Disclaimer: This information is based on my own research into this particular aspect of stoma care as well as some personal experience and should not be used as medical advice or a diagnostic tool. The suggestions given within are taken from sources laid out in the references header. If you seek advice regarding the things you experience within your own disease, please contact your SCN for medical advice.
Welcome to Part IV in my new blog series on “What is a Stoma?”
This instalment covers the ostomy appliances, their accessories, how to obtain your prescription and your options for getting hold of your supplies. There are some differences in appliances depending on your type of stoma and some instances when it might be different, but otherwise this advice and information is for all types of stomas.
This is information for those living in the UK. Some differences may occur in Northern Ireland and depending on your location in the UK with prescription services, and some items aren’t yet available in Scotland. Reference for this is in the Drug Tariff, which is updated monthly and the link is in the further reading. Comments are welcomed, enjoy! xox
Ostomy Appliances & Prescriptions
Types of Ostomy Bags
There are three main types of ostomy bags available:
Closed – These bags have no opening at the bottom. They are applied and removed when the user feels that they are full or due a change. This is typical for colostomates as their output is usually more like a bowel movement. Typically, they would use 2-3 bags per day.
Drainable – These bags come with an opening, either made of Velcro or a folding mechanism. This allows the user to drain the contents from the bag when it becomes heavy and / or full. This is typically used by ileostomates as they have an output that contains more liquid. They can typically get up to 48 hours use from one bag.
Urostomy – These bags come with an opening but it is a tap. This makes it easier to drain the urine collected in the bag when the user decides it is becoming full. The tap is important too if they require a night drainage bag to be attached also. This bag can last between 24-48 hours depending on the urine output.
Ostomy bags comes in a range of size of capacity, in the size of their flange cutting range, and in strength too. This latter one is called convexity and it can help with keeping the spout of the stoma upright – preventing leaks – and with lumps, bumps, dips and bulges around the peristomal skin. This particular range of bag needs to assessed by a SCN or HCP as it can cause injury if used incorrectly.
In addition; bags can come as a single ‘one piece’ – the flange and pouch are pre-attached together – or as ‘two piece’ system – where flange and pouch are separate, requiring the user to connect them together. This is an option if you find it difficult to get a good fit around the stoma. And for some, they just prefer it.
There are many different manufacturers of stoma bags. There are also many different brand lines within them. What can feel like a midfield when you first look into your options and when it comes to orders too, becomes easier. It helps if there is a SCN available to help you decide what is best suited to your needs. Everyone is different; this is the many reason why there is such a wide range of products available.
When it comes to accessories, this means the additional products needed for you to manage your stoma. Below is the most common and why they are used.
- Adhesive Remover Spray / Wipes – These are used to remove the bags from the skin and to help with removal or any residue or stickiness from the peristomal skin.
- Flange Extenders – These are additional pieces of the flange, like stickers, to help aid with security and piece of mind. They come in a variety of sizes and shapes.
- Skin Barrier Spray / Wipes / Applicators – These are used to help create a thin-film on the peristomal skin to help reduce soreness behind the flange, possibly due to leakage. It helps aid adhesion of the flange to the skin too so that leakage is reduced.
- Powder – This a product used to help dry the sore skin around the stoma. It can be used intermittently when leakage has caused sore skin close to the stoma itself.
- Barrier Cream – This helps to manage sore, irritated and dry skin, a lot like a moisturiser for the peristomal area.
- Deodorant – This product can help neutralise the odour from the bag, as well as lubricant the inside to help aid the removal of output from drainable bags.
- Odour Drops / Mists / Sprays – In the same vein as above, these products are scented and provide a neutralising element. They can be added to the pouch (drops) or sprayed in the air when changing or emptying your stoma bag.
- Belts – This product helps aid security of the bag around the abdomen, especially when active.
- Seals / Rings – These products help prevent leakage between the flange and skin. They are usually mouldable and can fit into the dips and creases around the stoma too.
- Paste – This product is used to fill in the folds and creases around the stoma to prevent leakage.
Most of the ostomy companies have variations of the above products. There are the most common terms for them and the most popular products. If in any doubt to what would work best for you, please seek the advice of a SCN and they will recommend what is best suited. These are usually solutions to a problem you might be having; such as sore, dry or irritated skin, security issues, leakage or odour problems. You shouldn’t have to just live with issues like this, or think that something such as leakage, for example, as the ‘normal’ thing. The products exist because there is a need for them. But overuse of them, can also cause problems. If you’re ever unsure of a problem or a product, seek some advice from your SCN.
For the above products, they are all prescribed items on the NHS.
In order to qualify for these to be on your prescription, the NHS Prescription Service states:
“People with certain medical conditions can get free NHS prescriptions if:
- they have one of the conditions listed below, and
- they hold a valid medical exemption certificate
Medical exemption certificates are issued on application to people who have:
- a permanent fistula (for example, a caecostomy, colostomy, laryngostomy or ileostomy) requiring continuous surgical dressing or requiring an appliance”
Upon discharge from hospital, you should be given a FP92A form to apply for a medical exemption certificate which needs to be completed by the hospital or your doctor to confirm your exemption. Following receive of this, you are able to show and use that card to order your stoma supplies. You have two choices for this: either use your GP’s local pharmacy or a home delivery company.
Obtaining your prescription is the same as getting your medication prescription. What you regularly order for stoma care will be on a repeat prescription and available to you. New items will possibly need additional approval from your GP. The minimum turn around time for a prescription is 48 hours; which does not include weekends or bank holidays. You are entitled to use whichever service you prefer unless your GP surgery is part of a Prescription Service; in which a third-party oversees the management of the prescriptions. This does not affect what you can and can not order.
Home Delivery Services
This a popular choice, and many ostomy manufacturers have home delivery services attached to them. The most popular are:
Usually, your SCN will register you with one of those. Most likely it will be the one they have used previously and have a good relationship with. What comes part of having a home delivery service – or called a DAC: Dispensing Appliance Contractor – is not only discreet delivery of your products to a UK address, but also they will obtain the prescription from your GP surgery on your behalf. They also are required by law to provide complimentary items – disposal bags, dry wipes and wet wipes – with all orders unless you state otherwise. They all also provide other additional complimentary items upon request. Some companies call you to place orders on a monthly basis, others require you to make the call or even order online. Due to the EPS system, it can be a soon as a couple of days for you to receive your delivery but most will ask for a time frame of 10-14 days notice of supplies for reorder. They also can provide a cutting service too – where they have machines and people to cut your stoma bag to the correct size for you. This is the main specialist difference between using a DAC over a pharmacy. Of course, this depends on what works best for you. But you have the choice to use which ever service or process you deem to work for you.
- Popular UK Ostomy companies for both appliances and accessories: (links to their product pages)
- Guidelines to Stoma Care Appliance Prescribing PDF
- A step-by-step timeline of best practice ordering from Northern Ireland’s Formulary
- NHS Choice’s page on Prescription Costs
Next week is all about all about managing with the mental physical recovery from ostomy surgery!