A colostomy is a surgical procedure that creates a new pathway for waste, forming a stoma from the large intestine through the abdominal wall. Since the body no longer passes stool through the anus, an external pouching system, often called an ostomy appliance, is necessary to collect the output. This appliance consists of a collection pouch and an adhesive wafer or skin barrier that adheres to the skin around the stoma. Regular maintenance is fundamental for comfort, security, and skin health.
Emptying the Colostomy Pouch
Emptying the collection pouch is the most frequent aspect of colostomy management, typically a daily routine based on bowel function. The guideline is to drain the contents when the pouch is between one-third and one-half full. Waiting until the pouch is completely full places stress on the adhesive seal, compromising the barrier’s integrity and increasing the risk of leakage. Colostomy output is typically semi-solid, requiring most individuals to empty their pouch one to three times daily, depending on diet.
The emptying process differs based on the pouch type. Drainable pouches have an opening secured by a clip or closure, allowing contents to be emptied into the toilet and the pouch to be reused. This design is convenient for managing the semi-solid output typical of a colostomy. Conversely, closed-end pouches have no opening for drainage and are designed for single-use.
When a closed pouch is used, the entire unit is removed and discarded upon reaching capacity, necessitating replacement supplies. While the drainable option is more common for colostomies, selecting a closed pouch may be preferred by those with a predictable output pattern. Regardless of the pouch style, timely emptying maintains the longevity of the skin barrier and ensures hygienic management.
Schedule for Changing the Appliance System
Changing the entire appliance system involves removing the adhesive wafer or skin barrier and replacing it with a new one. This process is distinct from merely emptying the collection pouch. For most individuals, the standard wear time for the skin barrier is approximately three to five days. This routine replacement prevents the adhesive from breaking down to the point of failure, even if the seal appears secure.
The type of system—one-piece or two-piece—influences the changing routine. A one-piece system has the adhesive barrier and the collection pouch permanently joined, meaning the entire appliance must be removed and replaced every few days. Some manufacturers offer specific one-piece closed pouches intended for daily or every-other-day replacement for those with formed output.
In a two-piece system, the pouch snaps onto a separate flange or barrier adhered to the skin. This design allows the user to change the pouch as often as needed (such as when using a closed pouch) while keeping the skin barrier in place for the full wear time of three to five days. The goal is to establish a consistent replacement schedule, rather than waiting for signs of lifting or leakage, which indicates seal failure.
Understanding Factors That Affect Wear Time
Several factors influence whether an appliance system can achieve the expected wear time of three to five days. The consistency of the stoma output is a primary determinant, as liquid stool can prematurely dissolve the hydrocolloid adhesive barrier from the inside. Although colostomy output is generally thicker, periods of diarrhea or loose stool significantly shorten the time an appliance lasts.
The physical contours of the abdomen also play a role in maintaining a secure seal. Body folds, creases, or scar tissue around the stoma can prevent the adhesive from lying flat, creating channels for output to seep under the barrier. In these cases, specialized products like barrier rings or convex barriers may be necessary to conform to the body’s shape and maintain an effective seal.
External environmental factors and personal activity levels can also reduce wear time. Excessive perspiration from intense physical activity, hot weather, or high humidity weakens the adhesive bond on the skin’s surface. Finding a personalized schedule that accounts for these variables, sometimes resulting in a change every two to three days, is more beneficial than attempting to force a longer wear time with a compromised seal.
Protecting Peristomal Skin Health
The skin immediately surrounding the stoma, known as peristomal skin, should appear healthy and intact. Since digestive enzymes in stoma output are highly irritating, any contact with the skin can quickly lead to painful skin breakdown. Adhering to a scheduled appliance change is the most effective preventative measure against this irritation.
Signs of compromised skin health include redness that does not disappear shortly after barrier removal, itching, or weeping or broken areas. A properly sized appliance is required to protect the skin, ensuring the opening in the skin barrier fits closely around the stoma, leaving only a one to two millimeter gap. If leakage occurs, the appliance must be removed and replaced immediately to clean the skin and prevent further damage.