch is uncomfortable.

Two-piece disadvantages:

tend to be bulkier and more visible under clothing
the convex models are somewhat rigid and can be more difficult to couple
more appliance’ inventory’ to purchase, match and keep track of

One-piece advantages:

fewer components to apply
soft convex are available
feel lighter, more flexible and have a lower profile under clothing

One-piece disadvantages:

can’t be ‘burped.’
some can cost more if you are using closed-end models (you’ll need to throw them away every time you empty them)

Convex Appliances

A convex ostomy wafer is designed to curve inward toward the stoma. It gently pushes down the surrounding skin to allow the stoma to stick out more. A convex appliance creates a more secure fit. It helps direct urine or stool into the pouch, not under the wafer or skin barrier. If your stoma sits at skin level, it is flush. If your stoma sits below skin level, it is recessed or retracted. These stomas can cause the surrounding skin to be sunken or uneven. A convex pouching system can help fix the problem. You should ask your Ostomy Nurse what type of convex flange might work better for you.

Pouch Liners

SThese are flushable, very thin plastic liners that fit inside a two-piece pouch. They perform best with colostomies or ileostomies with thicker output. When it comes time to empty, you remove the liner and flush it down the toilet, leaving your pouch empty and clean. These are popular with those who prefer using a closed-end appliance. Flushable liners can help save costs if this is a concern.