Chapter 07: About the Pouches
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When you mention the word "Colostomy" to someone the first thing that immediately comes to mind is bags. As I've already mentioned there are dozens, if not hundreds, of different appliances available to Colostomists now.
Although the first few bags you wear will be monsters as far as size goes you will soon be able to pick and choose to your own requirements, and there are numerous different sizes available for different occasions.
With continuing research todays pouches are close to miraculous compared to twenty five years ago. These days the bags are rustle free, can be opaque or clear, and most closed pouches are now fitted with integral filters which not only let out any passed wind but help retain any smell that may be around.
The adhesives used now are far more hypo-allergenic and skin friendly. As little as twenty five years ago most adhesives were made from rubber, a product that was about as hypo-allergenic as hot tar. Constant application and removal lead to skin ulcers and quite nasty rashes. When this occurred patients were admitted into hospital to have the area treated, this was necessary as no appliance was to be worn at the time for many days.
There are two main pouch systems available for you to try, and all bags revolve around this. One piece or two piece? That is the question.
A one piece bag has the adhesive built onto the back of the product. To use you simply cut the base to size and stick around the Stoma. Once the bag is full you have to peel away the bag, clean around the stoma and apply a fresh appliance. Over the course of the day you could end up changing bags three times. There are two ways over this hassle.
Firstly you could try a drainable bag. This sticks on the same way but because you are able to unclip the end and drain the contents the bag itself can stay in place for up to five days, although most glues are tested to seven days. This sounds ideal but you will be unable to clean the Stoma until the bag is removed.
Secondly you could try a two piece system. In this case the adhesive on the bag is replaced by a plastic clip, this in turn clips onto a flange (a base plate). The flange sticks to the skin, again for up to five to seven days, and used appliances simply clip on and off.
Because the bag is no longer stuck to the skin, the chances of rashes and sores from constant removal of bags is reduced to one removal every few days. The other main advantage of this over the drainable one piece bag is that you have access to the Stoma to clean it regularly, and being able to give it a wipe at every change of appliance cuts down on the amount of cleaning necessary when you do eventually remove the flange. Think of it as a saucepan after you've heated up a tin of baked beans. If you wash the pan straight away it is easy to clean, if you leave it on the draining board for days on end the task becomes much more labourous!
As your stoma starts to shrink after the operation, you'll be cutting less and less out of the bases. After about six months your Stoma will be at it's constant size and shape. Once this happens you'll be able to send a template of your stoma size to your bag supplier and they will cut all the flanges for you (this applies to flanges only, they will not do this for one piece systems).
Immediately after your operation your Stoma will be quite erratic. It can work a number of times each day at different times each day. In the early days it will be impossible for you to anticipate the time when the bowels will work. This is simply because the bowel has been handled and the routine upset. As the stoma heals you'll notice that it starts to work at a certain part of the day. This may take months, or a few weeks, it is up to your own system. Once the routine is back in place you'll be able to gain extra confidence by using various size bags during the day. In my case the Stoma starts to work usually just before I get up in the morning and are finished by ten o'clock. When I go to bed I put on a standard size bag and forget about it until lunchtime next day. By that time the bowels have emptied so there is no need for me to wear a huge monstrosity of a bag, I slip on a small sports pouch which are a third of the size. I find it gives me more confidence to go out as they are so small you might as well not be wearing one, however there is room in it should there be any last dribbles during the day. As time goes by you'll develop your own routines.
The various types of bags are illustrated over the page to give you an idea what is available. Most companies products are similar to each other although there can be big differences in the sizes of some bags.
Unfortunately you cannot mix and match bags and flanges from different companies. They all have different fittings and only their bags will fit. That is a bit of a shame really as you may like a certain flange but find the bags themselves to be no good for your needs. At the end of the day you'll find a brand to settle with and will probably use them all the time.
Just because you have a Colostomy though do not be lead to believe that you will always have to wear a bag. Even if you have had a permanent stoma you could well get away without using a bag.
There are two ways to do this. In either case discuss it thoroughly with your Stoma Nurse before you attempt it.
Firstly, you could irrigate. This is a lengthy process that can take up to and hour every two to three days. Basically it is like a self administered enema that flushes the bowel totally clean. Once this is done you need only cap the stoma off to prevent any damage and forget about it for the next few days. This can be useful if you are travelling long distances or going away for the weekend and don't want to be bothered with the routine of appliance changing and stoma cleaning in unfamiliar circumstances. The Stoma Nurse will probably ask you to check with your surgeon before starting this, to be sure that your condition does not prohibit this.
Secondly, a company called Coloplast have developed a stoma plug. This is very similar to a tampon when in use and looks like one only smaller and with a plastic cap at the base. It is a very simple idea really. After the bowel has worked it's main motion of the day you remove the bag and insert a plug into the stoma. This will then expand to block the stoma and prevent any further stool from being passed. This plug can be worn for up to eight hours and is ideal for people who wish to go to work or school and not have to worry about having to change their bag during the day.
It is a two piece system, once the base flange is applied the plug is carefully slid into the stoma and clipped into place on the flange. Once inserted the plug may at some point feel like it is dropping out but it isn't. A word of warning though, once the plug is inserted and clipped into place do not try to prise the cap off to see if the plug has expanded, this will dislodge the plug and it will not block as successfully.
The plugs are available in two different lengths. 35mm and 45mm. The size that is best for you is determined by your height and weight, your Stoma Nurse will have the chart and a demonstration kit to explain how everything works.
As with Irrigation it is necessary to check with your Surgeon that you can use this system before you try it. If you suffered from an inflammatory bowel condition then this system is not recommended.
With the developments that have been made towards colostomy appliances no one will be aware that you are wearing one. All todays equipment is very discreet. If you are worried about the bag security then you will be able to order either a belt, corset or pantie-girdle which you wear over your pouch so that in the highly unlikely event the bag does lose it's grip on your skin it will not fall onto the floor in sight of everyone. These are available on prescription too and your Stoma Nurse will gladly give you the details. Wearing one of these items will give you that little extra bit of self-confidence.