A colostomy appliance, often called a colostomy bag, is a system designed to collect waste from a surgically created opening in the abdomen called a stoma. This medical device manages the body’s output when the lower colon or rectum cannot function normally to pass stool. Learning to manage the appliance is a process that becomes routine with practice, which is fundamental to maintaining skin health and integrating the colostomy into daily life.
Understanding Colostomy Appliance Systems
The colostomy appliance is composed of two primary parts: the skin barrier and the pouch. The skin barrier, also known as a wafer or flange, is an adhesive component that attaches directly to the skin surrounding the stoma (peristomal skin). This barrier protects the skin from the stoma’s output and provides a secure base for the collection pouch, which collects the stool and gas.
Systems are generally categorized into one-piece or two-piece designs. A one-piece system is an integrated unit where the pouch and the skin barrier are permanently combined. These systems are often favored for their low profile, flexibility, and simplicity, as they are applied and removed as a single unit.
A two-piece system features a separate skin barrier and a detachable pouch that connects using a coupling ring or adhesive flange. This design allows the user to change the collection pouch without removing the skin barrier entirely. This option can be particularly beneficial for individuals who change their pouch frequently or have sensitive skin, as the barrier can remain in place for several days.
Step-by-Step Guide to Changing the Pouch and Wafer
Preparation and Removal
Changing the appliance requires preparation to ensure a secure seal and healthy peristomal skin. Select a time when the stoma is less active, such as before eating in the morning or two hours after a meal. Gather all necessary supplies, including the new pouch and barrier, a stoma measuring guide, scissors, cleansing materials, and skin protective products.
To remove the existing system, gently peel the barrier away from the skin, starting from the top edge. Use the “push-pull” technique: gently push the skin away from the barrier while simultaneously pulling the barrier back. An adhesive remover wipe can be used to dissolve the adhesive and minimize skin stripping. Dispose of the used appliance in a small plastic bag before cleaning the stoma area.
Cleaning and Sizing
Clean the peristomal skin with warm water, avoiding harsh or heavily fragranced soaps that can leave a residue and interfere with the new adhesive. Gently pat the skin completely dry with a soft cloth, as a moist surface prevents the new barrier from sticking properly. If the skin is irritated, lightly dust a skin barrier powder onto the affected area to absorb moisture before applying a protective wipe to seal the powder.
Measuring the stoma is fundamental to ensuring a precise fit for the new barrier opening. The stoma’s size and shape can change significantly in the weeks following surgery, so frequent measurement is necessary at first. Use a measuring guide to find the size that fits snugly around the stoma, leaving only one to three millimeters of skin visible around the base. An improperly sized opening is the most common cause of skin problems, as it allows output to contact the skin.
Application
Trace the correct size onto the back of the new skin barrier and use curved scissors to cut the opening, ensuring the edges are smooth. If using a paste or barrier ring, apply it around the inner edge of the opening to create a convex surface for a better seal.
Remove the protective backing from the new barrier and center the opening over the stoma, pressing firmly onto the peristomal skin. Hold the barrier in place with gentle pressure for a few minutes; warmth from the hand helps to activate the adhesive and secure the seal. If using a two-piece system, snap or lock the collection pouch onto the newly applied barrier.
Routine Pouch Emptying and Hygiene
Daily maintenance focuses on routine emptying and cleaning of the pouch while the appliance remains secured to the skin. The pouch should be emptied before it becomes too full, typically when it reaches one-third to one-half capacity. Overfilling creates unnecessary weight, which can pull at the skin barrier and compromise the seal, potentially leading to leakage.
To empty the pouch, position yourself near the toilet, either sitting on the toilet seat or standing close to the bowl. Place some toilet paper in the bowl beforehand to help prevent splashing. Unclip or open the tail, which is the drainable end of the pouch, and unroll it to allow the contents to drain.
Once the pouch is empty, clean the inside and outside of the tail with toilet paper or specialized wipes. Some users choose to rinse the inside of the pouch with water from a peri bottle to ensure all residue is removed, though this is optional. Note that excessive rinsing may weaken the seal around the stoma and potentially shorten the wear time of the appliance.
The tail is then securely rolled up and clipped or sealed shut, depending on the closure mechanism. Ensuring the tail is clean and properly sealed is important for preventing odor, though many pouches have built-in odor barrier technology. Maintaining a regular emptying schedule also helps prevent the pouch from ballooning with gas or straining the adhesive seal.
Preventing Skin Issues and Managing Daily Life
Maintaining healthy peristomal skin is fundamental to the long-term success of wearing a colostomy appliance. The skin around the stoma is vulnerable to irritation and breakdown if it contacts the output. The most frequent cause of irritation is leakage, which often occurs because the barrier opening is incorrectly sized, allowing digestive enzymes to irritate the exposed skin.
If redness, itching, or soreness develops, the seal may be compromised, and the appliance should be changed promptly to assess the skin. Consistent monitoring and a secure fit are the main defenses against these complications. A well-fitting appliance ensures that output is directed into the pouch without contacting the skin, which helps maintain the skin’s slightly acidic pH balance.
Odor management is primarily addressed by using a modern, odor-proof collection pouch and ensuring the pouch is properly sealed after emptying. Pouch deodorants or drops can be placed directly into the appliance to neutralize odors when the pouch is opened for drainage. Dietary choices can also influence the odor and consistency of the stoma output, with some foods known to produce stronger odors.
Integrating the appliance into daily life is straightforward. The appliance is water-resistant, meaning showering, bathing, and swimming are safe activities with the pouch in place. Clothing choices are rarely restricted, as the appliance lies relatively flat against the body, and many people find that regular clothing is sufficient to keep it discreet. Physical activity, including light exercise, is possible, but ensure the appliance is securely fastened and consider using a more flexible or smaller pouch for these activities.