Editorial #4: Flushable Pouches & The CliniMed Freestyle Vie Flushable Three Day Wear Test

Index:

First Impressions
Product Test Diary
-          Day 1
-          Day 2
-          Day 3
-          Day 3 & Conclusions
-          Conclusions: Pros and Cons
Should I try ‘flushable pouches’ or not?
Order Samples

Please Note: CliniMed created the Freestyle Vie Flushable and distribute it within the UK. Outside of the UK their sister company Welland Medical take over the distribution duties, hence you may see references to both CliniMed and Welland Medical throughout this editorial and the pictures within.

First impressions

Having been an ostomate for nearly 15 years, I’ve tried many different products in the search for the product pouch which best meets my needs, and in turn this means I’ve received my fair share of samples packs. The least impressive sample pack was from a company I shall not name (not CliniMed, obviously!) who sent me two single pouches that were stuffed into a bubble-wrap envelope accompanied by a “with compliments” slip; hardly an auspicious welcome to a new product! But, if one were to liken that rather feeble sample package to a clapped-out bicycle then the CliniMed Freestyle Vie (hereby referred to as FSV) sample pack is more akin to a Formula One car.

CliniMed Freestyle Vie Sample Pack

With running the Ostomyland website I’ve tried many different products over the years and I’ve received my fair share of samples packs. The least impressive sample pack was from a company I shall not name (not CliniMed, obviously!) who sent me two single pouches that were stuffed into a bubble-wrap envelope accompanied by a “with compliments” slip; hardly an auspicious welcome to a new product! But, if one were to liken that rather feeble sample package to a clapped-out bicycle then the CliniMed Freestyle Vie (hereby referred to as FSV) sample pack is more akin to a Formula One car.

Inside the cellophane wrapped and company branded box were five of the large-size FSV pouches – mine had the 25mm pre-cut hole. Numerous other sizes were available at the time of ordering, and CliniMed also kindly offered to manually cut them to specific sizes for me too. There was also an illustrative booklet showing how best to apply and flush the product, along with a stoma sizing guide for future ordering and five filter stickers. The inclusion of the filter stickers is a good illustration of how well thought-out this sample pack has been, as there have been countless times in the past where I’ve received samples of products without filter stickers. Whilst they are not something I personally use very often, I do appreciate that a lot of people do prefer to seal off the filter in their pouches at times, so it is nice to see some filter stickers included in the sample pack.

Information Pack and DVD

Also included was a welcome pack folder containing an A5 sized, tri folded leaflet detailing the product and a DVD featuring a short movie introducing the product, its design features and how to apply and discard of the product. There is a very specific routine involved when flushing the pouch, and as the saying goes a picture is worth a thousand words, and in this case a video is worth a million.

It’s a very impressive welcome to the product and it clearly continues CliniMed’s excellence in even the smallest details with their products and packaging.

Before reading the literature and watching the DVD I couldn’t help but inspect the pouch. My first impression is one of “sturdiness”. I’ve been sent the large size pouch and it certainly looks like it will hold a sizable volume before needing to be changed.

The pouch itself feels a bit thicker than most other 1piece products I’ve tried recently – no doubt down to the extra layers of plastic which comprise the flushable and disposable layers. It also looks to me like the adhesive flange is a little bit thicker and firmer than your average 1piece pouch. From a personal perspective I think that is a good thing, as I normally use 2piece products due to the flanges being thicker and stronger. I find this better for me due to my having a problematic stoma region. The stoma itself inverts at times, and it’s pulling the belly in around it to form a cavity or valley in which the stoma lies at the bottom. To add an extra level of fun I also have a natural belly crease which runs about 1” down from the stoma which is directly across the lower half of a pouch flange.

These days, a lot of companies appear to be taking their 1piece products down the route of making the flange/adhesive layers on 1piece products as thin as humanly possible; even up to the point where some are like nothing more than a piece of sticky-backed cling film. Maybe it’s just me and my problematic stoma region, but I find that those super-thin flanges tend to crease and lift much easier on me than the thicker flanged products do. Once a flange does start to crease it never sticks back down to the skin as securely as it did at the start and that makes it a weak point in my flange security.

So, I’m pleasantly pleased that the FSV has a thicker flange than the average 1pc product, and in turn that gives me an immediate feeling of reassurance ahead of the trial tomorrow where I’ll be wearing the pouch for the first time tomorrow.

The many different layers of the Freestyle Vie Flushable pouch

As you can see from the FSV breakdown diagram (right), a lot of plastic and fabric layers go into creating the final FSV product. Because of this it does initially appear to be slightly thicker than most other products (as I’ve already said) but it’s also noisier than other 1piece products I’ve tested. However, to be fair, all pouches are noisy when you are holding them in your hand and scrunching them up trying to make them yelp! The real acid test will be when I come to wear the product and if these are anything like other pouches then I probably will not hear anything.

The shape of the FSV is probably best described as oval. All “corners” are rounded off as you would expect, but there is no extreme shaping of the sides compared to some of today’s 1piece products. I must admit that I’ve never totally understood the thought process behind the shaping of some companies pouches, and neither have I found any particular shape to be more beneficial than the others, but this is a very personal situation which is affected by the location of your stoma.

As a colostomate, I really appreciate the fact that the bottom right hand corner of the FSV (as you look at its front side) is slightly more pronounced in its shaping. For me this helps keep the product away from my groin and thigh joint so it won’t rub. Nice one CliniMed!

Separating the Freestyle Vie Flushable pouch from the cover.

The FSV is made up of two separate pouches as I’m sure you are aware. As the separation of the two pieces are such a large part of CliniMed’s advertising campaign and the product’s feature set, I’ve just had to rip a few apart right away to see if it really is as easy as “removing a yoghurt pot lid”. And…… it is! I’m really impressed by how easy it was too. It’s clearly had a lot of thought put into it. As with any yoghurt lid you need to give the tab a bit of a tug at the start to break the seal, and then you’re off… just like the outer cover! The remainder of the peeling off procedure requires hardly any effort. I also like that the plastic pull-tab is a nice size, which means anyone with dexterity problems will have a decent amount of tab to get a hold on.

I’ve also discovered that if you are finding the initial separation difficult that you are probably gripping the inner pouch with your thumb and forefinger along with the outer cover – adjusting your grip slightly resolves that.

The size difference between the inner and outer pouches (sorry for the poor quality image)

Looking at the biodegradable inner pouch of the FSV I can see that it is considerably smaller in width than then outer layer. I’m sure there must be a reason for this (probably to let the outer layer cover the entire inner pouch as it fills up and swells) but the product would certainly be a lot smaller if the outer layer had a more snug fit to the inner pouch. I’m wondering if it might have been a better idea to have the bottom of the outer layer was gusseted so it could swell with the pouch but also allow the designers to limit the physical size of the outer layer a bit more so that the whole product does not seem quite so large.

The Product Test

I’m going to be testing the Freestyle Vie Flushable (Large) product for three days, using up a full sample pack of five pouches.

As I’ve already talked about the product design features in my initial impressions along with its look ‘n’ feel, this diary is going to be focusing on the stoma management side of the product such as its skin friendliness , and – of course – the most important “flush-ability”.

CliniMed Appeel Wipes Sample Pack

I’ m not going to be using any extra third party products during this test so that nothing can interfere with the product. By doing things this way the diary will not become an evaluation of my personal stoma management skills but instead it will be an honest assessment of FSV performance when it is being used as recommended by CliniMed. Speaking of CliniMed’s recommendations on how to apply and use the FSV most effectively, they also recommend using their CliniMed Appeel Medical Adhesive Remover wipe as part of the cleaning routine – this is due to the aggressive adhesive qualities of the flange possibly leaving some residue behind after removal. So I shall be using these. However, in the interest of fairness I will also be comparing the Appeel wipes to my usual brand of medical adhesive remover.

Day One – Morning

I’ve cleaned the skin thoroughly before application, and I’m now wearing my first ever CliniMed Freestyle Vie Flushable pouch! At the moment it feels no different to any other product I would normally use. In fact, to be honest, I can’t even feel it’s there at all as it is currently empty.

The adhesion quality is very impressive. There’s a small amount of crinkling around the edges but at this time it does not appear to be any detriment towards the pouch security as the inner section of the adhesive is still fastened in place securely.

The filter is coping well. I’ve been drinking too much fizzy pop today and have been trumpeting for Britain but there is no ballooning of the bag, and the air that is in there is quickly dispersed by the filter system.

As I’ve already had my bowel movement for today, it’s unlikely this pouch will be changed before tonight, or maybe even tomorrow morning, so it will be interesting to see how the security progresses with prolonged wear.

So, it’s an impressive start to the test so far, but the real challenge will be when the pouch is coping with a working stoma rather than one at rest.

Day Two

The stoma started to work during the late evening and night time. I left the change until first thing this morning as it will then have had a full 24 hour test.

Looking at the pouch before removing it I can see that, as expected, the flange has creased along where I have my body crease which always causes me problems with ostomy products. However, the FSV has some of the strongest 1piece adhesive I’ve ever tried, and although the edge of the creased area has started to lift a little bit, the inner part of the flange leading to the stoma is still rock solid and leak free. I have to be honest and say that I was prepared for it to leak, and was expecting it to do so. But, it hasn’t!

The fact that the edge has lifted slightly is not to be taken as a criticism of the product, as this crease always causes leakage problems for me, but the FSV has still not leaked and I’m delighted. If I were Dick Van Dyke I’d be grabbing my chimney brush and dancing for joy on CliniMed’s roof.

As I mentioned the adhesive sticks like heck so I did need to use the Appeel medical adhesive remover to get all the little remaining bits of glue off after removal, and I can appreciate now why CliniMed recommend its use. This was not a problem though as the Appeel product cut through it like the proverbial hot knife through butter. Normally, I would use a different brand of medical adhesive remover from another company, so with the next pouch I’m going to try using that product to see if there’s any advantage to using the Appeel over other brands; and if it is better or worse than the Appeel at the job.

With regards to the pouch itself, I found that removing the outer layer of the FSV was much easier whilst the product was stuck to my skin – and it was easy enough when it wasn’t on my skin! When you see a full inner pouch for yourself for the first time you can see how easily it will break down once in your toilet system. The fabric coating had torn a little but underneath the contents were still securely sealed up in what I can best describe as a very sturdy cling film wrapping.

I will put my hands up right now and say I was slightly apprehensive of the flushing procedure at first. I think it’s just a mental hurdle we will have to overcome to use the product – no doubt because for all the years we’ve been ostomates we’ve never flushed the pouches and we’re told they will clog the sewage system up. The longer you’ve been an ostomate the worse this feeling might be. And if you know you have a dodgy toilet system at home then this fear could be enough to stop you trying the product. But I can say that when I followed the product instructions to the letter there were no problems at all today.

When it came to flushing the FSV I first removed the outer layer of the pouch whilst it was still stuck to my skin, and then I disposed of that in the bin. Next, after peeling the flange off my skin I placed it at the front edge of the toilet with flange poking above the water line. I left that in place whilst I cleaned up the stoma and completed the change. Finally when I’d finished that job I crossed my fingers; took a deep breath and flushed the toilet. And what do you know – it flushed first time! My toilet didn’t block up, the system coped fine, and best of all the rest of the toilets in the street didn’t explode through their roofs and lead to my making the national news! Hurray! It was a success! The next time I flush an FSV it will be far less of a concern to me and I even started to feel a little bit embarrassed that I’d been so concerned about it in the first place!

The skin care side of the FSV is good. Considering I do have sensitive skin at the best of times, I was pleased to see that my skin was no different to how it was before I applied the FSV.

Personally I feel that 24hours is probably pushing the limits of the products security when it is covering a functioning stoma. If you were passing nothing then I think you could easily keep the product on for 36-48 hours. For functioning stomas I personally think it would be best to leave the pouch in place for no longer than 10-12 hours, and that is the routine I will be using for the next 48 hours of this test.

Day Three

I’m getting a dab hand at this flushing now! My pouches have flushed first time every time for me up to now which is more than in-keeping with CliniMed’s claims of it flushing first attempt 95% of the time, and 100% of the time for second attempts.

My skin continues to look fine. It’s no worse than it was at the start of the test, which in itself is a major accomplishment as twice daily removals of pouches usually do not do my skin any favours. I can only presume it’s either the flange itself being more hypoallergenic for my skin, or the medical adhesive remover is causing the skin less stress than removing the pouch without it would do – I’ve only been using medical adhesive remover for the last year or so, therefore I don’t know how my skin would normally be if I had been using it during my 1piece-using periods over 5 years ago.

The CliniMed Appeel adhesive remover which I used yesterday seems to have had an easier job of removing the FSV residue from my skin than my usual brand of adhesive remover managed today. It was a bit of a struggle. This is an even more impressive point when you take into account the fact that I only have Appeel wipes to try whereas I have the spray can of my usual product (Appeel is also available in a spray can!). So, I’m removing similar amounts of FSV residue with less CliniMed Appeel product, compared to my usual adhesive remover. That really should be no surprise when FSV and Appeel are both developed by CliniMed but I am pleasantly surprised nevertheless as I’ve always held my usual adhesive remover in such high regard.

End of Day Three & Conclusions

I’m down to my last FSV pouch now, and as each day goes by I’m gaining more confidence in the flush-ability of the product, so much so that during this morning’s change I didn’t even give it a second thought.

The performance of the FSV is just as comparable to any other 1piece product I’ve tried over the years, and I’m pleased I’ve given it a try. Should I ever switch away from 2piece products, or if a 2piece flushable version of FSV were to be developed then I would certainly be looking towards changing to it, although I’d need to give it a longer trial than just three days. It can me take a couple of weeks to make a final decision when it comes to changing pouch brands/products on a permanent/long-term basis.

The FSV was a light and comfortable pouch to wear and as time is going by I’m thinking that the midi size pouch would be all I’d need in terms of capacity. I’ve gotten more comfortable with the security of the product too.

During the test period I didn’t smell the pouch contents, and it never ballooned, so there is a quality filter integrated into the FSV too.

On the adhesive security front I’m pleased to say that the product did not leak once, even though my output consistency is currently perfect pancaking material (and that stoma of mine did try it’s best to cause problems by pancaking but it never found its way past the flange’s titan-like grip on my skin before I was able to change to a new one.

The FSV must have cost CliniMed millions in research and development and they can justifiably be proud of the product they’ve created which is, I think, unique among the marketplace and more than able to hold its own against the non-flushable competition which has had generations of development behind it. FSV is already a quality product, and I’m sure it will continue to get better and better as time goes by and more flushable products become available.

Conclusions: Pros and Cons

There’s lots of PRO’s to the FSV; the biggest being environmental. The product is fully biodegradable and takes no longer to break down in the sewage system than the normal everyday toilet waste. That means no more plastic pouches laid to rest in the land fill site, or being incinerated with clinical waste polluting the sky with its smoke.

The security of the adhesive flange is excellent. It has got one of the stickiest flanges I’ve ever tried. Once it’s in place and your body heat has permeated it, it grips like a vice. Also, it is the only one piece product I’ve tested to have survived my belly crease without leakage for a whole 24 hours! That alone would probably win the product the Ostomyland Editor’s Choice award if any such thing existed.

I think it has made me feel a bit freer and more “normal” whilst using this product. It’s been 15 years since I last flushed a toilet for my own waste, and as silly as it sounds, it felt really GOOD! I guess in a way, it made me feel a bit less like an ostomate.

The biggest problem the Flushable has is breaking down the mental barrier that for years we are told ‘Don’t flush a pouch down the toilet’ and now we are given a pouch that can flush away, so ironically this is the main pro point and that is one of the things we all really want from a pouch, easy disposal! It is a flushable ostomy pouch. It’s not the physical flush-ability of the product that’s the problem as its flushed first time every time for me in this test; it’s the mental-hurdle I touched upon earlier where we ostomates are fearful of giving the product a try in case it might clog up our toilets.

When we discussed flushable pouches on the Ostomyland community forums recently nearly everyone who posted a comment we’re concerned about how genuinely flushable the product was, and naturally focused on the hassle it would cause if it were to block up the home’s sewage system. That is going to be a very difficult hurdle for CliniMed to get over as it’s not as if it’s a physical issue with the product which can be re-designed, but I can vouch for the flushable, it did “exactly what it says on the tin” so to speak and flushed with no blockage and no hassle; it just flushed away like exactly as Mr Crapper no-doubt intended all those years ago.

For flushable products to really succeed CliniMed, and any other flushable-manufacturing company, will need to break this built-in preconception we have that flushing an ostomy pouch will cause the toilet system to block up. It’s been conditioned into us and could prove a big challenge to the success of flushable pouches.

“So should I try flushables or not?”

It would be a huge shame for us ostomates to not give flushable product a chance because of our fears of it blocking the toilet system. We could end up depriving ourselves of an excellent product here with the Freestyle Vie. CliniMed have developed a product that will flush first time 95% of the time and from what I remember of my times sat on the toilet before having my colostomy, I couldn’t even achieve that high a percentage with my own normal flushes!

Maybe you are in the market for a one piece product, or you want to use a more environmentally friendly product, or you wish to find a product that sticks better so that leakage is less of a problem – If so then you just have to try the FSV. If it was a non-flushable product you’d likely try it without concern so don’t let the fact that it is flushable put you off – after all you don’t have to flush it if you don’t want to! There’s nothing stopping you disposing of them via normal means although you will be bypassing the eco-friendly features of the product that way.

An awful lot of research, time and money has been invested into the product to make sure it’s a toilets “dream flush”, and it’s worth a try at the very least. You never know, you may well find yourself a new favourite one piece product… I have!

Order Samples:

UK Ostomates can order samples of the Freestyle Vie Flushable via this page: http://www.clinimed.co.uk/order-a-sample.aspx
For International sample requests please contact Welland Medical for advice on availability. Email: info@wellandmedical.com

External Links
The CliniMed Website: http://www.clinimed.co.uk
CliniMed Freestyle Vie Flushables product page:
http://www.clinimed.co.uk/stoma-care/products/closed-stoma-bags/freestyle-vie-flushable/product-design.aspx

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