Initially, you won’t have a choice regarding your pouching system. You will be placed in a cut-to-fit pouch, meaning that you will have to measure your stoma and cut an opening in the skin barrier to fit just right around your stoma. After the first 4 to 6 weeks following surgery, as your stoma shrinks to its final size, you may have the option of trying a pre-cut opening. This is a great time to experiment with various manufacturers and decide whether you prefer a one-piece or two-piece system. There is no one right answer for everyone, and the decision usually comes down to a combination of convenience and security.
Cut-to-fit or pre-cut or moldable or stretchable?
So many options! Once your stoma has shrunk to its final size, if it is lovely and round, a pre-cut wafer would be perfect, as long as you find one no more than 1/8 inch larger than your stoma. A pre-cut wafer is also a good choice if it is difficult for you to cut the opening yourself, for example, because of arthritis. If your stoma is more of an oval or irregular shape, you can make a pattern that you use to trace and cut your own openings. The pouch change in the bathroom is quicker if you just cut several in advance and have them ready. Finally, some of the ostomy appliance manufacturers have designed their own proprietary wafers that have openings that you shape with your fingers, eliminating the need for scissors to tailor the opening to fit just right.
Drainable or closed end?
Closed end pouches are meant to be disposed of rather than emptied. If you have a colostomy and your output is not frequent, this is a nice choice because it is less bulky. A closed end pouch is also good for intimacy. If you have an ileostomy or urostomy, you will need a drainable pouch.
Tail clip or integrated closure?
This is truly a matter of preference. Some people just feel more secure with the snap of a tail clip, although it is a bit more bulky.
Regular wear or extended wear barrier?
The regular wear barrier is suitable for colostomies. The extended wear barrier is designed to handle the output from an ileostomy or urostomy. Occasionally, a person may not be able to tolerate this extended wear formulation, and so they will choose the standard wear barrier but change it more frequently.
One-piece or two-piece?
The one-piece pouches generally have a lower profile, meaning they are a little less bulky under clothing and swimwear. These are also easiest for individuals who have difficulty with the manual dexterity needed to attach the pouch to the wafer. The two-piece pouches can be nice because you can discard the pouch (or rinse it for re-use) and apply a fresh one instead of just emptying it.
Adhesive coupling or plastic coupling?
Two-piece pouches have several different designs for attaching the pouch to the wafer or skin barrier. Plastic couplings have several designs, but they all provide the security of an audible snap that tells you that the pouch is properly placed. The adhesive coupling is a peel-and-stick design. The adhesive coupling has a lower profile and is more flexible than the plastic coupling. Two-piece systems can be difficult to handle if you have issues with dexterity; as a solution, some people attach the pouch to the wafer before applying the wafer around their stoma.
Filter or non-filter?
If you have an ileostomy or colostomy, you will pass gas through your stoma. The filter helps prevent this gas from filling the pouch which can increase the risk of a leak. The filter also keeps odor from being released as the air passes through it. If the pouch you like best is not available with a filter, you can add one yourself.
If you have a urostomy, you will need to attach to a separate bag at night to keep your pouch empty so it doesn’t start to leak. You will place an adapter either on the spout of your pouch, or on the tubing that is attached to the separate night drainage bag so that the two can be connected. After you disconnect in the morning, empty the urine from the night drainage bag into the toilet and rinse it out. Cap the end of the tubing. Each week the system should be cleaned in a 50/50 mixture of vinegar and water to keep it fresh and the whole system should be replaced monthly.