What is a colostomy bag?
A colostomy bag, also called a stoma bag or ostomy bag, is a small pouch used to collect waste from the body.
During a surgical procedure known as a colostomy, an opening, called a stoma or ostomy, is formed between the large intestine (colon) and the abdominal wall. This allows waste products to be excreted through the opening in the abdominal wall rather than via the colon through the anus and rectum. Stool and other waste products are drainable into the pouch, which can then be emptied at regular intervals.
This procedure is carried out in the treatment of conditions involving damage to the colon or large intestine, such as ulcerative colitis, Crohn’s disease, diverticulitis or colorectal cancer. The pouch is placed over the stoma/ostomy – in order to collect stool and other waste from the body.
An ostomy bag, therefore, is a fairly simple device intended to rest the patient’s colon in the case of a temporary colostomy, or to act as an artificial outlet for the bowel when the procedure is intended as permanent. The use of colostomy bags is surprisingly common and doesn’t necessarily involve a huge change of lifestyle. Full guidelines on using the drainable pouch will be provided by the clinic, as well as advice on finding all necessary continence products, such as replacement pouches.
When is a colostomy bag needed?
Colostomy bags can be necessary for people of all ages, typically for patients experiencing problems with their colons, such as Crohn’s disease, or when the anal sphincter does not function properly. They allow the body’s waste to bypass the colon via the stoma either permanently and temporarily.
The diversion of waste from the body via the stoma/ostomy may be necessary for the treatment or management of certain conditions involving inflammation of or damage to the large intestine, including:
- Abdominal/pelvic region cancers including colorectal cancer and more rarely anal, vaginal or cervical cancer
- Inflammatory bowel diseases including Crohn's disease, ulcerative colitis and, more rarely, diverticulitis
- Bowel obstructions or injuries
- Bowel incontinence (in severe cases)
- Hirschsprung’s disease (a rare disease where the bowel lacks nerve cells)
Colostomy bag surgery
There are two main surgical procedures used to create a stoma in the abdomen:
- Loop Colostomy: A loop of the colon or large intestine is pulled through the stoma in the abdomen, opened, and stitched to the skin. The pouch is then added.
- End Colostomy: The end of the colon or large intestine is pulled through the stoma in the abdomen and stitched to the skin. The pouch is then added.
Both procedures are considered routine, however, the exact method will depend on factors such as the medical condition that is being treated, and whether continence is expected to eventually be restored after recovery. Both procedures are usually performed using keyhole surgery, as an inpatient procedure at the clinic, but some situations may require open surgery. Open surgery often has a longer recovery time.
This is a similar procedure that also entails the use of a stoma bag, which sometimes termed an ileostomy bag to differentiate. It is commonly carried out as a treatment for ulcerative colitis. This surgery involves bringing the small intestine out of the body to divert waste, then placing a stoma bag over the opening. Bodily waste is then drainable through the opening, and does not need to pass through the colon and rectum.
A urostomy – also called an ileal conduit – is a procedure that creates a stoma specifically to drain urine when passage through the bladder and urethra is not possible. A urostomy bag, which is of similar design to a colostomy bag, is used to collect the urine, which is then drainable via the stoma. A urostomy is a permanent procedure.
Is a colostomy bag permanent?
Use can temporary or permanent, depending on the type of surgery needed to treat the underlying medical condition. Temporary colostomies tend to be “loop colostomies” whereas permanent colostomies tend to be “end colostomies.”
In the case of a temporary colostomy, surgery is needed to reverse the colostomy. This involves removing the colostomy bag and reconnecting the bowel, so that waste can then exit the body normal via the rectum and anus; the stoma will no be longer required. This is generally carried out 12 weeks or more after the initial surgery, but this time can be longer if complications arise during recovery. The procedure is considered straightforward and can usually be carried out using keyhole surgery.
Living with a colostomy bag
After a patient is fitted with a colostomy bag, doctors and nurses will thoroughly explain how to maintain the stoma and what lifestyle changes may be necessary for adapting to using the pouch. Below is some general information and advice that should be noted by all colostomy bag users.
The colostomy bag
Generally, colostomy bags consist of two pieces: the flange, which adheres to the skin, and the detachable pouch, which catches the waste. One piece systems, where the flange and bag are attached to each other are also available. The whole system is removed when changing this type of system. Colostomy specialists will assist in deciding which type of colostomy bag suits the needs of the individual.
Ensuring good adherence
To ensure a tight seal over the stoma in the abdomen, the skin should be clean and dry. Humid conditions and increased sweating may therefore lead to reduced wear-time, so keeping a ready stock of replacement pouches is advised.
How to change a colostomy bag
The pouch can be changed as often as needed – usually, shortly after a bowel movement. At first, the procedure may prove difficult but will get easier with practice. For basic guidelines, follow these six steps:
- Thoroughly wash your hands using antibacterial gel or soap.
- Gently ease the pouch from the stoma, using adhesive remover to help if necessary.
- By removing or cutting away the bottom section, empty the pouch of stool and other waste, into the toilet. If you don’t want to do this, pouches can be disposed of in their entirety into a disposal bag.
- Clean the stoma with warm water and mild soap and thoroughly dry with a dry wipe.
- Prepare the new pouch by removing the protective cover from the flange.
- Place the flange over the stoma, ensuring there are no creases.
Colostomy bag accessories and supplies
Aside from the basic components (flanges, pouches), there are a variety of accessories available to help with stoma care and use. The most commonly-used accessories include:
- Belts: Belts help secure the colostomy bag to the body, reducing the risk of dislodgement and leakage.
- Stoma paste: These pastes help adhere the flange to the skin of the abdomen.
- Stoma powder: Used to dry sore or inflamed skin around the stoma, allowing the flange to be applied more easily and effectively.
- Wipes: Wipes can be used to clean the skin, remove adhesive residue or to form a protective film between the stoma and flange.
Generally, colostomy bag users are able to lead a normal life and take part in all the activities they wish to. There are, however, a few tips to keep in mind to avoid damage to the colostomy bag.
- Spare colostomy bags and accessories should be carried whenever possible. Patients typically have less control over continence following a colostomy, meaning the pouch may need to be changed unexpectedly when away from home.
- Caution should be taken with pets or children who may unintentionally dislodge or damage the colostomy bag.
- Food and drinks that cause flatulence (carbonated drinks, beans, cauliflower, cabbage, etc.) should be avoided.
- Once the stoma has healed, sports and exercise are possible. Specialized supports and smaller, more agile pouches are available to aid in this.
Bathing and showering
When bathing or showering, the colostomy bag can be either left in place or removed. If left in place, the outside of the filter should be covered using a sticky patch (that should be supplied by the hospital/doctor) to prevent any damage. If removed, it is best to select a time when the stoma will be less active – before, rather than following, a meal, for example. Before refitting the colostomy bag, ensure the skin around the stoma is completely dry.
Generally, clothing able to comfortably support a colostomy bag can be found in regular clothing outlets. However, clothing designed specifically with the needs of users in mind is also available from specialist outlets. Items include high-waisted trousers to suit those with a waist-level stoma, high-waisted underwear and specially designed swimsuits.
A healthy sex life is generally possible for individuals living with a colostomy pouch. The main obstacle may be embarrassment, which may be helped by the use of a smaller pouch or by wearing clothing that covers or secures the device in place.
After surgery, appliances and accessories will be supplied by the clinic, along with a prescription detailing the individual’s requirements. When running low, the prescription can be taken to a doctor or pharmacy for replenishment of all essential items.
Colostomy bag FAQs
Q: After surgery for Crohn’s disease, will a pouch be needed permanently?**
A: Not usually. The type of surgery which is usually recommended in Crohn’s disease is called a resection. Doctors will consider performing a resection to remove the sections of the intestine which are inflamed, or damaged by inflammation. A resection of the intestine is carried out in cases where the symptoms of Crohn’s disease have not been alleviated by other treatments. When the inflamed sections of the intestine have been removed, the healthy sections will be stitched together. A resection is a major procedure and usually performed under general anaesthetic.
In people with Crohn’s disease who have undergone a resection, ileostomy may be prescribed, to divert stool and other digestive waste away from the colon to give the area of the intestine, which has undergone a resection, a chance to heal. Whether this is temporary or permanent depends on the nature of a person’s Crohn’s disease, their post-surgery recovery and their overall medical history. Even if doctors do not recommend reversal and it is decided that the best management plan involves a person using their continence pouch on a permanent basis, many people find that they experience a greatly improved quality of life with the pouch, compared to their previous experiences of managing Crohn’s disease.
However, the type of surgery usually prescribed to treat Crohn’s disease is a loop form of the procedure, which is temporary. Most people with Crohn’s disease who have undergone this procedure will be able to have it reversed following successful healing. They will excrete waste via the rectum and anus as normal thereafter. See this resource for more information about Crohn’s disease.
The Independent. "What is a colostomy bag and what is it used for?" July 7, 2014. Accessed June 28, 2017. ↩
Health Encyclopedia. “Colorectal Cancer: Tips for Living with a Colostomy.” Accessed June 28, 2017. ↩
Gastroenterology & Hepatology. “Efficacy and Complications of Surgery for Crohn's Disease.” September 2010. Accessed: 18 April 2018. ↩