Closed-End Pouches
Question:
I have had a colostomy for 5 years and have been using a 2-piece pouch with a drainable pouch/clip. Recently, a friend told me that I should try closed-end pouches. What are the advantages of a closed end pouch?
Answer:
Closed end pouches are an option for people with colostomies. This type of pouch is clip-less, with all peripheral edges completely sealed. It is intended to be removed and disposed when the pouch is 1/3rd to ½ full of stool, and replaced with a fresh pouch. Some closed end pouches have a charcoal filter, which allows any gas/flatus to escape the pouch while being deodorized; other pouches are available without filters. Most companies have a range of sizes in closed end pouches, with small ones that have a limited capacity of perhaps only a couple ounces (60 millilitres) of stool, to larger pouches that may comfortably hold up to 1 ½ cups (375 millilitres). Closed end pouches are also available as a 1-piece system, with a light barrier. The advantages and disadvantages of these pouches will be discussed below.
The most significant advantage of a closed end pouch is its contribution to simplifying ostomy care. Rather than needing to sit on a toilet and to milk thick/formed stool from your drainable pouch, a closed end can be easily detached from your flange, discarded in a plastic bag/waste container and a new pouch quickly reapplied. It can minimize the amount of time and effort required for routine ostomy care. Closed end pouches can also help to ease management in social environments and with physical activities. Concerns about emptying a drainable pouch in a public washroom can be eliminated by removing full closed end pouches, sealing it in a Ziploc™ bag and discarding in a waste container.
While there are several sizes of closed end pouches available, not each ostomy supply company will have a full range of sizes in each of their product lines. You may need to consider switching to an alternate product line if variety is important to you. Finding one that will suit your needs is dependent upon the volume of your stool and the frequency/predictability of your bowel movements. If your pattern of movement is predictable, you can try wearing a larger closed end pouch to accommodate your stool, then switch to a smaller stoma cap with gas filter for the remainder of the day. If you tend to have smaller, more frequent movements, you may want to use a medium sized pouch, and change it once or twice daily.
Your choice of closed end pouch may also be determined by the quality of the gas release filter, if this is a feature that you would like to have. Not all filters function the same: if your stool is a bit looser or if you have periods of liquid stool, you may find that the filter is ineffective. It can become clogged with stool, causing break-through odor and seepage of tiny amounts of stool through the filter itself, subsequently staining your clothes. Filters are also rendered ineffective by outside moisture, such as that from bathing or showering. Most companies provide adhesive filter protectors that can be attached/removed in these circumstances. The filters also tend to work better if there is some external compression on the pouch; this helps to force the gas through the filter. For large volumes of gas, or if you opt to try a non-filtered pouch, “burping” the pouch to release the gas may be easier (releasing the top edge of the pouch from the flange, to quickly release gas).
Perhaps the most significant difference of a closed end pouch is the cost: typically individuals who use closed end pouches will use 1 to 2 pouches each day (rather than 1-2 drainable pouches in a week). Your decision to use closed ends may be dependent upon your financial situation. Extended medical programs will usually reimburse 80-100% of ostomy supplies used after payment of a nominal deductible fee. Some provinces may have government support programs that allow for specific groups of individuals to obtain funding for supplies (income assistance or welfare programs, seniors programs). Federal programs, such as the Department of Veteran Affairs or the Department of Indian and Northern Affairs, may also cover the cost of closed end pouches with a physician subscription. Financial support for ostomy supplies differs widely across the provinces. I suggest contacting a local Enterostomal Therapy Nurse to help you find appropriate funding sources.
Some of the costs can be ameliorated with creativity. There are thin plastic liners available that work in conjunction with closed end pouches. These are cheaper than the closed end pouches, and may make a closed end more financially feasible. These liners go inside the closed end pouch. Once the liner is filled with stool, the pouch and liner are removed; the filled liner is removed/discarded and a new liner placed inside the same closed end pouch. Use of liners, however, prevents the filter option from functioning, and the liner may also prevent a secure seal between the pouch and the flange. You may want to continue to use drainable pouches, and reserve the use of closed ends for specific scenarios, such as outings to restaurants or for travel.
While usually closed end pouches are reserved for those individuals with colostomies and formed stool, people with ileostomies may also choose to use closed ends. Poor hand strength and dexterity may make traditional clipped pouches difficult to use, while a closed end system may facilitate self-care and independence. As with colostomies, there may also be events when or places where discarding a pouch may be easier than trying to empty.
Lastly, there are also one-piece closed end pouches. These have a very thin barrier with less tack than traditional 2-piece systems. These are intended to not be worn more than 1-2 days (depending upon stool volume and frequency), and the whole appliance is removed and discarded. No paste is used with this type of pouching, and is best reserved for those with formed stool. This system has a low profile and most closely mimics usual bathroom habits: filled pouch is removed/discarded, stoma and skin quickly cleansed and a new pouch applied.
Use of closed end pouches is an option for care. An Enterostomal Therapy Nurse can help you to determine appropriate products and samples. See our article on pouch liners for more information.