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How Can I Get the Best of Stoma Collars

How Can I Get the Best of Stoma Collars?

Stoma collars are items some ostomates use to avoid stoma leakage. Patients must place it between their skin and the stoma, forming a collar around it.

The main function of a stoma collar is to provide a barrier that prevents stoma output from coming out and touching the surrounding skin, to avoid irritation and peristomal skin problems.

“Peristomal skin problems are common affecting up to 73% of ostomates. Peristomal irritant dermatitis is the most frequent skin complication and can be both a cause and a consequence of poor adhesion of stoma appliances associated with leakage of stoma contents. Leakage of stoma contents is common affecting up to 62% of ostomates and can be associated with considerable social, psychological and physical morbidity.

Irregularities of the skin surface contours surrounding stoma sites are one cause of poor appliance adhesion and leaks. Such irregularities can arise through remodeling of the skin, pressure from stoma devices, change in body habitus or adjacent scar tissue. Changes to skin surface contours can arise early after stoma formation or as a late complication many years after formation. Regular review of stoma appliances, dressings or use of filler pastes can be used to compensate for alterations in skin surface contours, but are not successful in all cases.”1

The following are some recommendations to get the best of stoma collars.

Consider the Stoma Type, Size and Appearance

“A healthy stoma is red or pink in appearance and usually round or oval in shape. An ideal colostomy should be minimally raised above the level of the abdominal skin and is often 30–35 mm in diameter and is generally formed in the left iliac fossa. An ileostomy and a urostomy look similar (except for the output) they should ideally have a small spout of about 25 mm and be about 28–30 mm in diameter and they are formed in the right iliac fossa most commonly. A colostomy or an ileostomy can be temporary or permanent, depending on the type of operation performed and the indication for the operation, whereas a urostomy is permanent. A colostomy or ileostomy will be either an end or a loop stoma, again depending on the operation. A urostomy is always an end stoma.”2

Therefore, consider the patient’s stoma size when selecting the stoma collar; otherwise, it will leak and the fluids will accumulate below the wafer. If they are detached, an efflux will be inevitable. If they are pressed against the stoma, there will be a blockage.

“Selecting a plate with too small size in relation to the size of the ostomy causes the necessity to cut too large an outlet in relation to its size. Then, the margin between the outlet in the plate and the plastic ring for attaching the pouch is too small. This makes it difficult to adhere to the plate to the skin directly around the ostomy, i.e. where it is the most important. Correspondingly, the adhesive of the one-part pouch in which the outlet is too large, i.e. outside the margin marked on the protective paper, will not hold the skin as long and well as it should. Improper choice of the equipment’s size in proportion to the size of the ostomy can thus lead to a decreased connection to the skin and reduced time of adhering to the stomach and can cause one of the most frequent complications, i.e. skin inflammation around the ostomy. Improper matching of the size of the equipment to the size of the fistula can be equally unfavorable as its improper cutting.”3

Stoma Collars Are Not Suitable for Everyone

For some patients, stoma collars are useless. Patients with considerably thick stool, for instance, do not get any benefits from using them due to the nature of the device and how it is attached.

Stoma collars can stay directly in contact with the patient skin before placing the wafer, or they can remain above the wafer. Both of these techniques will serve. Stoma collars come out easily when discarding the wafer.

Select A Suitable Wafer

“The wafer or skin barrier of a pouch is composed of adhesives, softeners, and hydrocolloid. Adhesives aid adherence of the barrier to the skin, softeners arc oils that soften the skin barrier and allow it to mold or flow into normal abdominal surface irregularities, and hydrocolloids absorb moisture released from the skin and stoma while maintaining peristomal skin adherence. As hydrocolloids absorb moisture, they swell and eventually break apart, signaling they need for pouch change. Skin barriers vary in moisture-absorbing capacity depending on whether they are regular wear or extended wear skin barriers. Extended wear skin barriers absorb moisture more slowly and provide greater adhesion. Regular wear skin barriers should be warned with the hand and pressed onto the skin after application, whereas extended wear skin barriers only require pressure to enhance the skin barrier seal. Wafer composition varies from company to company. It may be possible to get longer wear time by changing to a different company.

Types of Wafers

Wafers are available in different shapes and sizes. They are also available with or without apertures, or openings. The cut-to-fit skin barriers are generally used postoperatively to accommodate a wide variety of stoma shapes and sizes. They also offer flexibility, as the stoma will decrease in size during the first 6 to 8 weeks after surgery. Once a stoma has stopped changing size, a wafer that is pre-cut by the manufacturer is quicker and more convenient to use. Wafers that have no starter opening can be cut anywhere inside the diagram on the back of the wafer, allowing shifting of the wafer in different directions. This is particularly helpful when there is an end stoma with mucous fistula in close proximity and there is a need to cut two separate openings within one wafer. They are also helpful in close proximity and there is a need to cut two separate openings with one wafer. They are also helpful when trying to avoid gastrostomy tubes, other drains, or other abdominal problems.”4

Using Stoma Collars in Herniated Stomas

“The opposite of a retracted stoma, a herniated stoma protrudes further than average. The protrusion can cause your stool to collect and ‘pancake’ at the top of your ostomy bag, and leak into the flange. To better manage a herniated stoma, use a stoma collar or hat. Stoma collars consist of a flexible adhesive channel that sits over your stoma and acts as a funnel to keep waste away from the flange.

Pros:

  • The collars keep stool away from your flange, helping to prevent leaks.
  • Collars can be used to prevent leaks even if you don’t have a herniated stoma.

Cons:

  • Although the collars are available in several sizes, they are not adjustable; you need to ensure you have the correct size for both comfort (not too tight), and efficiency (not too loose).”5

Importance of Stoma Collars

A stoma collar can help shape the stoma, allowing it to aim directly into the bag to avoid leakage. Actually, according to a pilot study, the most important research priority from the perspective of ostomates was pouch leak problems and stoma bag/appliance problems. “Pouch leakage can cause discomfort and distress and the fear of this happening can profoundly affect daily life, activities, and social life. Modern stoma appliances have improved flatus filters and there are a variety of stoma accessories now available on prescription to secure the appliance and reduce risk of leaks.”6

Other studies also reflect that leakage is an issue for urostomates. “Patients who have a urostomy may experience difficulties in coping with their stoma as a result of urine leakage that causes skin irritation or breakdown”.7

Ask Your Ostomy Nurse the Correct Usage of Collars and Other Accessories

“There is a multitude of stoma accessories that are used in conjunction with stoma appliances. These are available on prescription. Accessories can be used to prevent leaks, to remove adhesive and to protect the peristomal skin. The nurse needs to carefully assess the situation to ascertain whether accessories are necessary and if so, that accessories are used correctly. While it is important not to waste products, as they are expensive, it is also necessary to provide the ostomate with a secure appliance that does not leak. Following a careful assessment by the community nurse, it still might be necessary to refer to the stoma specialist or stoma care nurse (available in the local district hospital), but it is possible to resolve some situations in the community setting. Often the community nurse can guide the ostomate on the correct usage of stoma products and educate them as necessary.”8

The top commercial brand comes from Salts Healthcare, with a product called DERMACOL. Stoma collars, as they are usually made of soft and flexible material like polyurethane, allow the patient to be comfortable during movement while maintaining a normal routine, which, along with other factors, might help the patient adapt to the stoma and improve his/her quality of life.

References:

(1) Weidmann, A. K., Al-Niaimi, F., & Lyon, C. C. (2014). Correction of skin contour defects in leaking stomas by filler injection: a novel approach for a difficult clinical problem. Dermatology and therapy, 4(2), 271-279.  Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257946/

(2, 8) Burch, J. (2011). Resuming a normal life: holistic care of the person with an ostomy. British journal of community nursing, 16(8), 366-373.  Available online at https://pdfs.semanticscholar.org/20fe/fe3fae8a1edf50a6defe7b668b09e4aa556b.pdf

(3) Muzyczka, K., Kachaniuk, H., Szadowska-Szlachetka, Z., Charzyńska-Gula, M., Kocka, K., Bartoszek, A., & Celej-Szuster, J. (2013). Selected problems associated with the treatment and care for patients with colostomy–part 2. Contemporary Oncology, 17(3), 246. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934070/

(4) Browne, N. T., Flanigan, L. M., McComiskey, C. A., & Pieper, P. (2008). Nursing care of the pediatric surgical patient. Jones & Bartlett Publishers. Available online at https://books.google.com/books?hl=es&lr=&id=wRqGwrdmxCcC&oi=fnd&pg=PR3&dq=Nursing+Care+of+the+Pediatric+Surgical+Patient+Nancy+Tkacz+Browne&ots=eE1jI7BcJQ&sig=QGCH0TUyXMLvSxlDpaMjCi2wZXQ

(5) Cross, A.W. (2016). My Other Bag Is a Prada: Quick and Dirty Tips for Surviving an Ileostomy. Glory Box Press. Available online at  https://books.google.co.ve/books?id=xUlLDwAAQBAJ&pg=PT27&dq=stoma+collars&hl=es-419&sa=X&ved=0ahUKEwiK54Xk8pviAhXLnOAKHR6dDikQ6AEIJjAA#v=onepage&q=stoma%20collars&f=false

(6) Hubbard, G., Taylor, C., Beeken, B., Campbell, A., Gracey, J., Grimmett, C., … & Gorely, T. (2017). Research priorities about stoma‐related quality of life from the perspective of people with a stoma: A pilot survey. Health Expectations, 20(6), 1421-1427. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689233/

(7) Marquis, P., Marrel, A., & Jambon, B. (2003). Quality of life in patients with stomas: the Montreux Study. Ostomy wound management, 49(2), 48-55. Available online at https://pdfs.semanticscholar.org/477b/109e963b306e2a530d9334e53bc582f8a120.pdf

María Laura Márquez
13 October, 2018

Written by

María Laura Márquez, general doctor graduated from The University of Oriente in 2018, Venezuela. My interests in the world of medicine and science, are focused on surgery and its breakthroughs. Nowadays I practice my profession...read more:

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