How to choose ostomy accessories

When living with an ostomy, choosing the right accessories is paramount for comfort, security, and quality of life. This isn’t a “one-size-fits-all” scenario; it’s a deeply personal journey of discovery and adaptation. This comprehensive guide will equip you with the knowledge and actionable strategies to navigate the vast world of ostomy accessories, ensuring you make informed decisions that optimize your well-being.

Navigating Your Ostomy Journey: The Critical Role of Accessories

An ostomy, whether a colostomy, ileostomy, or urostomy, creates a new pathway for waste elimination from your body. While the surgical procedure is a significant step, the daily reality of living with an ostomy hinges heavily on the effectiveness of your pouching system and the accessories that support it. These aren’t just add-ons; they are integral components that prevent leaks, protect your skin, manage odor, and ultimately allow you to live a full, active life without constant worry.

Imagine trying to run a marathon in ill-fitting shoes – uncomfortable, inefficient, and potentially damaging. Similarly, an ill-fitting or inappropriate ostomy accessory can lead to skin irritation, leakage, odor concerns, and a significant impact on your confidence and daily activities. The goal is to create a secure, comfortable, and discreet system that seamlessly integrates into your lifestyle, rather than dictating it.

This guide delves into the nuances of selecting each type of accessory, providing practical advice and real-world examples to help you make the best choices for your unique needs.

Understanding Your Foundation: The Pouching System

Before diving into accessories, it’s crucial to understand that accessories complement your primary pouching system. Your system consists of a wafer (also known as a flange or skin barrier) that adheres to your skin around the stoma, and a pouch that collects output. Systems are broadly categorized as:

One-piece systems: The wafer and pouch are combined into a single unit. These are often perceived as simpler and lower profile.
Two-piece systems: The wafer and pouch are separate components that connect, often with a snapping or adhesive coupling mechanism. This allows you to change the pouch without removing the wafer, which can be beneficial for skin health and convenience.

Your initial choice of a one-piece or two-piece system will influence the types of accessories you prioritize. For example, a two-piece system might benefit more from adhesive removers if you frequently change pouches, whereas a one-piece system might emphasize extended wear barriers.

Essential Ostomy Accessories: A Detailed Exploration

Let’s break down the key categories of ostomy accessories, offering detailed insights and actionable advice for each.

1. Skin Barriers and Adhesives: Your First Line of Defense

The skin barrier is arguably the most critical component after the pouch itself. Its primary function is to protect the peristomal skin (the skin immediately surrounding your stoma) from irritating stoma output and to provide a secure adhesion for your pouch.

Types of Skin Barriers:

Flat Barriers: Most common, suitable for stomas that protrude well and for relatively flat abdominal surfaces.
Convex Barriers: Designed for stomas that are flush or retracted, or for irregular abdominal contours. The convexity gently pushes down on the peristomal skin to encourage the stoma to protrude and create a better seal, preventing leakage under the barrier. Example: If your stoma retracts when you sit or bend, a convex barrier could be a game-changer for preventing leaks during these activities.
Extend Wear Barriers: Formulated for longer wear times (e.g., 3-7 days), offering enhanced protection against enzymatic breakdown from stoma output, particularly beneficial for ileostomies and urostomies with more corrosive output. Example: For someone with an ileostomy who experiences frequent leaks with standard barriers after 2-3 days, an extended wear barrier could significantly improve wear time and reduce skin irritation.
Cut-to-Fit Barriers: Allow you to customize the opening to precisely fit your stoma. Ideal during the initial post-operative period when stoma size may fluctuate, or for unusually shaped stomas.
Pre-Cut Barriers: Come with a pre-sized opening. Convenient once your stoma size has stabilized.

Choosing Your Skin Barrier:

Stoma Type and Output: Ileostomies and urostomies typically benefit from extended wear barriers due to the more corrosive nature of their output. Colostomies, with thicker, less irritating output, might do well with standard barriers.
Stoma Protrusion: Does your stoma protrude, or is it flush/retracted? This dictates whether a flat or convex barrier is needed. Actionable Tip: Have a stoma nurse or healthcare professional assess your stoma and abdominal contour to recommend the appropriate barrier type.
Skin Condition: If you have sensitive skin, look for hydrocolloid barriers or those infused with ceramides for added skin protection.
Wear Time: How long do you want your barrier to last? This will influence whether you choose a standard or extended wear option.
Abdominal Contours: Do you have creases, folds, or a hernia around your stoma? These can necessitate specific barrier shapes or additional accessories (like pastes or rings) to ensure a flat, secure seal.

Adhesives (within the barrier): The adhesive on the barrier itself is crucial. Look for adhesives that are gentle on the skin but provide strong, reliable adherence. Some adhesives are more breathable, which can be beneficial for skin health.

2. Ostomy Pastes and Rings: Filling the Gaps

These accessories are designed to create a smooth, even surface for your skin barrier to adhere to, preventing leaks and protecting your skin from output. They are not glues!

Ostomy Paste:

Function: Fills in uneven skin surfaces, creases, and scars around the stoma, creating a level platform for the skin barrier. It also helps to prevent output from getting under the barrier edge.
Composition: Typically hydrocolloid-based, similar to the adhesive in the skin barrier.
Application: Apply a thin bead around the stoma opening on the skin barrier, or directly onto the skin. Allow it to set slightly before applying the barrier.
Example: If you have a deep scar near your stoma that causes a dip, applying a small amount of paste in that depression before applying your barrier can prevent leakage into that area.

Ostomy Rings (Seals/Washers):

Function: Provide an extra layer of protection around the stoma, creating a more secure seal and helping to prevent leakage. They are more pliable than paste and can be molded to fit various shapes.
Composition: Hydrocolloid-based, often with varying levels of thickness and pliability.
Application: Stretch and mold the ring directly around the stoma, then apply the skin barrier over it.
Choosing Between Paste and Rings:
- Small Gaps/Fine Lines: Paste is often sufficient.
- Larger Irregularities/More Protection: Rings offer more bulk and moldability for a more robust seal.
- Sensitive Skin: Rings can sometimes be gentler to remove than paste, as they lift off more cleanly.
Example: For an irregularly shaped stoma or one that changes shape with movement, a moldable ring can conform better to the changing contours, offering superior leak protection compared to paste alone.

3. Adhesive Removers: Gentle Detachment

While you want your barrier to stick securely, you also need to remove it gently without traumatizing your skin. Adhesive removers are essential for this.

Types of Adhesive Removers:

Wipes: Convenient for on-the-go use. Saturated with a silicone-based or alcohol-free solvent.
Sprays: Allow for a wider, more even application, particularly useful for larger barriers or for those who prefer not to touch the adhesive directly.
Liquid: Applied with a cotton ball or gauze.

Choosing and Using Adhesive Removers:

Silicone-based vs. Alcohol-free: Silicone-based removers are generally preferred as they evaporate quickly, leaving no residue that could interfere with the adhesion of your new barrier. Alcohol-free options are also available for very sensitive skin. Avoid alcohol-based removers as they can dry out and irritate the skin.
Application: Gently peel the barrier back while spraying or wiping the adhesive remover underneath the lifting edge. This “slides” the barrier off rather than ripping it.
Residue: Ensure all remover residue is gone before applying a new barrier. Some removers may require a light rinse with water and gentle pat drying.
Example: Instead of forcefully pulling off your skin barrier, which can cause skin stripping and redness, use an adhesive remover spray. As you slowly peel the barrier from top to bottom, spray the remover directly into the gap between your skin and the barrier, allowing it to dissolve the adhesive as you go.

4. Ostomy Belts and Support Garments: Added Security

These accessories provide an extra layer of security, helping to keep your pouching system snug against your body and preventing accidental dislodgement, especially during physical activity.

Ostomy Belts:

Function: Typically elastic or fabric, worn around the waist and often connect to specific tabs on two-piece pouching systems. They provide gentle pressure, keeping the wafer securely in place.
Benefits: Can enhance the seal of convex barriers, provide reassurance during activity, and prevent the pouch from pulling away from the body when it fills.
Choosing an Ostomy Belt:
- Comfort: Should be snug but not uncomfortably tight.
- Width: Wider belts can distribute pressure more evenly.
- Material: Breathable materials are preferable.
- Attachment Points: Ensure it’s compatible with your specific pouching system (if using a two-piece with belt tabs).
Example: If you’re an avid golfer, an ostomy belt can prevent your pouch from shifting or pulling away from your body during your swing, giving you peace of mind and allowing you to focus on your game.

Support Garments (Hernia Belts/Pants/Wraps):

Function: Provide overall abdominal support, often recommended for preventing or managing parastomal hernias (a bulge around the stoma). They can also offer discretion by holding the pouch closer to the body.
Benefits: Reduce the risk of hernia development or progression, provide comfort and support for existing hernias, and offer a smoother silhouette under clothing.
Choosing Support Garments:
- Level of Compression: Varies from light support to strong compression for hernia management.
- Design: Vests, briefs, wraps, or high-waisted options.
- Material: Breathable, comfortable fabrics that don’t irritate the skin.
- Fit: Crucial for effectiveness. Should be fitted by a professional if managing a hernia.
Example: After noticing a small bulge around your stoma, your surgeon recommends a light support garment. Wearing this regularly helps contain the bulge and reduces strain on your abdominal muscles during daily activities, potentially preventing the hernia from worsening.

5. Deodorizers: Managing Odor

Odor is a common concern for many ostomates, but with the right accessories, it’s highly manageable.

Types of Deodorizers:

Pouch Deodorants (Drops/Gels): Added directly into the ostomy pouch. They neutralize odor-causing bacteria.
Room Deodorizers/Sprays: Used in the bathroom after emptying.
Pouch Filters: Integrated into many ostomy pouches, these contain activated charcoal that filters gas from the pouch, reducing ballooning and odor.

Choosing and Using Deodorizers:

Pouch Deodorants:
- Form: Drops are easy to use; gels can cling to the inside of the pouch for extended action.
- Frequency: Add a few drops/a small amount with each pouch change or emptying.
- Compatibility: Ensure they don’t interfere with the pouch material or adhesive.
- Example: Before emptying your ileostomy pouch, add 5-10 drops of a liquid pouch deodorant. This will neutralize any potential odor when you open the pouch, making the process more discreet.
Pouch Filters:
- Benefits: Allow gas to escape slowly, preventing “ballooning” of the pouch and reducing outward bulging under clothing.
- Considerations: Can become wet and clogged with liquid output, making them less effective for ileostomies or urostomies unless they have specific anti-clogging features. Some filters have covers that can be used during swimming/showering.
- Example: If your colostomy pouch frequently balloons with gas, opting for a pouch with an integrated charcoal filter can significantly reduce this issue, maintaining a flatter profile under your clothes.

6. Powders: Protecting and Healing Skin

Ostomy powders (skin prep powders) are designed to absorb moisture and protect irritated peristomal skin, creating a surface where the skin barrier can adhere. They are not talcum powder.

Function:

Moisture Absorption: Helps dry weeping or macerated (water-logged) skin, allowing the barrier to stick better.
Skin Protection: Forms a protective layer over irritated skin, shielding it from further exposure to stoma output.

Choosing and Using Ostomy Powders:

Application: Dust a small amount directly onto clean, dry, irritated skin around the stoma. Gently brush off any excess powder.
“Crusting” Technique: For severely irritated, weeping skin, a “crusting” technique can be highly effective:
1. Clean and gently pat dry the irritated skin.
2. Dust a thin layer of ostomy powder over the irritated area.
3. Lightly spray or dab a skin barrier protective wipe (like a no-sting barrier film) over the powder. This seals the powder onto the skin.
4. Repeat steps 2 and 3 once or twice to build up a protective layer.
5. Allow to dry completely before applying your skin barrier.
When to Use: Primarily for red, weeping, or excoriated (eroded) skin around the stoma. Not for routine daily use on healthy skin.
Example: You notice your peristomal skin is red and weeping slightly after a minor leak. After cleaning the area, you sprinkle a thin layer of ostomy powder on the irritated skin, gently brush off the excess, then dab a no-sting barrier film over it. This creates a dry, protective surface for your new skin barrier to adhere to, allowing the skin to heal.

7. Barrier Films and Wipes: Enhancing Adhesion and Protection

These products create a protective film over the skin, enhancing adhesion and offering a barrier against irritants.

Function:

Protective Layer: Forms an invisible, breathable barrier on the skin, shielding it from stoma output, adhesives, and friction.
Adhesion Enhancement: Can improve the tackiness of the skin, leading to a more secure seal for the skin barrier, especially in humid environments or for those with oily skin.

Types:

Wipes: Pre-saturated wipes that are easy to use.
Sprays: Allow for quick and even application over larger areas.

Choosing and Using Barrier Films:

No-Sting Formulations: Always opt for “no-sting” formulations, as older alcohol-based products can cause discomfort on open or sensitive skin.
Application: Apply to clean, dry peristomal skin before applying the skin barrier. Allow it to dry completely (it should feel slightly tacky) before proceeding.
When to Use: Beneficial for sensitive skin, to prevent skin stripping from frequent barrier changes, or to improve adhesion in challenging conditions (e.g., hot weather, sweating).
Example: Before applying your new skin barrier, you wipe the peristomal skin with a no-sting barrier film. This creates a thin, breathable layer that not only protects your skin from potential irritation but also provides a better surface for your barrier’s adhesive to bond with, extending your wear time.

8. Pouch Covers and Wraps: Discretion and Comfort

While not directly related to leak prevention, pouch covers and wraps significantly enhance comfort and discretion.

Function:

Discretion: Conceal the pouch, making it less noticeable under clothing.
Comfort: Prevent the plastic of the pouch from rubbing against the skin, reducing irritation and sweating.
Noise Reduction: Some covers can muffle the sound of output.
Temperature Regulation: Can help prevent the pouch from feeling cold against the skin or getting overly sweaty.

Choosing Pouch Covers/Wraps:

Material: Soft, breathable fabrics like cotton or bamboo are ideal.
Design: Various styles are available, from simple slip-on covers to more elaborate wraps or ostomy underwear with integrated pockets.
Fit: Should be snug enough to hold the pouch close to the body but not so tight that it restricts output or causes discomfort.
Washability: Look for easy-to-wash options.
Example: For added discretion under your favorite dress, you use a soft, stretchable pouch cover. Not only does it hide the pouch, but it also prevents the plastic from sticking to your skin in warm weather, enhancing your comfort throughout the day.

9. Irrigation Supplies (for Colostomy Only): Scheduled Evacuation

For some individuals with a colostomy, irrigation can be an option. This procedure involves flushing water into the stoma to stimulate the bowel and achieve a predictable emptying pattern, often allowing for “no-pouch” wear or a mini-pouch for part of the day. This is a specialized technique that must be taught and approved by a healthcare professional.

Supplies:

Irrigation Bag/Container: Holds the water.
Coning/Stoma Cone: A soft, cone-shaped device that fits into the stoma opening to direct the water.
Sleeve/Drainage Bag: A longer bag that collects the flushed output.
Water and Lubricant: Necessary for the procedure.

Important Note: Irrigation is only suitable for specific types of colostomies and requires proper training from an ostomy nurse. It is not for ileostomies or urostomies.

10. Measuring Guides and Templates: Precision Matters

Your stoma size and shape can change over time, especially in the initial months after surgery. Accurate measurement is crucial for preventing leaks and skin irritation.

Function:

Accurate Sizing: Ensures the opening in your skin barrier is the correct size – just slightly larger than your stoma.
Prevents Irritation: An opening that is too large exposes peristomal skin to output; too small can constrict the stoma.

Choosing and Using:

Materials: Often clear plastic or cardstock with various sized holes.
Frequency: Measure your stoma weekly for the first 6-8 weeks post-op, then periodically (e.g., monthly) or if you experience persistent leaks.
Method: Hold the guide over your stoma, finding the hole that is the closest fit without touching the stoma.
Example: You notice your skin barrier is adhering less effectively and you’re experiencing some itching. Using your stoma measuring guide, you discover your stoma has shrunk slightly. Adjusting the opening size on your cut-to-fit barrier immediately resolves the issue and prevents further skin irritation.

Strategic Selection: Beyond the Basics

Choosing accessories isn’t just about identifying what they do; it’s about how they integrate into your lifestyle and address your specific challenges.

Assess Your Lifestyle and Activities

Active Individuals: If you exercise frequently, swim, or have a physically demanding job, you might prioritize extended wear barriers, strong adhesives, ostomy belts, and discreet, secure pouching systems.
Sedentary Individuals: Comfort and skin protection might be higher priorities, with less emphasis on extreme adhesion.
Travelers: Compact, easy-to-use accessories like wipes and sprays are beneficial. Consider pre-cut barriers for convenience.
Social Life: Discretion is often a major concern. Pouch covers, effective deodorizers, and anti-ballooning pouches can boost confidence.

Identify Your Specific Challenges

Frequent Leaks: This is a red flag. Re-evaluate your skin barrier choice (convexity?), consider paste or rings, check stoma size, and assess your application technique.
Skin Irritation/Redness: Focus on skin protection – barrier films, powders, and ensuring the stoma opening is precise. Consider hypoallergenic products.
Odor Concerns: Explore different deodorizers, anti-odor pouches, and ensuring a secure seal.
Pouch Ballooning: Pouch filters are key here.
Discomfort/Rubbing: Pouch covers or soft support garments can alleviate this.
Peristomal Hernia: Consult your healthcare provider for appropriate support garments or surgical options.

The Power of Trial and Error (and Professional Guidance)

It’s unlikely you’ll find your perfect combination of accessories on the first try. This is a process of experimentation.

Sample Packs: Many manufacturers offer free samples of their products. Take advantage of these to try different barriers, pastes, and accessories without financial commitment.
Ostomy Nurse (WOCN/ET Nurse): This is your most valuable resource. Ostomy nurses are specially trained to assess your stoma, skin, and lifestyle, and recommend appropriate products. They can also demonstrate proper application techniques. Schedule regular check-ups.
Manufacturer Support: Don’t hesitate to call the customer service lines of ostomy product manufacturers. They often have nurses or product specialists who can offer advice.
Support Groups: Connecting with other ostomates can provide invaluable real-world advice and tips that you won’t find in product manuals.

Storage and Management of Supplies

Cool, Dry Place: Store all ostomy supplies in a cool, dry place away from direct sunlight and extreme temperatures, as this can affect adhesive integrity.
Organized Storage: Keep your supplies organized in a dedicated drawer, bin, or travel bag. This makes changes quicker and less stressful.
Adequate Supply: Always keep at least a week’s worth of supplies on hand, preferably more, to avoid running out unexpectedly.
Travel Kits: Prepare small, discreet travel kits with everything you need for a pouch change, including wipes, disposal bags, and spare pouches.

Flawless Application: The Missing Piece

Even the best accessories won’t perform optimally without correct application.

Preparation is Key: Gather all your supplies before starting. Clean your hands thoroughly.
Gentle Removal: Always use an adhesive remover to prevent skin stripping.
Clean Skin: Wash the peristomal skin gently with warm water and a mild, unperfumed soap (or just water). Avoid harsh scrubs or oil-based products.
Thorough Drying: Pat the skin completely dry. Moisture is the enemy of adhesion. A hairdryer on a cool setting can be helpful.
Skin Protection (if needed): Apply skin barrier film or powder before the main barrier, if using.
Accurate Sizing: Ensure your barrier opening is the correct size for your stoma.
Warm the Barrier: Warm the skin barrier gently with your hands or by holding it against your body for a minute or two. This makes the adhesive more pliable and increases its tack.
Press Firmly: Apply the barrier smoothly from the bottom up, pressing firmly around the stoma for 30-60 seconds to ensure a good seal. The heat from your hand helps activate the adhesive.
Monitor Your Skin: Regularly inspect your peristomal skin for any redness, irritation, or breakdown. Early detection allows for prompt intervention.

Conclusion: Empowering Your Ostomy Life

Choosing the right ostomy accessories is an ongoing process, not a one-time decision. It requires understanding your body, identifying your unique needs, and being willing to experiment. By meticulously selecting and correctly applying these essential tools, you transform the daily management of your ostomy from a source of anxiety into a manageable, even routine, aspect of your life. Embrace the journey of discovery, leverage the expertise of healthcare professionals, and empower yourself to live with confidence and comfort. Your well-being depends on it.