What is an ostomy pouching system?

A pouching system collects output from an ileostomy or a colostomy. It protects the peristomal skin and provides security by keeping the pouch sealed to the skin.

It consists of an odor-proof pouch that collects and contains output from the stoma, and an adhesive (called a skin barrier) that attaches to the skin around the stoma. The skin barrier will protect the skin around the stoma and adhere the pouch to the skin. The bottom of the pouch has a tail, which can be opened to drain collected stool, but otherwise stays sealed with an integrated pouch closure.

The pouching system should be emptied when it is about one-third full, and changed every three to four days.

How does a pouching system work?

An ostomy patient with a two-piece ostomy bag and pouching system
Application of a two-piece pouching system

An opening is made in the skin barrier of the pouching system that matches the size and shape of the stoma. For example, if the stoma is round-shaped, the opening is round; if the stoma is oval-shaped, the opening is oval. When the skin barrier is applied it should fit to the skin stoma junction providing skin protection. As the stool drains from the stoma it will pass over the skin barrier into the pouch and be contained in the pouch until emptied. There are many types of pouching systems available. The ostomy nurse will help you find the best, most secure fit.

What is the difference between a one-piece and a two-piece pouching system?

There are two types of pouching systems: one-piece and two-piece. Each has unique features and benefits. You may decide to use both at different times, to suit your changing needs.

A one piece pouching system consists of the pouch and the skin barrier. The skin barrier is attached to the pouch as one piece.

A two-piece pouching system consists of a pouch and a separate skin barrier, which features a flange or a landing zone. The pouch can be attached and detached to the flange as needed. The skin barrier is placed on first and the pouch snapped and/or attached to the skin barrier.

How do I choose an ostomy pouching system?

The ostomy nurses at the University of Chicago Medicine will help you choose an appropriate ostomy bag and pouching system. Factors to consider when selecting a pouching system include the type of stoma, your body shape, stoma construction, issues with concealment, activities of daily living and your preference.

An ostomy bag and pouching system should provide you with security— no leakage between the time you place on the pouching system and when you remove the pouching system as well as protection of the peristomal (around the stoma) skin. You should achieve a consistent wear time that should be approximately three to four days. If you are unable to achieve a consistent wear time you should check with the ostomy nurses for an evaluation of your pouching system.

Where should I purchase a pouching system?

Your health insurance usually determines where to purchase a pouching system. When discharged from the University of Chicago Medicine, you will have adequate supplies to use for the first two weeks at home. If you have home care nursing following your hospital discharge, he/she may provide you with the necessary supplies.

Nurses at the University of Chicago Medicine will provide a list of local and online ostomy suppliers that you can use. We recommend that you contact your insurance to see if they have a preferred provider for supplies.

It is important that you always have an adequate amount of ostomy products on hand in case of an emergency. Expect a delay between the time you order your ostomy supplies and when they arrive at your home.

Are ostomy pouching systems covered by health insurance?

Many private health insurance policies pay a percentage of the pouching system supplies, but this varies. Ask your insurance provider which of your expenses are covered.

Medicare pays 80 percent of allowable monthly expenses for pouching systems. The remaining 20 percent balance may be covered by supplemental insurance.

If your insurance requires that a health care provider sign for your ostomy supplies, provide them with the name of your outpatient ostomy nurse. In some instances, sending the approval to the surgeon may delay the delivery of supplies.

Understanding Ostomy Bags and Pouching Systems

We want to help you adjust to living with an ostomy. Below are several terms, definitions and pictures related to ostomy care. 
A cut-to-fit skin barrier can be customized to a desired size and shape. It's ideal for stomas that are not round or stomas that are still changing size, like when healing after surgery. A cut-to-fit skin barrier is available on a one and two piece system.
A skin barrier that is already cut to the proper round size.
A pouch with no opening at the bottom and when stool has filled half of the pouch it is removed and discarded. Most people use a closed end pouch on a two piece pouching system to allow removal of the pouch and not the adhesive. Frequent adhesive removal can injure the skin around the stoma.
A one piece drainable pouch has the skin barrier (the part that protects the peristomal skin and attaches the pouch to the skin) and the pouch (the part that collects the stool) all in one piece.
A skin barrier that has an outward rounded adhesive that can be used to flatten creases in the peristomal area or to help a stoma protrude above the skin level.
A skin barrier that is flat and used when the skin around the stoma is flat and the stoma has protrusion above the skin.
A filter integrated into the ostomy pouch allows the passage of gas from the ostomy pouch but not odor. This is a feature that is available in some pouches, but not all.
A flange is the plastic ring in a two-piece pouching system The flange connects the skin barrier and the pouch together.
Wear time is the length of time a product can be worn before failure (leakage). Wear time varies widely based upon a variety of factors.

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