Pouch Selection and Fitting ... Truth or Consequences
Issue Seven


"Pouch size and capacity for any of the ostomy services should be tailored to the personal body size, drainage output and desired frequency of pouch changes."

Ostomy surgery involves a major change in 'body' life style as well as personal and emotional adjustment. Fortunately, this type of surgery can also represents a tremendous blessing in easing painful discomfort and offering renewed control of body functions when major organ failure occurs. This second beginning establishes a new approach at regaining control of bodily functions in a manner best suited to the new ostomates 'personal' needs. However, it is important to note that this new lifestyle can only be realized through proper pouch selection and fitting.

Pouch Selection

The type of ostomy you have certainly dictates the style of pouch you need. Urinary diversions require urinary pouches with appropriate drain valves and connectors. Urinary pouches are often constructed with flutter valves which prevent pouch fluids from returning to the stoma's opening site. This pouch design may be helpful to some ostomates whose skin is particularly sensitive to urine. Also, flutter values may offer advantages to individuals who have a problem with appliance adherence. Without a flutter valve incorporated inside the pouch, fluid back pressure can be accentuated. This in turn undermines the adhesive seal which could already be weakened by oily skin or poor stoma location. Moreover, flutter valve pouches can hinder pouch hygiene and prevent the vinegar and water cleaning solution to reach the targeted area (stoma area) for treatment. Also, it is important that the pouch adherence seal be able to withstand urine and not be allowed to dissolve or weaken when moisture is introduced. Nighttime drainage collection support is another consideration.

For fecal ostomies the pouches should provide suitable odor control. This means materials like saran or the construction of a double-wall pouch be incorporated into the design. The drainage outlet should be wide enough to easily accommodate semi-solid or solid effluent. A secure and positive seal is essential along with a comfortable adherence to your body. A waist belt for additional pouch support may be needed. Flatus in fecal ostomies may call for a gas relief valve in the pouch.

For colostomies the possibility of irrigation may influence the type of pouch to be selected. Irrigation requires time and equipment. Many colostomies do not use the irrigation method and simply rely on a pouch to collect the stool as the bowel dictates. In this situation the pouch requirements are similar to an ileostomy.

Basic considerations for all pouch selection

Pouch size and capacity for any ostomy should be tailored to the individuals body size, drainage output and frequency of pouch changes. There may be a preference as to opaque or clear pouch construction. However, simplicity and ease of handling are the basic considerations for any pouch and/or accessories, particularly when the user has dexterity or visual problems.

Availability and Cost

A dependable source for pouches and accessories is fundamental, of course. The support you get on individual equipment needs from the manufacturer and/or dealers, as well as regular educational and development updates are important considerations. The costs of pouches and replacement parts are a concern to every ostomate. They are part of your regular cost of living. Therefore, company programs aimed at extending product life and efficiency are especially meaningful. Quality and reuseability of Nu-Hope's semi-disposable pouches have helped many individuals on fixed income and others facing financial stress.

Proper Fitting

Measurement of the stoma is most important in obtaining good skin protection and a proper pouch fit. Protruding stomas require a slightly larger opening (1/8" to 1/4") in face plates made of rubber, plastic or metal. This slight increase in measurement can prevent stoma damage when there is stomal movement (peristaltic action). The gap between stoma and face plate opening can be filled with a skin barrier for ileostomy care. No barrier is needed for a urinary diversion. Flush stomas can be measured from skin line to skin line for face plate openings. This precise fit will not harm the stoma since its movement does not go beyond the skin level. Always remember that your stoma size is not absolute, fixed or permanent and should be checked periodically. The Nu-Hope's Measuring Guide provides easy and accurate sizing.

Body contour around the stoma is critical toward a properly fitted pouch. It is rare to find the mounting surface of a pouch completely flat. Most abdomens are round in contour. Concave face plates or base plates can resolve this situation. Stomas that are situated in a recessed area, regardless of whether they are flush or protruding, should incorporate a convex style support plate to maintain and secure a properly mounted seal. Many pouch mounting systems have failed due to contour oversight. The consequence is frequent leakage.

Nu-Hopes semi-rigid pouch face plates (or base plates) are adaptable to body crease lines, concave and/or convex profiles, and do not spring back to the original position once they have been contoured in place.

Application Technique

Always follow manufacturers instructions for proper application as well as instructions from qualified ostomy consultants for correct use and handling of equipment. As always, this method normally follows a simple but basic practice. Proper use of skin care materials is critical to these particular application techniques; and, routine equipment hygiene is a must.

Finally, recheck your pouch and accessories program at regular intervals. Stoma size, body contour and personal activities change throughout your life. Be prepared to alter your equipment to meet these changes. If you maintain true to your needs, you won't have to pay the consequences later!