An ileostomy or colostomy is an opening made in your abdominal wall that allows stool to leave the body. An ostomy bag and related supplies help to collect the stool — but there are many different types out there.

From a two-piece to one-piece pouch to considerations about skin barriers, here’s what you should know about choosing an ostomy bag and supplies.

In the United States, approximately 725,000 to 1 million people have an ostomy. Those with an ostomy will wear a bag (often called an ostomy appliance) to collect their stool.

An ostomy bag is important not only because it collects stool, but also because it protects the skin. Stool can be irritating to your outer skin layers. To protect your skin, an ostomy bag will connect to the skin via a skin-friendly adhesive tape that looks much like a large bandage that sticks to your skin.

Ostomy bags can be one or two pieces.

A one-piece pouching system consists of a pouch (bag) that has a skin barrier attached. The stool exits from the bottom of the bag when you unroll or unclip the end.

A two-piece pouching system has a pouch and skin barrier. This skin barrier has a method of attachment. You can detach the entire bag without removing the skin barrier with a two-piece system.

Some pouches are closed-end while others are drainable. If you have a one-piece pouching system, your bag will be drainable. This is because you won’t detach a one-piece pouch to drain it.

However, two-piece pouches can be drainable or closed-end. Often, those with a two-piece pouch opt for a closed-end pouch because they can remove the pouch, empty it, and replace it. This reduces the need for frequent adhesive removal and changes.

Ideally, you should change your ostomy bag about every 3 to 4 days. If you find you are changing it more frequently, talk to your ostomy specialist. You may need to consider a different pouching system.

You may find you need supplies in addition to the bag and skin barrier itself. These depend on your personal preferences, skin quality, and where your ostomy is. Examples include:

  • barrier paste to protect your skin and ensure a tight fit between the skin barrier and pouch
  • barrier strips to prevent the skin barrier edges from rolling
  • deodorant tables to place inside the bag
  • ostomy belt or wrap

You may want to check with your insurance company to ensure these supplies are covered before ordering them.

Knowing you need an ostomy can be overwhelming. Educating yourself about different appliance types can help you make the best decision. Remember, if you start using a certain type of appliance that doesn’t work well for you, there are other options available.

Pre-Education

Ideally, discussions over the right ostomy bag start before you have your surgery. A surgeon or wound care/ostomy expert should review the available options. Even if you don’t choose right away, starting to think about ostomy bags and care can help.

Considerations

When it comes to choosing an ostomy bag, there are five major considerations that can help you make your decision. These include:

  • your stoma type: Pouching systems are available in pre-sized skin barriers or in cut-to-fit skin barriers to fit around your stoma. If your stoma is still changing in size or is not very round, a cut-to-fit skin barrier may be a better option.
  • your body shape: If you have several skin folds or creases around your stoma, a convex skin barrier may be helpful. If your skin is fairly flat around your stoma, a flat skin barrier will still allow your stoma to go above your skin.
  • concerns about concealing your ostomy bag: Ostomy bags come in different shapes and sizes. Some may fit in a more streamlined fashion to your body (such as a one-piece pouch). Some have a clip on the end that can add bulk while others have a plastic, self-adhering end that may have a more flattering fit on the body.
  • how active you are: Having an ostomy should not limit your physical activity. You can place waterproof tape over the ostomy barrier to protect your skin before swimming. You can also wear an ostomy belt, which is an fabric device that goes around your stomach and allows you to pull the ostomy through the belt, if desired.
  • your preferences: You are the one living with your ostomy. If you prefer the idea of managing one type over the other, talk to your ostomy specialist. This will likely be the best option for you.

Talking with ostomy experts and those you may know with an ostomy are great resources to help you select ostomy supplies.

About 55 percent of people with an ostomy report they have out-of-pocket costs for supplies. More than 80 percent pay less than $100 out of pocket on a monthly basis. About 40 percent of the remaining patients reported insurance covers the costs of their ostomy supplies entirely.

Medicare will pay 80 percent of costs related to ostomy supplies, and you’ll pay 20 percent. Private insurance companies will usually cover all or a portion of ostomy supplies. However, you may need a healthcare professional’s prescription to order or obtain the supplies. You can usually order supplies online or through your doctor’s office.

Here are ways you can help make ostomy supplies more affordable:

  • Check with your insurance company to determine if they have preferred vendors or ostomy supplies. Using preferred supplies can usually save you money.
  • Contact the company that makes your ostomy supplies. For example, ostomy company ConvaTec has a patient assistance program to make ostomy supplies more affordable.
  • Contact the non-profit organization Kindred Box. This is a non-profit organization that can help you secure no- or low-cost ostomy supplies.
  • Some local organizations may maintain a donation or emergency closet to help you obtain supplies. Examples include local hospitals, clinics, and Goodwill.

You can also ask your doctor or ostomy specialist for resources and free samples to help make ostomy supplies more affordable.

Choosing an ostomy bag involves considerations regarding your stoma type as well as personal preferences. Your surgeon, ostomy specialist, and others you may know who have ostomies can all be resources in making your decision. You may also want to contact your insurance company to determine if there are certain brands or types they cover at a higher rate.

If the bag you’ve chosen ultimately doesn’t fit your lifestyle, talk to your doctor or ostomy expert. There are many available options.