Ask the Ostomy Nurse

Linda Coulter has been a Certified Wound Ostomy & Continence Nurse for 10 years. In addition to working with hundreds of people with stomas, she has trained several WOC nursing students at the R.B. Turnbull Jr. School of WOC Nursing. Linda has presented nationally and internationally on ostomy related topics. From her home base at University Hospitals’ Ahuja Medical Center, Linda is active in raising Ostomy Awareness, and works to distribute ostomy supplies to people in need throughout the world.

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Open or Closed-End Pouch?

I recently had colostomy surgery and am doing pretty well managing everything. I use an open-ended pouch and empty three times a day usually. I’m starting to wonder about using a closed-end pouch. They seem easier to use. I’m only allowed two per day according to Medicare, so I’m not sure if that would be enough. Do I need to change my schedule of when to empty the pouch?

N.T.

Dear N.T.,

I’m glad to hear that you are managing well with your colostomy. You are correct that Medicare allows 60 pouches per month or the equivalent of about two closed pouches per day. You are also correct that many individuals with colostomies find closed-end pouches easier to use. After all, thick or formed stool can be quite difficult to empty from a drainable pouch, even if the pouch is coated with lubricating drops. Removing and replacing a closed-end pouch is quicker and easier.

  Regarding your emptying schedule, if you drain your pouch three times a day currently, consider how full it is each time you do so. If it is less than half full each time, then you may be able to get by with two pouches per day. However, if it is half full or more, you may need more pouches than Medicare will cover each month. If you’re unsure if you need two or three per day, contact your pouch manufacturer and request samples of closed pouches. Try using two pouches per day. Maybe you will find that two per day will be enough.

If you find you need three closed pouches per day, closed pouches might still be an option for you. One option is to pay your supplier out-of-pocket for the additional box of pouches that is not covered by your insurance. A more economical solution may be to buy the additional box through a different supplier who does not take Medicare assignment. Some of my patients who don’t have insurance have used Medical Monks or Parthenon because their prices are more affordable. Search online and you will find a large number of other medical suppliers. You might just find a great deal.

  If you have no more than two bowel movements a day or empty your pouch no more than twice a day, closed-end pouches might be a good solution for you. Closed pouches come in both one-piece and two-piece versions. Regardless of the type you choose, the pouch is replaced after each BM. Most insurance plans will allow 60 closed pouches per month, which is about two pouches per day. If you are interested in trying closed pouches, contact your current pouch manufacturer and ask for samples or visit your stoma nurse. She/he will likely have samples or can facilitate ordering the samples to figure out the best options for you.

Additionally, you should contact your supplier. You may learn, as one of my patients recently discovered, that your insurance allows you to order both 60 closed pouches and 10-20 drainable pouches each month. On the days you need more than 2 closed pouches, using a drainable pouch can get you through to the next day. Perhaps this is an option for you.
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