A two-piece ostomy bag is one of the two main types of ostomy appliances a patient can choose from, the other being the one piece bag or pouch. The main difference between both options is the part that attaches to the peri-stomal skin. In the one piece bag, the adhesive base plate (also known as the skin barrier, flange, or wafer) is part of the bag and cannot be separated. In the two-piece, the bag is a detachable part independent of the wafer.
A patient using the two-piece system can remove and replace the bag without removing the wafer. The bag can be attached to the wafer by means of an adhesive surface or by a press-on-click mechanism. This type of ostomy appliance can be purchased as a kit or separately.
Advantages of a two-piece ostomy system:
- The ostomy bag can be removed without detaching the skin barrier reducing the incidence of skin irritation, inflammation and infection all of which are more common with one piece bags.
- The one piece system is discarded with every change of pouch, whereas the wafer in the two piece system can outstay more than one pouch change before disposal.
- The bag can be switched to suit different occasions. For example, a smaller pouch can be used during exercises or intimacy.
- The stoma is easily visible during flange placement.
- The bag can be rotated.
- The system can be used with single use pouch liners.
- The system is ideal for those with impaired dexterity and vision.
- The easier bag exchange facilitates travel, the use of public restrooms and a more active social life.
Disadvantages of a two piece ostomy system:
- The system is bulkier, more rigid and more visible under the clothes, a problem for patients looking for discretion or tighter fitting clothes.
- The bag and the wafer may be more prone to detachment and cause accidental leaks.
- The wafer needs to be kept clean between changes, sometimes a challenge for those with low dexterity.
- The system has a higher chance of stomal discharge accumulating behind the flange increasing the risk of irritations if not cleaned timely.
- The system is more expensive.
An appointment with an ostomy nurse before discharge from the hospital and follow-up reviews are important in selecting the best system. Patients will be advised to experiment with one and two piece bags as well as to try out the different features that each system offers. A good advice is to request samples as a way to determine what’s available without the need to embark on an unnecessary buying spree.