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Decrease the potential risk of stoma leakage 

Convex ostomy bags - a solution for your patients?

Stoma complications can occur within one month after surgery but also at a later stage.[1] Some of the contributing factors may be the stoma placement, its characteristics, fistula formation or a high liquid output.[1] When any of these obstacles arise, effluents may irritate the peristomal skin and even seep under the stoma wafer.[2] As a result, the adhesion of the device can be compromised, and the surrounding area may also be irritated.[3]

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If your patient suffers from stoma leakage, a convex stoma appliance may solve the issue. You can determine whether it is suitable by assessing the type of stoma and the patient’s abdominal contours.

Convex bags may help to avoid stoma leakage

A convex ostomy bag system can possibly make the appliance adhere better to the surrounding skin to prevent stoma leakage, which is a frequent worry[4,5] for many ostomates. Convex ostomy bag systems are designed to[6,7,8,9]

 

  • apply sufficient pressure around the stoma to smooth out peristomal contours, especially in creases and skin folds, to ensure the wafer forms a tight seal with the skin.
  • exert the right amount of pressure onto the peristomal skin, to allow the stoma to protrude further inside the bag. This improves the drainage of stoma effluents into the bag and is especially helpful with retracted or flush ostomies.
  • make accessories such as convex barrier rings unnecessary.

 

The choice of soft convexity can bring additional advantages[8,9]

 

  • flexible enough to adhere to and form a seal with the patient’s body profile while they move and change position.
  • even more comfortable to wear for your stoma patient.
     
When should you suggest a convex stoma system?

Every ostomy is different and often, convexity can be a great help. To select the right device, the appliance must be adapted both to the anatomical conditions and dynamics of the patient’s abdomen as well as to the characteristics of their stoma. Therefore, convex stoma bag systems differ among other thing in angle, shape and depth of the convexity.[10]

Ultimately, it is your clinical experience which determines whether you recommend a convex system to your patient and what properties it should possess.

Convex appliances may be appropriate for[7]

  • Flush stoma: A stoma should be 2.5 cm in length, so the seal around the base of the stoma can work well. However, if a stoma sits at the level of the abdominal skin, it is considered flush.
  • Retracted stoma: A retracted stoma sits below the level of the skin. This may have been caused by a technical difficulty during surgery or by postoperative weight gain.
  • Telescoping stoma: Especially at night, when patients are supine, the telescoping stoma can slide towards or below skin level.
  • Poorly placed stoma: If a stoma was formed during an emergency surgery while the patient was supine or had a distended abdomen, the result may be not optimal.
  • Folds of peristomial skin: The skin may form canal-like folds that cause leakage.
  • Soft abdomen: An abdomen with weak muscle tone provides little support for the stoma, resulting in contours in the peristomal plane.
  • High-output stoma: When the stoma discharge exceeds 750 milliliters per day, the likelihood of leakage rises. The same applies if the output is of a rather liquid nature.


Liquid discharge has the potential to seep into smaller gaps in the skin more easily than formed stool and crosses the skin barrier faster, even with well-protruded stomas. In such cases, convex-shaped products can increase the wear time of the wafer.[2,11]

Our offer of convex ostomy bag systems

Depending on individual needs, you always have the option to choose between standard or soft convex stoma bags with deep or medium convexity. B. Braun has a whole range of convex options to suit your patients‘ needs. Find a good solution for each individual patient.

Gently sloping convexity

Gently sloping convexity is a feature of all 4 to 6 mm products. It was developed to provide better pressure distribution and to apply sufficient pressure around the stoma to shape and form the patient’s peristomal contours.

Intensify convexity effect with a stoma belt

To create a higher sense of security, many users recommend the use of a stoma belt to intensify the effect of convexity. Three different attachment positions* allow the belt to match the preferred position of the bag on the abdomen.

Highlight product

Discover the new generation of soft convex stoma bags: Flexima® Active O' convex

“The Flexima® Active O’ convex has advantageously replaced the rigid convexity and offers a wider range of action. When convexity is needed, soft convexity is a good choice for me.”

Anne van der Drift, ET Nurse – Bichat Hospital, France

O' what a difference

Features and benefits of Flexima® Active O' convex

“When I use Flexima® Active O’ convex, I can rely on softness and my patients' chances of being protected from leakage increase.”

Virginie Lhommet, ET Nurse – Bichat Hospital, France

“In my experience, this bag is particularly suitable for stomas that are flat or slightly retracted. Especially if the stool is liquid, this can be used to avoid leakage and thus peristomal skin irritation. I recommend the product especially for active and sporty people who will choose this appliance for its softness, which is a key criteria for their daily activities and quality of life.”

Danièle Chaumier, ET Nurse, President of the French Association AFET

Product overview

Our offer of one-piece convex stoma bags

Flexima® Active O' convex

The flexible convex wafer allows flat stomas to protrude and to seal stomas in folds. It can even fill in small hollows while simultaneously limiting the peristomal pressure. Moreover, the flexible ring can create a seal around the stoma. 

Illustration

Flexima® Active O' convex drainable bags

Stoma bags with bottom outlet

skin side

Flexima® Active O' convex urostomy bags

Stoma bags with uro outlet

Flexima®

Moderate convexity of 4 mm can help make the stoma protrude.

1-piece closed convex pouch, skin side

Flexima® Convex Colostomy Bags

Closed stoma bags

Product picture

Flexima® Convex Drainable Bags

Stoma bags with bottom outlet

Product picture

Flexima® Uro Silk Convex Urostomy Bags

Stoma bags with uro outlet

Our offer of two-piece convex stoma systems

Flexima® 3S with mechanical coupling system

Moderate convexity of 6 mm can help fill in medium to deep hollows and the folds in the skin.

external side

Flexima® 3S Convex Wafers

Convex wafers

transparent external side

Flexima® 3S Colostomy Bags

Closed stoma bags

skin side

Flexima® 3S Drainable Bags

Stoma bags with bottom outlet

body side

Flexima® 3S High Flow Bags

Stoma bags with high flow outlet

beige, skin side

Flexima® 3S Urostomy Bags

Stoma bags with uro outlet

Flexima® Key with adhesive coupling system

Moderate convexity of 4 mm can help make the stoma protrude.

Base Plate convex

Flexima® Key Convex Wafers

Convex wafers

2-piece system

Flexima® Key Colostomy Bags

Closed stoma bags

skin side

Flexima® Key Drainable Bags

Stoma bags with bottom outlet

2-piece drainable Maxi pouch

Flexima® Key Maxi Drainable Bags

Stoma bags with high flow outlet

Proxima® 2+

Proxima® 2+ with mechanical coupling system

Deep convexity can help fill in deep hollows and skin folds.

2-piece system, skin side

Proxima® 2+ Convex Wafers

Convex wafers

Skin side Beige

Proxima® 2 Colostomy Bags

Closed stoma bags made out of washable baking material

Closed Pouch Skin Side

Proxima® 2+ Colostomy Bags

Closed stoma bags made out of soft non-woven material

2-piece beige bag, skin side

Proxima® 2 Drainable Bags

Stoma bags made out of washable baking material with bottom outlet

Drainable Pouch Beige Skin Side

Proxima® 2+ Drainable Bags

Stoma bags made out of soft non-woven material with bottom outlet

Skin side

Proxima® 2 Urostomy Bags

Stoma bags with uro outlet

[1] Malik T, Lee MJ, Harikrishnan AB. The incidence of stoma related morbidity - a systematic review of randomised controlled trials. Ann R Coll Surg Engl. 2018 Sep;100(7):501-508. doi: 10.1308/rcsann.2018.0126. Epub 2018 Aug 16. PMID: 30112948; PMCID: PMC6214073.

[2] Evans M, White P. Selecting convexity to improve and maintain peristomal skin integrity. Br J Nurs. 2020 Sep 10;29(16):S8-S14. doi: 10.12968/bjon.2020.29.16.S8. PMID: 32901550

[3] Andersen NK, Trøjgaard P, Herschend NO, Størling ZM. Automated Assessment of Peristomal Skin Discoloration and Leakage Area Using Artificial Intelligence. Front Artif Intell. 2020 Sep 10;3:72. doi: 10.3389/frai.2020.00072. PMID: 33733189; PMCID: PMC7861335

[4] Rolls N, Yssing C, Bøgelund M, Håkan-Bloch J, de Fries Jensen L. Utilities associated with stoma-related complications: peristomal skin complications and leakages. J Med Econ. 2022 Jan-Dec;25(1):1005-1014. doi: 10.1080/13696998.2022.2101776. PMID: 35833520.

[5] Nafees B, Størling ZM, Hindsberger C, Lloyd A. The ostomy leak impact tool: development and validation of a new patient-reported tool to measure the burden of leakage in ostomy device users. Health Qual Life Outcomes. 2018 Dec 14;16(1):231. doi: 10.1186/s12955-018-1054-0. PMID: 30547808; PMCID: PMC6295083.

[6] Cronin E. A guide to the appropriate use of convex stoma care products. Gastrointestinal Nursing 2013; Vol. 6, No. 2. DOI: 10.12968/gasn.2008.6.2.28803. ISSN: 14795248

[7] Perrin A. Convex stoma appliances: an audit of stoma care nurses. Br J Nurs. 2016 Dec 8;25(22):S10-S15. doi: 10.12968/bjon.2016.25.22.S10. PMID: 27935354.

[8] Hoeflok J, Salvadalena G, Pridham S, Droste W, McNichol L, Gray M. Use of Convexity in Ostomy Care: Results of an International Consensus Meeting. J Wound Ostomy Continence Nurs. 2017 Jan/Feb;44(1):55-62. doi: 10.1097/WON.0000000000000291. PMID: 28002174; PMCID: PMC5266410.

[9] Turnbull GB. 2003. The Ostomy Files: The Convexity Controversy. https://www.hmpgloballearningnetwork.com/site/wmp/content/the-convexity-controversy. Accessed November 1, 2022.

[10] Hoeflok J, Kittscha J, Purnell P. Use of convexity in pouching: a comprehensive review. J Wound Ostomy Continence Nurs. 2013 Sep-Oct;40(5):506-12. doi: 10.1097/WON.0b013e3182a219b7. PMID: 24448619.

[11] Richbourg L, Thorpe JM, Rapp CG. Difficulties experienced by the ostomate after hospital discharge. J Wound Ostomy Continence Nurs. 2007 Jan-Feb;34(1):70-9. doi: 10.1097/00152192-200701000-00011. PMID: 17228210.

* except for Proxima® 2+, which has one hooking position for the belt

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