A colostomy is a surgical procedure that creates an opening, called a stoma, on the abdomen, connecting the colon to the outside of the body. This allows stool and gas to exit when the lower large intestine cannot function. An ostomy appliance, often called a colostomy bag, is a medical device worn over the stoma to securely collect this waste. Adapting involves learning specific techniques for wearing and caring for the appliance, which quickly becomes a manageable part of one’s routine. Proper methods ensure comfort, security, and a return to daily activities.
Selecting the Right Appliance System
A one-piece system combines the collection pouch and the adhesive skin barrier, or wafer, into a single integrated unit. This design is favored for its simplicity and lower profile, making it less noticeable beneath clothing. The entire unit is removed and replaced during a change, which can be easier for individuals with limited dexterity.
In contrast, a two-piece system features a separate skin barrier and a detachable pouch that connects via a mechanical coupling ring or an adhesive flange. This modular design allows the pouch to be changed frequently without disturbing the skin barrier, which can remain in place for several days. Two-piece systems offer greater versatility, letting users switch pouch sizes or types for different activities, though they can be slightly bulkier. The size and shape of the stoma must be measured accurately to ensure the skin barrier opening provides a snug fit and protects the surrounding area from output.
Step-by-Step Application and Securement
Applying the colostomy appliance correctly establishes a secure, leak-proof seal that protects the peristomal skin. After removing the old appliance and thoroughly cleaning the skin with water or a non-moisturizing cleanser, the area must be completely dry before proceeding. Moisture compromises the adhesive bond, which can lead to premature lifting and skin irritation from effluent exposure. The stoma should be measured with a sizing guide to confirm the correct diameter needed for the opening in the new skin barrier.
The barrier’s opening must be cut or selected to fit closely around the stoma, typically allowing only about one-eighth of an inch of space between the stoma and the adhesive material. To create a smooth surface over uneven skin contours, a barrier ring or paste may be applied directly around the stoma before the wafer. These accessory products help fill in folds and creases, creating a level foundation for the adhesive material.
Once prepared, the release paper is peeled from the adhesive wafer. The wafer is then carefully centered over the stoma, ensuring the opening aligns precisely with the base of the stoma. Gentle, sustained pressure should be applied to the entire surface of the wafer for about thirty to sixty seconds, using the warmth of the hand to activate the adhesive. This ensures the barrier adheres completely to the skin for a reliable wear time.
If using a two-piece system, the collection pouch is then snapped or locked onto the barrier flange, verifying that the connection is secure with a distinct click or firm press. A pouch belt can be used as an accessory to provide light, supplementary support. The belt should not be so tight that it places excessive pressure on the abdomen or interferes with the appliance seal. Securement is confirmed by a final check around the edges of the wafer for any wrinkles or areas that have not adhered fully to the skin.
Routine Emptying and Changing Procedures
Routine maintenance involves routinely emptying the pouch and completely changing the entire appliance system. The collection pouch should be drained when it is approximately one-third to half full to prevent distention or strain on the adhesive seal. Overfilling the pouch can lead to leaks due to the weight pulling the barrier away from the skin.
To empty a drainable pouch, the user typically sits on or facing the toilet and unrolls the tail end of the pouch over the bowl. The contents are allowed to drain, and the tail is then wiped clean with toilet paper before being securely re-rolled and clipped or sealed. This procedure is usually necessary one to three times daily for a colostomy, as the output is typically more formed compared to other ostomy types. Closed-end pouches, which are not drainable, are simply removed and discarded when full.
The entire pouching system, including the skin barrier, should be changed on a routine schedule, generally every three to five days, or immediately if any leaking, itching, or lifting of the barrier edge is noted. A predictable change schedule helps prevent peristomal skin irritation caused by prolonged exposure to effluent or frequent removal of the adhesive. During the full change, the old barrier is gently peeled off while pressing down on the adjacent skin to minimize trauma.
The exposed skin around the stoma must be cleaned with mild soap and water or plain water and then patted completely dry. Inspecting the peristomal skin for any redness, breakdown, or signs of irritation is an important step to ensure long-term skin health. Any irritated areas can be treated with specialized products like barrier powder before applying the new system, ensuring the skin is protected and ready for the next adhesive application.
Daily Life and Comfort Considerations
Wearing a colostomy appliance requires few changes to one’s wardrobe, as modern pouches are designed to be thin and discreet. The most practical consideration is avoiding clothing with tight, restrictive waistbands that press directly on the stoma or the appliance, which could cause discomfort or dislodge the seal. Loose-fitting tops, elastic waistbands, or high-waisted garments are comfortable and effective for concealing the pouch. Specialized ostomy support garments, belts, or wraps can also be used for extra security and to hold the pouch close to the body during physical activity.
Physical activity, including swimming, is possible with a securely applied appliance, as the adhesives are waterproof and resilient. Users should ensure the pouch is emptied before engaging in exercise and may use waterproof tape around the barrier edges for added peace of mind during water activities. Odor is managed effectively with internal pouch deodorants, drops, or sprays, and the multi-layered pouch material itself is designed to be odor-proof. For travel, carrying a small, pre-packed kit with extra supplies is advisable, especially on long trips, to manage unexpected changes or emergencies away from home.