The ostomy pouch and skin barrier, or wafer, are two separate and distinct components in a two-piece ostomy system. This provides the user with the convenience of changing the pouch while the skin barrier continues to remain attached to the skin. The pouch is attached to the barrier either using an adhesive mount or is snapped on by means of a plastic ring on both the pouch and the skin barrier. The advantage of this system is that you can vary the size of the ostomy pouch as per your activity and wear different-sized bags. We carry a number of two-piece systems from top manufacturers like ConvaTec, Hollister, Coloplast, Cymed, Genairex, and Marlen.
There are different types of two-piece ostomy systems; choosing one will depend on your needs. One criterion for selection is surgery type - ileostomy, colostomy, or urostomy. Your selection will depend on the surgery you have had.
Drainable ostomy bags have an opening at one end for easy emptying of the ostomy pouch. The opening is closed tightly with a clamp or Velcro closure, keeping the output securely within the bag.
Closed ostomy bags cannot be emptied out but has to be disposed of when full. If you lead an active lifestyle, a closed pouch is more convenient because there are fewer risks of leaks and odor, and you do not have to worry about drainage.
An ostomy bag is available in three color options – opaque, transparent, and ultra-clear. Opaque is for users who want discretion and do not wish to view the pouch content. Transparent is more for those who want to monitor the output.
In a two-piece ostomy system, the pouch is attached to the flange either with an adhesive or through a plastic coupling barrier ring locking the two into place. Adhesive attachment is more suitable for those with limited dexterity.
Those who like to go swimming should use a closed pouch with an integrated filter which neutralizes odor and avoids ballooning of the pouch. The filter allows the odor to pass out without letting fluid escape from or enter the pouch. The Coloplast SenSura Mio Flex Two-Piece Convex Light Standard Cut-To-Fit Skin Barrier pouch from Coloplast has an integrated three-layered filter that neutralizes odor and prevents the pouch from ballooning and causing unnecessary bulges.
A two-piece system with a standard skin barrier is best for someone who has had a colostomy. The Coloplast Assura AC is a good example of a standard wear skin barrier that has belt tabs for wearing an ostomy belt.
The extended wear skin barrier in a two-piece ostomy system suits those who have had an ileostomy or urostomy because it provides additional protection from stoma output, thus preventing skin irritation. The SUR-FIT Natura from ConvaTec has a urostomy pouch with an extended wear barrier.
If your stoma size is regular and just needs attaching a skin barrier to it then choosing a two-piece ostomy system with a pre-cut skin barrier makes sense. A pre-cut pouch is pre-sized and has a hole already cut to fit around the stoma. The Center Point Lock system is a pre-cut system from Hollister with a synthetic skin barrier designed to be the most resistant to discharge.
A cut-to-fit two-piece ostomy system requires cutting the hole in the wafer to fit around your unique stoma as per its size and shape. This type is more suitable for someone with an irregular-sized stoma. The ConvaTec SUR-FIT Natura is cut to fit and ideal for those with semi-formed to formed output.
A two-piece ostomy system with a moldable skin barrier is required by those whose output is more liquid. The skin barrier swells up and molds around the stoma to provide a firmer and more secure seal.
A two-piece system with a convex skin barrier is suitable for those with an irregular stoma size and shape. The convex shape of the barrier with a protrusion in the center allows it to provide a snug fit over the stoma, thus disallowing any leakage. A non-convex skin barrier is flat.
The choice of a two piece pouching system will depend on individual preferences and needs. If you have sensitive and fragile skin, then a two-piece system will be convenient because only the pouch must be removed for emptying. In a one-piece system, the entire pouch has to be removed, including the skin barrier, which means there is constant friction with the skin. If your output is high and you need to drain out the pouch frequently, then a two-piece ostomy bag is more convenient because only the bag can be removed, drained,, and re-attached. Before making a selection, it is important to check out all the features available and then make an informed decision. Only the right product will give you peace of mind.
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In a two-piece ostomy system, the ostomy bag is separate from the skin barrier. The skin barrier is fixed on the peristomal skin of the stoma using adhesives and then the ostomy pouch is attached to the barrier. The barrier and bag may be linked using adhesives or a coupling system.
Many change the ostomy pouch within 3 to 7 days or if there is itching or burning under the baseplate. It is recommended not to wear the pouch for more than seven days.
The stoma bag can be cut and its content flushed down the toilet and the bag disposed of. Alternately, the pouch can be disposed of along with its content into a disposal bag. Seal the bag, put it into the domestic refuse bin and wash your hands.