No. 6: Things I wish I knew back then…

Ostomy Appliances

When you first wake up from stomal surgery you will generally wake up to a clear bag with a swollen red bud (your stoma). If you're anything like me this vision scared and even disgusted me, the anxiety of having the bag was bad enough let alone one that hung what felt like half way down my thigh and was transparent for the world to see. Some ostomates have had a pre op appointment with the stoma nurse and are hopefully aware that there are many types and options available. With the array of appliance types out there how do you know which fits you best? This is something only you yourself can answer, as preferences vary widely from person to person and the purpose of this blog is not to guide you down one supplier or another, it's only to let you know there are many varieties available and do seek other options if you are not happy with your current appliance. Below are some of the key differences, some I had no clue about for years.

Transparent v. Opaque

For every transparent version, there would be an opaque substitution available. Please note that changing from transparent to opaque bags has its own issues as you can no longer see your stoma when putting the bag on, which can lead to putting the bag on off-center which in turn can lead to skin and/or stoma issues. This issue has been identified and many of the newer style ostomy bags have added peek holes for added convenience.

Convex v. Flat Base

Nearly every appliance option has flat and convex options, some suppliers have soft convex as well as deep and shallow options available. Convex bases can be a great option for problem stomas, please note that before changing from a flat to a convex base you should see your stomal therapy nurse. I use a convex base due to having a flush stoma, prior to using a convex base I had issues with leaks and continually burning and itching skin.

One Piece v. Two Piece

If a one piece appliance exists then there is generally a two piece alternative. It just comes down to preference. There are pros and cons to each and I know people who swear by both. I use a two piece version of any appliance I am trying, there are a few reasons for this but the main one is due to the ability to change the bag without changing the base plate, for me this reduces skin irritation from frequent changes and opens bag changing times up throughout the day as I have a high output stoma and changing the base plate anytime other than first thing in the morning has been known to cause some issues. The other bonus to this is that you can change the size of the bag to suit the occasion, see sizes below.

Click v. Adhesive (Two Piece Only)

Some appliances have a click and or an adhesive coupling between the base plate and bag. Again it comes down to preference, some believe that you can achieve a flatter profile with the adhesive option, I prefer the click option mainly due to the option to adjust the angle of my bag at any time without removing the bag from the base plate. Why would I do this you may ask, a variety of reasons, the angle of the bag may make the sealed opening visible under my clothes, it may be irritating my leg or I may want to use an accessory that requires your bag to be sideways. e.g. a Ruched 'Les' Belt from Ostomate Active or the Stealth Belt.

Drainable v. Closed

This really depends on the type of stoma you have, anyone with an ileostomy will have a drainable bag as the output can range from water to a toothpaste consistency that is fairly constant throughout the day. The many colostomates will use a closed bag as the output can be as regular as pre op only requiring to be changed once daily. However, the output can vary greatly depending on where along the large colon the stoma has been created and some colotomies require a drainable bag. Within the drainable range there is a range of openings and again each to their own. Some I find easy to empty and clean while others find the same appliance a nightmare.

Maxi v. Midi v. Mini

Many suppliers have the same product in a variety of sizes, from mini to maxi. Some appliances even now have the option to make your maxi bag into a midi and a midi into a mini with a simple Velcro dot, a huge added bonus. I'm slightly lazy and since having the option to adjust my bag size without changing the bag I love my maxi and use it 99% of the time. Some weeks, however, I use a different appliance due to skin irritations and then could use the mini for intimate moments. Another option that I have previously used for intimate moments was a stoma cap, available from some suppliers, and initially designed for colostomates. Note that if you do have a high output stoma, this will only work for a short period of time.

Pre Cut v. Cut to Fit

Initially, due to your stoma having the ability to change size quite dramatically during the first few months, everyone begins with a cut to fit. I didn't even know there was a pre cut option until years later. This is a huge convenience for those with a round stoma and something to investigate if you do have a one as saves time when changing appliances. Tip: I used nail manicure curved scissors to cut out my base plates for years, they are compact and great for travel packs. 

Skin v. Overall Appearance & Usability

Skin health is key to getting along with your stoma, nothing can ruin your day faster than getting a leak or put a stop to your fun quicker than the itching and burning sensation that can be a result of reactions to some adhesives or leaking around the stoma. Many of the options above can help in reducing the leaks but skin irritations can also be due to adhesive irritations and that comes down to what individual suppliers use in their products, everyone's skin is different and if you do get irritations do try other brands as there is an appliance out there for your skin type. Side note: as a woman hormone changes during monthly cycles can increase skin irritations. 

The decision that we all have to make as individuals is that all suppliers have their own styles, so the bag style, shape, and even materials along with the drainable outlets do change dramatically, so the compromise can be between your skin and the appearance, usability and even comfortability of your bag. Some say this is an easy question and yes your skin should come first but we shouldn't discount the other factors as they all play key parts in the whole process.