This topic is about why most ostomy pouches have an inch-high empty strip above the stoma opening. The person who started the discussion uses Hollister two-piece pouches and is curious about the design choice, as they find the unused strip visible under a T-shirt. They noticed that only Nu-Hope bags have the hole at the very top and are seeking reasons for this design and if they might be missing something.

Here are some insights and advice shared by others:

1. The space above the stoma is useful for installing an aftermarket EZ Vent. Placing the vent higher helps prevent it from clogging.

2. For those with thicker output, like after eating high-carb meals, the extra space can help manage pancaking by allowing room to push contents downward.

3. For urostomates, the strip is often the first part visible under clothing. A quieter pouch film is preferred. One user sticks with Hollister but uses an Ostomy Secrets wrap and a Nu-Hope support belt to keep the pouch flat and reduce noise.

4. Some believe the gap provides "breathing room" for gas, which:
- Prevents pressure on the seal or top seam when the bag inflates, reducing the risk of blowouts.
- Keeps the integrated filter away from wet output, helping it function longer.

5. Custom adaptations include using a homemade 90-degree waste-bend to direct output downward and combat pancaking. Nu-Hope belts can be sized to fit Hollister barriers for extra support.

6. If noise is a concern, Hollister’s opaque flesh-colored pouches are recommended as they are softer and quieter after the first day.

7. It's suggested to contact product-support teams from companies like Hollister, Coloplast, and Nu-Hope directly, as they now have technicians available to discuss design issues with users.

8. There is a theory that placing the hole slightly lower might help distribute weight better and reduce stress on the upper seal when the bag gets heavy.