Which Appliance is Best? Part 1

There are many ostomy companies and a multitude of different ostomy supplies and accessories on the market.  Every year an overwhelming number of new products are on offer.  Both my patients and my nurse colleagues ask me regularly: “Isabelle, which appliance is the best one?  Which is the Cadillac of bags?”  My response often surprises them.  “They’re all good...but…wait!  They’re not all suited to everyone.”  And why is that?  Because each person is unique and that goes for their ostomy appliance as well.  What works for one person isn’t necessarily appropriate for another.

A large part of my work consists of evaluating which kind of appliance is best adapted for each of my patients.  Of course, I don’t decide for my patient.  I’m more like a facilitator where my recommendations but also the patient’s preferences, realities and needs come into play.

Here are the different elements we need to take into consideration in order to choose the right ostomy appliance.

Type of Stoma

Is it a colostomy, an ileostomy or a urostomy?  Is the output paste-like, liquid or formed?  Different adhesives from different companies are more or less resistant to liquid stool or urine.

Position of Stoma

Does the stoma protrude from the skin or at skin level?    When the stoma sticks out (by 1 or 2cm). the stool or urine flows directly into the bag but if the stoma is near the skin’s surface, waste has a tendency to leak under the protective barrier or the flange.

Shape and Size of Stoma

Is the stoma round, oval or irregularly shaped?  It is important to cut the correct opening in the flange.  The stoma must be measured at its base – the place where it meets the skin’s surface.  A space of 1-3mm extra must be allowed to create an adequate opening in the flange.

The Shape of the Abdomen

The location of the stoma on the abdomen as well as the shape of the abdomen surrounding the stoma must all be taken into account.  Is there a dip around the stoma or is it in a skin fold?  Or, on the contrary, is there a lump all around the stoma or is it on a bulge of skin?  Those notorious ‘love handles’ can be tricky often causing problems, and honestly, everybody has them!  A flaccid or soft abdomen also create a certain instability around the stoma and complicate things; sometimes this is due to weight loss related to illness or surgery. The shape of the flange and its rigidity or flexibility must be well adapted to the shape of the abdomen.

The Condition of the Skin around the Stoma

Regardless of the brand or the company if the patient’s skin is irritated, broken, red or weeping there will be problems with the appliance adhering.  The cause of redness or irritation must be treated at the source.  I invite you to read my article on peristomal skin.  One thing people don’t always think about that have an impact on their appliance are stoma and abdomen positions.  Take the time to check your stoma in different positions using a mirror.  Try standing, sitting and lying down you might be surprised. Sometimes different movements and positions can change the stoma: it can retract or protrude and skin folds can suddenly appear where before there were none.

I know, I know, I still haven’t answered the question: which appliance is the best?  So, wait, I’ll let you check out your stoma and your belly first – you might never look at them the same way again.  And, continued in my next article, the answer to the real question: which appliance is best for you?

Clinical Nurse and stomatherapist

Translated from French by Jane Loignon

Brought to you by: ANA