Regular vs. Extended Wear Barriers
Question:
I have an ileostomy, and was told that I should change my flange from my current regular barrier to an extended wear barrier. What’s the difference?
Answer:
There are different types of barriers available for people with ostomies. Most ostomy product suppliers offer a range of barriers or wafers. Selecting the most appropriate barrier for your type of stoma is dependent upon the desired/required frequency of appliance changes, the characteristics of the drainage from your stoma (fecal versus urine; liquid versus formed; volume), and cost.
Ideal barriers should:
- protect the peristomal skin from feces or urine;
- provide a safe/secure seal;
- be gentle to skin during flange removal; and,
- provide cost effective stoma management.
Skin barriers are composed of a variety of materials, including karaya, pectin, gelatin, and other synthetic materials. Various formulations of adhesives are also used on the barriers to allow for initial tack and enduring adhesion. The exact formulation of the barriers will differ between each supply company. Despite these differences, basic principles of barrier selection will still apply.
In general, regular wear barriers have less resistance to liquid stool and urine. Shorter wear-times are expected if you are going to use a regular wear barrier for ileostomies or urostomies (usually no more than about 3-4 days). These types of barriers tend to “melt” more readily with exposure to stool and liquid (and higher volumes/frequency of urine or stool movement), allowing for unwanted peristomal skin exposure and the potential for skin irritation if left on for too long. Regular wear barriers work well for formed stool, such as that typically found with colostomies. Because there is less liquid content to the stool, and the stoma tends to function less often, a regular wear barrier will not ‘melt’ as easily and longer wear-times (up to 5-7 days) can be achieved. Tack and adhesion, while sufficient to provide a secure seal, tend to be slightly less with regular wear barriers, allowing for more frequent changes if needed/desired without causing skin damage.
Extended wear barriers, on the other hand, are formulated to provide greater resistance to liquid stool and urine. Consequently, longer wear times with these products are more realistic. Some of the extended wear barriers also contain substances that absorb the moisture from the stool or urine, causing the barrier to swell or ‘puff-up’ around the stoma. This swelling action allows for a better seal and resists undermining of the stool or urine under the flange. The barrier will move with the stoma and normal peristalsis, and will not occlude or block the opening of the stoma. There also tends to be greater tack and adhesion with extended wear products. While this adhesion assists with longer wear times, care must be taken with flange removal to avoid peristomal skin damage. Extended wear barriers are an appropriate choice for people who have ileostomies or urostomies, as they will be able to consider longer wear times of up to 7 days. For those who have liquid stool with colostomies, extended wear barriers should also be considered.
Costing may also be a consideration when choosing an appropriate barrier. In general, extended wear barriers tend to be more expensive. However, consideration must be given to the fact that the frequency of the flange changes will likely be less with the use of extended wear barriers. Equally, if the peristomal skin is well protected with an extended wear product and skin irritation is avoided, you may be able to eliminate the use of additional accessory products such as powders. Some product styles, such as convex flanges, may only be available as extended wear barriers.
Deciding upon the degree of ‘melt-out’ and the appropriate duration of your barrier’s wear-time is dependent upon the condition of your peristomal skin with each appliance change, and assessing the degree of barrier melt on the back of the flange during routine changes. An ET can help you to assess both the type of barrier that is appropriate for you, as well as the recommended frequency of appliance changes.