Editor's note: These tips were offered during discussion at our March 18, 1996 chapter meeting. They are simply opinions of the people who suggested them, and should not be regarded as professional medical advice. Always consult with your doctor or ET nurse before changing your treatment.
When considering cost of appliances, be sure to account for wear-time. A $10 bag that stays on for 7 days ($1.43/day) is cheaper than a $3 version that lasts only 2 days ($1.50/day). The longer-wearing appliance has an even greater advantage when considering the cost of items used once during each appliance change (paste, removers, etc.).
Longer-wearing appliances have a cost advantage. But even if your appliance maintains its seal for a long time, be careful to change it often enough to avoid developing skin problems under the adhesive.
One or two piece? Some ostomates prefer one-piece appliances because they are less bulky (more comfortable and less hardware to show under clothing) and avoid the possibility of separation that can occur with a two-piece. Others prefer two-piece appliances so they can easily change to pouches of different size (e.g., small ones during intimate moments), or 'burp' the pouch when gas builds up. If you have an ileostomy or urostomy, or you have a colostomy and don't irrigate, your choice of one- or two-piece is purely personal preference.
Among colostomates who irrigate, those who have a strong preference for one-piece pouches can use them (and some do), although it can be quite expensive, and you have to enjoy changing your pouch because you may need to do it several times a day.
Colostomates who irrigate usually find it more economical to use two-piece appliances, so it's easy to change between different pouches (irrigation sleeves, stoma caps, and regular drainable or closed pouches) without discarding the appliances. In these cases, some people can wear a wafer for two weeks, and obtain several months' wear from each pouch by rotating several of them and cleaning the pouches between use. (Soaking in Polident® is a good cleaning method.)
Colostomates should remember that, even if some hospital personnel seem to think that all colostomates who can irrigate should irrigate, irrigation is strictly optional. It is perfectly acceptable to wear a pouch all the time (like an ileostomate) to collect the output whenever it comes. Those who choose to irrigate do so in order to better control the times of bowel movements to fit with their lifestyles, allowing them to wear a smaller appliance (e.g., stoma cap) at other times.
You'll probably have the best chance of irrigating successfully if you were very regular (bowel movements the same time every day) before colostomy surgery. If bowel movements were unpredictable before surgery, they'll probably still be unpredictable after surgery.
Although hospital workers sometimes say you can irrigate in half an hour, expect the full process to take at least 45 minutes. It may, however, be possible to perform other activities (brushing teeth, shaving, etc.) during part of the process--while wearing the irrigation sleeve and waiting for material to return.
The right amount of water for irrigating a colostomy in an adult is
Use of an ostomy belt is another personal preference item. Some ostomates feel greater security by wearing a belt during some activities. There is even a pouching system (VPI) that relies entirely on a belt and uses no adhesives; this may be a good choice for ostomates who get irritated skin using other, standard adhesive systems. (Several of our members have been intrigued by this system, although none have actually tried it.)
Use of some ostomy belts may not be appropriate during strenuous activities such as running. Here, the bouncing of each step may cause extra motion through the belt, leading to possible pain, and perhaps loss of adhesion, or actual injury to the stoma. For these activities, you may simply have to find an adhesive pouching system that holds adequately without a belt.
Ostomates with a large abdomen that makes it difficult to see the stoma can set up mirrors so they can see what they are doing while changing the appliance.