Ostomates can lead an active and productive life after surgery. However, this success primarily depends on how the patient manages the stoma and prepares psychologically. The use of accessory products along with the main system contributes to a more productive, stress-free and healthier life. Most of these accessories address issues related to stoma discharge and peristomal skincare, including odor, flatulence, leakage and intimacy issues.
“A secure seal of the ostomy barrier against the skin can be difficult to obtain, especially as the stoma and surrounding skin evolve as edema resolves during the immediate postoperative period; when the stoma is located in a challenging anatomical position; when the peristomal skin is uneven because of scars or skin folds; or when the peristomal skin is fragile owing to age or cutaneous conditions. In these cases, component products (currently classified as ostomy accessories) such as skin barrier rings or seals, stoma paste, or barrier strips can be used to fill in and eliminate gaps, thereby creating a secure seal between the ostomy barrier and the peristomal skin. Other components, such as adhesive removers/releasers, also may be used to support integrity of the barrier seal. Appropriate use of these components allows conventional ostomy barriers to better conform to challenging abdominal planes, thereby preventing leakage, protecting peristomal skin, and preventing the occurrence/recurrence of peristomal skin complications (PSCs).”1
Some of the common stoma accessories are discussed below.
Skincare ostomy products
The stoma affects surrounding tissue, so the goal of ostomy skincare products is to protect the peristomal skin from possible leakage and discharge. Creams and pastes are available for this purpose.
Since some patients have different reactions to such products, wound and ostomy care nurses recommend keeping the use of such creams and pastes to a minimum. To retain the ostomy adhesiveness, ostomates who sweat profusely can use the following products:
- Powders that form a barrier against perspiration. “You can dust the skin with an ostomy skin barrier powder to help absorb perspiration. Then dab skin sealant on top of the powder so the pouching system will stick to the skin. There are additional ostomy adhesives available in sprays, wipes, skin cement and tapes.”2
- Skin sealants. “Liquid skin protectants, or skin sealants, are formulated with a polymer and solvent. When the product is applied to the skin, the solvent evaporates, and the polymer dries to form a transparent, protective barrier. Select liquid protectants that may irritate denuded or compromised skin. The clinician should be aware that liquid skin protectants can be formulated with or without alcohol. Liquid skin protectants are manufactured in wipes, swabs, sprays, and foam applicators. Because of the variation in coding for liquid skin protectants, it’s the clinician’s responsibility to verify coding and payment of each product with the manufacturer.”3
- Adhesive sprays.
- Skin cements. “Applying either skin cement or spray adhesive to the artificial scab and pouch adhesive surface is often needed to enhance adherence. Skin barrier powders should not be confused with talc or cornstarch, which do not provide skin protection.”4
Using these products can prevent skin irritation; however, what can we do if the skin is already irritated? “Applying a pouch over very irritated skin can be challenging, especially if the skin is wet of weeping. Using stoma powder and an alcohol-free skin barrier in a process called crusting is often helpful. Only sting-free sealants should be used to prevent additional pain. Lightly dust the area around the stoma with stoma powder; brush off any excess.
Wafers can be reinforced with a skin barrier supplement to help with premature melting. Barrier rings and strips are an excellent option for filling crease of skin folds or incisions or adding an extra layer of protection around the stoma. They can be cut or rolled to fit any area. Stoma pastes, while an option, are often used incorrectly. They should only be applied around the aperture or on the wafer where it will fill a crease. Paste applied to the entire back of the wafer will cause it to fall off quickly and leave a great deal of residue on the skin. Another option for skin irritation from leakage is to change the pouching system to a more flexible one-piece style, or alternately to a less flexible two-piece appliance.”5
Other products include ostomy washers and barrier strips that offer further peristomal skin protection. “To treat the denuded skin, there are several choices. A no-sting liquid barrier/skin sealant can be applied, which provides a protective film and helps dry the area so that a pouch can adhere successfully. Skin sealant also reduces epidermal stripping and many people will incorporate this into their pouching routine. Sometimes, a light dusting of stoma powder can dry the skin enough to provide an adequate pouching surface. Many patients also report success with something as simple as a light coating of calamine lotion, another well-known drying agent. The most important course of action is to determine if the pouch in use is the best for that stoma and for that patient’s contours. Fix the cause and the problems will resolve.”6
Causes of Peristomal Skin Irritations
“Painful denuded areas of the skin develop, typically in the distribution in contact with adhesives. Patients need to be assessed for their proficiency in appliance removal, and underlying causes for frequent appliance changes should be investigated. Applying a skin sealant to the damaged area can assist healing and prevent further skin stripping. Pressure injuries occur from tightly fitting ostomy belts or use of convex flanges. Ulcers can form, at times full-thickness, at pressure points. Movement of such devices against the skin also causes shear injury. Topical wound care products can be used to treat the damaged peristomal skin. Ideally, the offending device (ostomy belt or convex flange) should be discontinued; however, the patient may require these devices to obtain an adequate seal.”7
Ostomy tape secures the area around the flange, offering adhesion and preventing leakage. Different types are available, including hypoallergenic options for those with sensitive skin.
This product helps if the tape removal is difficult or painful when changing the ostomy pouch or flange. They can be useful if an ostomy tape was used on a hairy area.
“Medical adhesive sprays/wipes and removers aid appliance adhesion and offer skin protection. Most patients find the impregnated adhesive/removal wipes easier to use, especially when away from home. Aerosol adhesives should be carefully applied to the bag flange/base, which will then be applied to the skin, and not be applied to the skin itself. This helps ensure the spray is only applied to the relevant area of the skin. However, some people have found these sprays inhibit adhesion when used with hydrocolloid flanges. Proprietary adhesive removers should be used where residue occurs, to minimize trauma to the skin.”8
Ostomy belts offer additional pressure to the flange, reducing the chances of leakage. This accessory is particularly useful in convex ostomy systems. Fixed and adjustable sizes are available to fit every patient’s needs, including children.
“Two types of belts are available: ostomy and abdominal support belts. Ostomy belts attach to or around the pouching system, creating pressure at the stoma base. Abdominal support belts are 3- to 9-in. wide and have an opening that surrounds the pouching system in the peristomal field.”9
Ostomy Closure Equipment
Drainable ostomy pouches need a closing mechanism, such as the pouch clamp. Clamps are available in various designs and different materials. Some are latex-free, for allergic patients.
Frequently, accessories with clamps are useful for colostomates and ileostomates. “The patient who must empty his pouch often (because of diarrhea or a new colostomy or ileostomy) may prefer a one-piece drainable, disposable pouch with a closure clamp attached to a skin barrier. This pouch may be used permanently or temporarily until stoma size stabilizes. Also, disposable and made of transparent or opaque odor-proof plastic, a one-piece disposable closed-end pouch may come with a carbon filter for gas release. A patient with a regular bowel elimination pattern may choose this style for additional security and confidence. A two-piece disposable drainable pouch with separate skin barrier permits frequent changes and also minimizes skin breakdown.”10
Ostomy-related wear gives the patient confidence to lead an active life without fear of accidental leakage, or people noticing the ostomy pouch bulging underneath the clothes. The range of ostomy clothing is wide, but a few examples are:
- Panties with an inner pocket to hold the pouch in place
- Wraps that hold the pouch close to the torso.
- Waterproof pouch pockets for showering.
- Swim wraps that enable a patient to swim confidently. “Firstly, you may be worried about the possibility of the bag or flange dropping off in the water. Be assured that most modern adhesives are designed to stay on in the water, in fact, the water strengthens the adhesives to make sure the bag is super secure during a swim or bathing. There are special swimming costumes available from several ostomy manufacturers. These come in a variety of styles, including two-piece costumes. Al these costumes are designed to both hide the bag and to ensure that it is safely held in place. Male swimmers may also prefer to wear a t-shirt/vest above their swimming trunks to hide a high stoma/bag / scars.”11
- Special briefs and boxers for men
- Cummerbund wear. These are useful during physical activities such as running and intimate moments. They prevent the pouch from moving from side to side and risking detachment. “Having an ostomy shouldn’t prevent you from exercising. The main precaution for a person with an ostomy is to avoid contact sports because a blow could result in injury to the stoma and because the pouching system could slip or become dislodged. Weight lifting can result in a hernia at the stoma. […] Swimming is not a problem as long as the ostomy is sealed.”12
- Hernia support belts, to reduce the incidence of stomal hernias. “Hernia support belts or binders will provide support around the stoma, reducing the protrusion of the hernia, and can help with appliance adherence. The belt or binder should be put on when the hernia is reduced or when the patient is supine. It is best to use a flexible appliance to fit the changing contour around the stoma. The stoma size should be evaluated when the patient is sitting and standing as it will usually become larger when the hernia protrudes. It is necessary to seek medical attention if the stoma color becomes darker or there is significant pain around the stoma with a change in stoma function.”13
Most ostomy accessories are made specifically to deal with stoma problems, as it is a structure that requires special attention and care. “With good care and maintenance, you can avoid many problems, but even with the best care, complications can arise.
Certain patients are more at risk for complications than others. Older patients, those who are malnourished, and those who have difficulty properly caring for the stoma are at increased risk. Patients with Crohn’s disease may run into trouble if they have inflammation at the stoma site.
Many of the complications that occur with ostomies need to be cared for by a doctor or an ostomy nurse. Let your provider know if you notice any changes in the stoma, bowel function or anything else that concerns you.”14
“There is no limit to clothing for an ostomate. However, the stoma location may make some clothes uncomfortable. It is better to avoid tight clothing, waistbands or belts that may press upon the stoma. It is better to experiment different styles of clothing and then choose the comfortable one.”15
While the number of products available to offer comfort and quality of life may confuse ostomates at first, it is paramount to inform patients about their alternatives. Certain continuous issues may solve if you find the right products for your case. Ask your ostomy nurse for advice and guidance.
(1) Neil, N., Inglese, G., Manson, A., & Townshend, A. (2016). A cost-utility model of care for peristomal skin complications. Journal of Wound, Ostomy, and Continence Nursing, 43(1), 62. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699471/
(2) Colwell, J. C., Goldberg, M. T., & Carmel, J. E. (2012). Fecal & Urinary Diversions-E-Book: Management Principles. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?id=sglasEE3eqEC&pg=PA481&dq=Skin+sealant&hl=es-419&sa=X&ved=0ahUKEwisg-Tv2KXiAhUiU98KHUc8AccQ6AEIODAC#v=onepage&q=Skin%20sealant&f=false
(3) Hess, C. T. (2008). Skin and Wound Care. Lippincott Williams & Wilkins. Available online at https://books.google.co.ve/books?id=VaJ84CryFmwC&pg=PA170&dq=Skin+sealant&hl=es-419&sa=X&ved=0ahUKEwisg-Tv2KXiAhUiU98KHUc8AccQ6AEIQTAD#v=onepage&q=Skin%20sealant&f=false
(4) Bryant, R., & Nix, D. (2015). Acute and chronic wounds: current management concepts. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?id=q58_CwAAQBAJ&pg=PA551&dq=Adhesive+sprays.+Skin+cements.&hl=es-419&sa=X&ved=0ahUKEwj5-ujYw6viAhVMq1kKHcK2A5kQ6AEINzAC#v=onepage&q=Adhesive%20sprays.%20Skin%20cements.&f=false
(5) 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.co.ve/books?id=K9V–QV-72oC&pg=PA142&dq=stoma+powder&hl=es-419&sa=X&ved=0ahUKEwjb0bnA2KXiAhVom-AKHVsWBUUQ6AEIJzAA#v=onepage&q=stoma%20powder&f=false
(6) Alvey, B., & Beck, D. E. (2008). Peristomal dermatology. Clinics in colon and rectal surgery, 21(01), 041-044. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780183/
(7) Kwiatt, M., & Kawata, M. (2013). Avoidance and management of stomal complications. Clinics in colon and rectal surgery, 26(02), 112-121. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709920/
(8) Breckman, B. (Ed.). (2005). Stoma care and rehabilitation. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?id=F7NE_iXpEvgC&pg=PA57&dq=adhesive+spray+ostomy&hl=es-419&sa=X&ved=0ahUKEwiGou7G36XiAhVpqlkKHew5BSoQ6AEINDAC#v=onepage&q=ostomy%20tape&f=false
(9) Gordon, P. H., & Nivatvongs, S. (2007). Principles and practice of surgery for the colon, rectum, and anus. CRC Press. Available online at https://books.google.co.ve/books?id=GEXMBQAAQBAJ&pg=PA1076&dq=ostomy+belts&hl=es-419&sa=X&ved=0ahUKEwjdt9LP-aXiAhVCrVkKHcJSDtcQ6AEILjAB#v=onepage&q=ostomy%20belts&f=false
(10) Lippincot Williams & Wilkins. (2009). Lippincott’s Nursing Procedures. Available online at https://books.google.co.ve/books?id=fhYoKc0bg-QC&pg=PA696&dq=comparing+ostomy+pouch+systems&hl=es-419&sa=X&ved=0ahUKEwih5celvqviAhULy1kKHXdmBm4Q6AEIJzAA#v=onepage&q=comparing%20ostomy%20pouch%20systems&f=false
(11) Prosser, E., Prosser, P. (2011). Unwanted Baggage: A comprehensive Introduction Surgical Ostomies. Available online at https://books.google.co.ve/books?id=BpbQADFcXogC&pg=PA144&dq=ostomy+clothing+sports&hl=es-419&sa=X&ved=0ahUKEwjHoLXHuqviAhWoq1kKHbhZDhkQ6AEIKjAA#v=onepage&q=ostomy%20clothing%20sports&f=false
(12) Silver, J. K. (2015, February). Cancer prehabilitation and its role in improving health outcomes and reducing health care costs. In Seminars in oncology nursing (Vol. 31, No. 1, pp. 13-30). WB Saunders. Available online at https://books.google.co.ve/books?id=PLKlCgAAQBAJ&pg=PT111&dq=Swim+wraps+Ostomy&hl=es-419&sa=X&ved=0ahUKEwimosjR2afiAhXHpFkKHdtoCNkQ6AEIPzAD#v=onepage&q=Swim%20wraps%20Ostomy&f=false
(13) Fischer, J. E., Bland, K. I., & Callery, M. P. (Eds.). (2006). Mastery of surgery. Lippincott Williams & Wilkins. Available online at https://books.google.co.ve/books?id=PgUFJg_-f4YC&pg=PA1460&dq=hernia+support+belt&hl=es-419&sa=X&ved=0ahUKEwi6pOq2jqjiAhXJmVkKHaI0Dy4Q6AEIPjAD#v=onepage&q=hernia%20support%20belt&f=false
(14) Ali, T., Rubin, D. (2013). Crohn’s and Colitis For Dummies. Available online at https://books.google.co.ve/books?id=5m0tDwAAQBAJ&pg=PA138&dq=ostomy+clothing&hl=es-419&sa=X&ved=0ahUKEwiC0uGeq6viAhWSjVkKHSqwAjAQ6AEIOzAC
(15) Balachandar, T. G. (2018). Stoma Care. Available online at https://books.google.co.ve/books?id=Tq52DwAAQBAJ&pg=PA110&dq=ostomy+clothing&hl=es-419&sa=X&ved=0ahUKEwiC0uGeq6viAhWSjVkKHSqwAjAQ6AEINDAB#v=onepage&q=ostomy%20clothing&f=false