Customizing for the Consumer

It is not something people commonly talk about. Losing control of the bladder or bowel is not an easy thing to face. What was once a typical body function that is given little thought, turns into a concern that affects and often hinders personal freedom and quality of life. However when ostomy surgery is necessary, patients have the opportunity to live life as they used to because the surgery results in a renewed control of these bodily functions.

Home medical equipment (HME) providers can help ostomy patients to live more independently by providing the right products and education as well as customizing products to meet the needs of an individual.

Ostomy patients, referred to as ostomates, have had a surgery such as urostomy, colostomy, ileostomy or ideal conduit as a result of birth defects, injury, disease or other disorders. The surgery allows for normal bodily wastes to be expelled through the new surgical opening on the abdominal wall. People with ostomies must wear an external pouch to collect food or liquid waste and there are some newer procedures allowing for internal pouches.

Urostomies, also known as ideal conduit or urinary diversion, are when tubes that are implanted drain urine from the kidneys into an isolated piece of the small bowel which acts as a tube to divert urine.

A colostomy is a surgical procedure creating an opening (stoma) on the abdomen for the drainage of feces from the large intestine. The ileostomy is surgical removal of the diseased bowel. An ostomy may be necessary when cancer or disease strikes the bladder or digestive tract.

Currently there are 750,000 ostomates in the United States and Canada ranging in all ages, according to the United Ostomy Association (UOA), Irvine, Calif. The primary causes of needing an ostomy are the three Cs: cancer in the colon and rectum and Crohn's disease and colitis which are inflammatory bowel diseases.

Currently there are 750,000 ostomates in the United States and Canada ranging in all ages, according to the United Ostomy Association (UOA), Irvine, Calif.

Nu-Hope Laboratories, Pacoima, Calif., designs and manufactures one-piece and custom pouches, ostomy pouches, ileostomy or colostomy pouches, skin barriers, support belts and accessories.

According to Nu-Hope Laboratories, the type of ostomy a patient has had dictates the style of pouch that is needed. Urinary diversions require urinary pouches with appropriate drain valves and connectors. For fecal ostomies the pouches should provide suitable odor control. This means materials like saran or construction of a double-wall pouch should be incorporated into the design. The drainage outlet should be wide enough to easily accommodate semi-solid or solid effluent.

Brad Galindo, company representative of Nu-Hope Laboratories Inc., said that having product customization is important because pouch size and capacity for any ostomy needs to be tailored to individual body size, drainage output and skin type. Dexterity and vision are also important factors to take into consideration for older patients.

HME providers of ostomy products have many consumer needs to consider in the development of their products. These include: controlling odors, treatment of the skin, improving adhesives and belts, and having different types of pouches to accommodate all body types.

Colostomates control odor with diet and with odor-free stick-on pouches, deodorants for external use and odor-reducing compounds to be taken by mouth.

Some urinary pouches are constructed with flutter valves which prevent pouch fluids from returning to the stoma's opening site. This pouch design can be helpful to ostomates whose skin is particularly sensitive to urine, according to Galindo. Flutter valves offer advantages to individuals who have a problem with appliance adherence.

VPI Non-Adhesive Ostomy System, Spencer, Ind., offers an alternative to glues and barriers with a soft silicone ring that conforms to the contours of the stoma site. The system features a nonbinding belt which holds the ring in place and helps to evenly distribute the weight of fluids. The ring and pouches are reusable.

Dan Tyrrell, president of the United Ostomy Association, said that some patients may prefer a two-piece pouch to a one-piece since it has snaps and can be easier to empty and fingers are less likely to be soiled.

There are many detailed decisions to make when choosing the right products. Patients need a secure and positive seal along with a comfortable adherence to the body, not irritating the skin. Some may need a waist belt for additional pouch support. Flatus in fecal ostomies may call for a gas relief valve in the pouch.

Tyrrell said manufacturers work to develop products that patients can wear for a long time as this feature is more convenient to the user. Better adhesives will give patients confidence and security in the usage of the product and protect the skin.

In order to help patients with pouches that have not worked, Nu-Hope offers custom pouches featuring choices of different types of convexity, special size pouches, special size barrier, double openings and an irregular opening.

HME providers of ostomy products have many consumer needs to consider in the development of their products.

In addition, Tyrell said there are many extras on the market such as spray deodorants for the pouches and bags, pills that can be taken orally and suggestions for changes in diet for odor control.

Nu-Hope works to educate patients with detailed information on product usage and with a newsletter addressing various concerns of ostomates.

Marketing

Galindo said Nu-Hope markets products through pharmacies, dealers and hospitals. Pharmacists can help patients by recommending the type of equipment that is appropriate for each individual patient. The pharmacist also can advise the patient on how medications will interact with other medication that he or she may currently be using.

Many manufacturers said the largest referral source is often the enterostomal nurse who directs patients to the appropriate products.

"Education from an enterostomal (ET) nurse, or what we call a bag lady or a nurse specialist for ostomy is important. A good ET nurse can help a patient tremendously," Tyrrell said.

Ostomy patients have many concerns with the products they chose that manufacturers have to take into consideration when developing new products. Some of these concerns include how diet affects product usage; whether they can travel; how having an ostomy will affect an intimate relationship; and encountering discrimination at a job.

HME providers answer the needs of consumers by providing them with products that are effective for travel, control odor and noises, protect the skin and can be used for a variety of activities.

Some manufacturers offer waterproof pouches for swimming and hot tubs.

Tyrrell said that UOA has an industrial advisory committee that works closely with manufacturers to address problems with appliances and to find ways to implement or incorporate patient feedback. HME providers continually improve the products they offer in order to make them more effective for consumers.

Reimbursement

Most ostomy products are covered by private insurance and Medicare but there are instances where Medicare will need written documentation to support medical need for ostomy supplies to be ordered by a physician or an ET nurse. Medicare also specifies a limited number of supplies covered per month.

Many HME providers take assignment with Medicare where they accept what Medicare gives them for boxes of pouches.

Education and Advocacy

In an effort to further the educational process for the ostomate, many manufacturers become members of the UOA, an organization dedicated to the education and advocacy of ostomy patients.

Nu-Hope Laboratories works with the UOA to increase membership by getting more ostomates involved and advertising the types of products available.

The UOA has more than 500 local chapters across the United States and Canada. Local programs offer support through a visiting program, newsletters and monthly educational meetings.

Dan Tyrrell, president of the UOA said his organization has 26,000 members nationally, comprised primarily of persons who have had ostomy surgery, but also including doctors, nurses, spouses and suppliers.

Tyrrell said these local organizations help offer support to ostomy patients providing them with a place where they can discuss the adjustments with people in similar situations and participate in social events.

Learning to become proficient with the management of the stoma may require additional time in the beginning but soon it becomes a routine.

Learning to become proficient with the management of the stoma may require additional time in the beginning but soon it becomes a routine.

Although bladder and bowel diversions can help ostomates to regain control of their body functions, ostomy surgery leaves many patients with emotional and psychological concerns. Many people have to deal with a change in perception about their bodies.

Covering All Ages

Young Ostomy United (Y.O.U.) is a community support group offering social and educational focus for young ages. Y.O.U. provides information and a place where young ostomates can ask and get answers to questions.

Y.O.U. provides members with newsletters, social gatherings, educational meetings, counseling and information on the latest product developments.

UOA also works with the young ostomates at a five-day mini camp held each year at different locations. The camp includes discussion groups and social and recreational activities.

Tyrrell said that they feature stories from ostomy patients in UOA's publication of Ostomy Quarterly that demonstrate that ostomates can lead lives as productive and active as people who have not had ostomy surgery. The stories feature ostomates who are mountain climbers, deep-sea divers and professional athletes.

Although having ostomy surgery requires a period of adjustment the right products and education can help patients acclimate to the change with their bodies and go on to lead active and autonomous lives.

Annual Conference

For HME providers who want to join UOA and others interested in the organization, the 38th Annual Conference of the UOA will be held in St. Louis, Mo., August 16-19 at the Adam's Mark Hotel. Sessions will include: a program for newcomers to the conference; discussion group for singles living with ostomy; basic fundamentals of colostomy, ileostomy, and urostomy; a question and answer session with an enterostomal therapist; a session addressing ostomates and fitness; and many others. For information, call UOA at (800) 826-0826.


Biekowski is managing editor for Home Health Products.

This article originally appeared in the July 2000 issue of HME Business.

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