Ady is a member of the Notts & Derby ileostomy association, and having met him recently he told me about a review of support wear he was asked to write, for a company who never used it. It is a brilliant thorough review with some interesting results that I think all ostomates should be aware of. perhaps it was a too genuine warts and all review ( the only review in my opinion) for the company, so I was happy to add it to my site
After surgery, the last thing you want is any kind of complication, and a hernia is high on the list of potential complications. An ostomy is a procedure where the bowel passes through an incision in the abdominal muscles and a stoma is created on the outside of the body, this creates a point of weakness in the muscle. Increased pressure on this muscle, for example when lifting, coughing or sneezing, can exploit this weakness allowing tissue and intestines to force their way through the muscle and build up under the skin creating a parastomal hernia. To reduce the risk of getting a hernia, light exercises are encouraged to strengthen the abdominal muscles though you should always consult with your stoma nurse or surgeon before starting any exercise regime.
It is also important to wear support garments to support the weakened area as these can reduce the risk of getting a parastomal hernia. Light support can be used for the first couple of weeks whilst your body heals after surgery. As you become fitter and start to do more strenuous things you are best to have more support. Support wear is also used to support an existing hernia or prolapse as it helps hold the hernia in place, helping slow down the process of the hernia getting bigger and making living with a hernia more comfortable.
For anybody new to support wear, it is vitally important to measure yourself correctly to get the right fit. You also need to consider how and when you will be wearing it, and if you require an aperture for your ostomy bag to come through. Unfortunately, this is not always enough as a couple of the belts I have ordered, although being advertised as my size, have not fitted as I would have liked, either being too tight or not giving enough support. If there is an aperture in the support wear, it should be as small as possible and just fit around the flange on your ostomy appliance. As your stoma changes size, it is essential that the size of your appliance backplate is changed to match. By making sure your appliance is not too big you can ensure you get the most benefit from the support garment, being close to the stoma gives the best support, whereas, if there is a gap the stoma site may bulge. Some manufacturers offer a measuring service but if not I would strongly advise getting help from your stoma nurse. I would like to see more manufacturers supplying stoma nurses samples of their products or developing a way of measuring to ensure a good fit as badly fitting support wear may not be giving the necessary support or could possibly create potential problems.
Support wear comes in three support levels, level one or light support wear that can be used throughout the day and overnight, level two or medium support wear or belt for sports and active lifestyles, and level three for firm support for more strenuous tasks such gardening and lifting. For existing hernias, the level of support depends on the hernia but ideally should give enough support to secure the hernia in place.
Several companies do support wear so there is a large range of garments you can try, but as you are restricted on the number of products you can get on prescription in the UK, you must be very careful about what you order. Most areas in the country allow you to order 3 support garments, and 6 underwear garments per year on prescription, although I know some areas can be more restrictive, so you do have to be careful especially if it is your first-time ordering. I would like to see items like the lighter support garments be included as underwear as you can have 6 of on prescription as they are changed daily. This could potentially save some people from developing a hernia or prolapse. I used up my allocation quickly and soon started having to spend my own money as having clean supports for each day is a must for me.
Comfizz offer a free waistband to all new customers so you can try before you buy and I would recommend getting the free waistband as soon as you can after surgery. I had to hold a pillow over my stomach every time I coughed to support my incision and stoma, which was quite often due to the anaesthetic, a frantic process of grabbing a pillow whilst putting my hand over my mouth. If I had had a waistband I would have had extra support for when I was caught by surprise. Why is it you may cough more after surgery when you least need it? Life is so unfair sometimes.
The Comfizz of Kavendor (that name always reminds me of Lord of The Rings) level three support belt I tried is 15cm deep, with built in struts so it can maintain its shape, there are three options of aperture size, 60, 72 and 85, and the belt has an integrated prolapse cover. I found the large size, my size according to the literature, was too big so didn’t give enough support. As I’d tried it on over my clothing, Comfizz were kind enough to exchange for a medium sized belt. There is very little room for adjustment on this belt, which was sometimes too tight, trust me to be the one that falls between two sizes. The belts are very stiff all the way round and incorporate a lumbar support which is unnecessary for me. The 15cm depth doesn’t adapt well when worn, I would prefer something a little wider and something with proper two-way stretch as most of the stretch is along the belt. The belt is comfortable to wear for prolonged periods despite being stiff, a compromise between having enough support and being comfortable. Given how deep it is, I am only able to wear my trousers over the belt and when wearing above my stoma bag I need to wear my stoma guard to allow the flow of output in to the bag. This was the first product I’d tried with an aperture for my bag to come through, this is when I discovered the importance on having the smallest aperture as when the belt is tightened the area of the stoma bulges through. The prolapse cover pushes it back in but I never felt that confident about it.
The HiLine Activ medium support belt looks a little like a bum bag with a choice of aperture sizes which allows you to thread your ostomy bag through to a zipped waterproof compartment. To empty, you just unzip the compartment, pull out the bag and empty as normal. There is a bespoke belt option, but it is my understanding that the bespoke only refers to the zippered compartment which is tailored to the size of your ostomy bag. The belt has a double Velcro closure which makes it feel secure. I found the sizing did not match my waist size. I measured as per instructions but when the belt arrived it was too big to pull tight enough for me and when speaking to Respond was told that occasionally you could fall between two belt sizes, not this again. They told me that they offered an altering service to those who had purchased the bags directly from them but unfortunately I had purchased my belt through my delivery service so I could not have my belt modified. I therefore ordered some sticky back Velcro which I stuck in place to enable me to tighten the belt so it now gave the proper support. The stick on Velcro has lasted a couple of wears without pulling off but didn’t wash well. Sewing sticky back Velcro in to place has proven to be difficult, something to do with the adhesive sticking to the needle. The Activ belt has a slight stretch to it and the belt is narrower around the body. Overall the belt is just about adequate, but only in certain situations. Worn like a bumbag over the top of my shorts it is comfortable and offers some support. When worn with my trousers pulled up over the belt it is too thick, and the narrow part allows it to move about, pull on my stoma bag, and I have to keep adjusting my belt and trousers to make it comfortable again. I found that a stoma guard fits nicely inside the zipped compartment allowing me to wear a trouser belt. I can empty my bag easily whilst wearing the belt although if pancaking has occurred it is more difficult to get to the area of the bag around my stoma.
The most comfortable support I have found, that allows the most flexibility, is the use of stretch support wear. I have several garments that can be used individually or together to give better support. I also find that when fitting a new bag, wearing light support over it, straight away, really does aid adhesion. I have had instances where the bag wouldn’t stick properly in places when first applied, but after wearing support wear for a while I have had no instances when the bag had not eventually stuck down securely.
One of my favourite garments is a level 1 v-neck t-shirt. It may feel a little tight at first but once you’ve had it on for a while you can feel the support it is giving. The support does affect the flow of waste a little but nothing that should cause a problem. The vest is a little figure hugging for me as I haven’t got the physique to be showing it off, so I like to wear a loose garment on top. In hot weather this can become uncomfortable. There is also a vest, the round neck I found rides up too close to throat, the v-neck is more comfortable. I would like the neck at the back to be higher up my neck as at the moment they fit low and gape a little.
The garment I got first is a level 1 waistband, useful when you only want a very light support such as when in bed or lounging about the house. I have both the black and the white version and I like the 10” depth one as the smaller 7” depth cuts across the bag and restricts the flow. I have the Comfizz version with silicon at the top and bottom which help keep the waistband in place and having tried the previous version I can say it works. The waistband holds the bag securely although I’m not convinced that it gives as much support as a vest or boxers. It is comfortable enough to wear in bed and is ok to wear in hotter weather. It is also useful to hold up my shirt when changing my bag rather than using one of those clips.
I also have level 1 boxers which I find very comfortable especially when it is warmer and other garments can become uncomfortable. I got mine from Comfizz and preferred the ones with the cup and opening fly, this makes life a great deal easier when going for a pee. The band around the top is a little tighter than the rest of the boxers, I think I’d prefer the waist band to be a folded over section like the other garments. If you do want to wear the boxers under your bag I have found folding the boxers down is no less comfortable so adds a little bit of flexibility. The boxers in black have an off-white waistband, I would have preferred it if they were all black.
To accompany the above support garments (including the Activ), I have a Stoma Protector set by Comfizz. The set comprises a backing pad with a choice of apertures and a plastic protector with Velcro along two edges. The backing doesn’t have Velcro on so the protector isn’t as secure as I would like but I use a support garment to keep it in place. When going to empty my bag I must be careful when revealing the protector as it has a habit of falling off and has nearly fallen in to the toilet on a couple of occasions. The protector allows me to wear trousers with a belt either above or over the protector. The protector is smooth so when the belt is on top of the protector is does slowly slide down, and if wearing a waistband, the waistband is eventually pulled down below the protector. But this is the most comfortable solution I have come up with up until now, my trouser belt gives that little extra support, and I can mix and match the support wear to change the level of support. It is also possible to wear my trousers under the protector and appliance, this allows me to wear a t-shirt or shirt out over my trousers allowing air to flow. The one thing to be careful of is, if you do wear a belt, not to over tighten it as, if the protector is pressed in to the body, the body can bulge in to the guard, squashing the stoma underneath. I’ve found that although this may increase the amount of pancaking, output can still flow, and it doesn’t cause any discomfort.
I have also tried high waisted cotton underwear from CUI, I opted for a couple of pairs of the men’s fitted trunks. Sizing is again hit and miss, I initially order the correct size for me but found they didn’t offer enough support so ended up ordering a smaller size. The underwear has a pocket which you put your bag in to support it, and holes in the bottom to allow you to empty the bag. I found that trying to empty the bag through the leg hole very difficult so just pull them down now. The pocket is in a fixed position so how well they fit with your bag in the pocket depends on where your stoma is, I think my stoma is a little too high. The underwear is comfortable to wear and lounge about the house, but they don’t give as much support as I would have liked so I now mostly use them as nightwear. I don’t wear them as much as I would have liked but I couldn’t find a good alternative that was available on prescription.
Corsinel underwear can be used for supporting an existing hernia or prolapse, but can also be worn for hernia prevention. They are available with indifferent styles, I have the high boxers. They look more like a medical garment than the Comfizz boxer and are comfortable to wear all day. The sizing is about right although I would say if you are to the top of the size range, go to the next size up.
One thing to be aware of with stretch fabric is that after wearing it for a while the material relaxes reducing the amount of support it gives. A quick wash, and the garment is, or should be, as good as new (never use conditioner when washing stretch material).
I have spent a great deal of my time looking at the alternative level 3 belts from different manufacturers, given my limited experience, and have been unable to find the ideal product. I would like to see more research done on the effectiveness of the current support wear available, there is plenty of room for improvement. I can’t comment on how the support wear works with a hernia or prolapse as I haven’t got either. I am hoping wearing support wear, even when a little uncomfortable, will minimise the chance of getting them. I have had inguinal hernias so can appreciate what it is like to have one. I spent many hours trying to make some sort of support to make living with them, until surgery, more comfortable.
I wrote this some time ago, and have found, over time, that I am mostly still wearing the Comfizz support t-shirt, the Comfizz boxers, or a combination of both. The protector I only use when I want to make sure my stoma is protected. I can wear any combination of clothing, belts, elasticated, tight t-shirts and it makes no difference to the flow of waste into my bag, in fact try stopping it, my stoma is a lot tougher than I first thought. I do get some pancaking but find that wearing support garments help keeps my bag in place and adhered well. I still like to wear light support in bed for the same reason, to keep the bag in place and adhered well. I use my level 3 belt when doing anything strenuous and will continue to use it.