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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Recessed Stoma

I had colostomy surgery three weeks ago. It wasn’t planned. They were supposed to remove a tumor and reconnect my colon, but I got sepsis and then the ostomy. The problem is the skin around the stoma has shifted and is almost flush with the top of my stoma. It’s getting very hard to keep a pouch from leaking. What can I do?


Dear E.L.,

I’m sorry to hear that you’ve had such a difficult journey. Based on the information you’ve mentioned, specifically that your stoma is now flush with the skin, it sounds like you would benefit from a convex pouching system.

Convex pouching systems can provide a better match between the pouch and the contour of your abdomen around the stoma. By doing so, the pouch will fit better and should leak less. There are many types of convex pouching systems and it can be difficult and confusing to determine the one that will work best for you on your own. Ideally, you should visit your stoma nurse. They can assess your stoma and abdomen and recommend the best pouching system for you. They will also provide you with some products and help you order the correct items from your supplier. However, if you don’t have access to a stoma nurse, there are other ways to help you identify a pouching system that will work for you.

First, call the customer service phone number for the brand of pouch that you currently use. Tell them that you are interested in trying a convex pouching system. They will need to know the size of your stoma in order to provide you with the best product for you. Also, be sure to ask for a barrier ring and a belt. Often, a convex pouch with a barrier ring and a snug stoma belt will dramatically improve pouch fit, wear time, and reduce leaks.

For many years, each pouch manufacturer used a filter with a similar design: a carbon/charcoal filter, located at the top of the pouch, with a few tiny holes in the plastic of the pouch that allow gas to escape. Again, designs were similar, but exactly which filter they used and how it was attached varied by manufacturer. As stated above, with all of those pouches, people have told me either that the filters don’t work or that they don’t work after a day or so of wearing the pouch.

Things changed a few years ago. That’s when Coloplast introduced a new product to the market, called Sensura Mio. This product includes a lot of new features, including a reformulated skin barrier, a different pouch material, and a new filter. This filter looks and performs completely differently than other filters, including filters on other Coloplast products, namely Assura and Sensura. The Mio filter is circular and it includes a “pre-filter” with protects the filter from output, so it won’t get clogged, and the filter will last longer. In my practice, I’ve actually encountered situations when this filter will be too effective. That is, it lets out so much gas that the pouch looks like it is suctioned down, onto the stoma, which hinders the stoma output from flowing freely into the pouch.

Additionally, there are two online resources that will help you learn about convexity and identify a pouching system that will work for you. First is the Hollister “Using Convexity” care tip sheet, which provides a nice overview of what convexity is, why it is used, and the types of convexity that are available. To find the sheet, search for “Hollister Care Tips Convexity.” A printable pdf will come near the top of your search results.

Second is the “BodyCheck” tool from Coloplast. Search for “BodyCheck” online. Through a series of 8 illustrated questions you will be able to identify a good pouch for your stoma and abdomen. You will be also able to request samples from the same site. If you do request samples, remember to request a barrier ring and belt as well. These will provide additional security.

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