I have seen belts for ostomy pouches in the retail stores. I am not sure if I need one. How would I know?



Ostomy belts come under the category of “accessories” for ostomy products. A belt may be a feature that you require for your care, or it may be completely unnecessary. You should consider several factors when determining if you need to add an ostomy belt to your care.

Belts can serve many purposes for your pouching system, including ensuring enhanced adhesion, accentuating a convex system, and providing a sense of security. The construction of your stoma (how it was made and how it protrudes from your skin) and the characteristics of the skin around your stoma (whether it is flat, or if there are dips, creases, and folds) may impact the security of your pouching system. Certain clues, such as premature lifting of the borders of your flange, consistent leaks at an edge/crease, or a system that shifts with your regular activities in a day, may indicate the need for a belt. A belt may help to tug the pouching system toward your abdomen preventing those lifts and leaks.

Stoma and skin characteristics may require the use of a convex pouching system. Belts may help to pull that system into the abdomen, increasing the tension of the flange against the skin. The combined tension of the convexity and the belt may help to flatten out skin folds, to make stomas tip up (draining better into the pouch), or to prevent seepage of stool under the flange. Your goals of care should include prevention of leaks and determining predictable wear-times for your pouching system; belts may help you to achieve those goals.

Some individuals don’t require a belt to ensure a predictable wear-time or to prevent leaks, but simply desire an enhanced sense of security. For those who actively participate in sports, enjoy soaks in baths or hot tubs, or readily perspire, belts may offer improved support, particularly if there is worry about compromising the tack of the pouch. Some individuals prefer to wear belts during sleep because of frequent position changes and pouch movement.

Not all pouching systems will accommodate a belt. If a belt is required for your care, it may limit the type of pouching system that you can use. Belts attach to tabs, ear-like appendages, located at the 3 and 9 o’clock positions on either the pouch or the flange. Your product boxes may have icons that indicate the presence of belt tabs. Variations between the locations of the tabs differ among product companies: Hollister and ConvaTec place the tabs on the pouch, while Coloplast places the tabs on the flange. Pouching preferences may guide the choice of belt tab location: if using closed-end pouches that are changed one or more times daily, belt tabs on the flange may be more convenient than tabs on the pouch itself. Again, not all product lines within each company will incorporate belt tabs as an option, so you may want to review the best options with your ET or company customer service representatives.

The belt works best when it is worn in line with the belt tab position: directly across at 3 and 9 o’clock. This may or may not be in line with your natural waist. If your natural waist is higher than the position of the belt tabs and pouch, try to avoid having the belt “ride up” into your natural waist. Doing so will pull on the pouch, changing the dynamic of the pouch and belt: rather than the belt tugging the pouching system toward your tummy, a higher or misplaced belt will only pull the pouch up, reducing security and potentially causing leaks. If you have correctly applied your belt, you may find that with normal movement it will shift. Just reposition the belt during your visits to the bathroom, moving it back into its ideal location.

Belts are elastic and will stretch out over time and with repeated use. Gentle care will add longevity: hand-washing, mild soap, cold water, and drip drying are suggested measures. Despite good care, the belts will still need to be replaced on a regular basis to ensure effectiveness, typically 2-3 times per year. Belts obtained through Coloplast, ConvaTec and Hollister are all latex free.

Belts should be snug but not tight when worn. They are generally available in three sizes: small, medium, and large. To determine correct sizing, attach the belt to one belt tab and pull the belt around the back of your waist. Unstretched, the end of the belt should be about 1½-2 inches (3.8-5cm) away from the next belt tab. Once attached, you should be able to comfortably slide a couple of fingers under the belt. Wearing belts too tightly can cause skin problems: pressure points or ulcers may develop under the hard plastic tabs, or irritation may occur where the tab rests on the skin. Some 2-piece pouching systems will distort when belts are too tight, causing pouches to pop off the flange.

You can discuss with your Enterostomal Therapy Nurse if a belt is required for your care.