Colostomy Bag

A colostomy bag, also called a stoma bag or ostomy bag, is a small, waterproof 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 rectum and anus. Stools and other waste products are drainable into the pouch-like colostomy bag, 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
• Colorectal cancer

The colostomy bag is placed over the new opening that has been created in the abdominal wall in order to collect stool and other waste from the body. 1

A colostomy bag, therefore, is a fairly simple device intended to rest the patient’s colon in the case of a temporary procedure, or to act as an artificial outlet for the bowel when the surgery is intended as permanent.

The use of a pouch to collect waste outside the body:

• Is surprisingly common
• Is not painful
• Does not necessarily involve a huge change of lifestyle

Full guidelines on changing a colostomy bag and/or using a drainable version will be provided by the clinic that is treating the affected person, as well as advice on finding all necessary supplies, such as replacement pouches.

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Colostomies can be necessary for people of all ages. Typically, they are recommended for those experiencing problems with their colons, such as Crohn’s disease, or when the anal sphincter does not function properly. The temporary or permanent use of a stoma and colostomy bag allows the body’s waste to bypass the colon. 2

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: 3

• 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

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 used to collect waste thereafter.
• 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 used to collect waste thereafter.

Both procedures are considered routine, however, the exact method will depend on factors such as:

• The medical condition that is being treated
• Whether continence is expected to eventually be restored after recovery by means of a follow-up procedure known as colostomy reversal

Both loop and end 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. 4 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.

Use can be 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.” 5

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.

After a patient is fitted with a colostomy bag, doctors, nurses stoma care experts or colostomy specialists 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.

Generally, colostomy bags consist of two pieces: 6

• The flange, which adheres to the skin and should be changed every one to two days
• The detachable pouch, which catches the waste.

One piece systems, where the flange and bag are attached to each other, and are both disposed of and replaced simultaneously, are also available.

Bags come in a wide variety of different sizes and capacities and most brands offer each bag they make with a one-piece or two-piece option. Different bags may be suitable for different occasions and purposes. For example, a person may choose to use:

• A larger size stoma bag while sleeping, e.g., one which can hold around 650 ml of waste. This will help them to avoid leakage, because they cannot control or predict the volume of their nightly waste output.
• A small stoma bag during their waking hours, when it can be changed as needed. For example, one which can hold around 400 ml of waste.

It is generally recommended that a person empty their colostomy pouch when it is one third to one half full. The smaller a colostomy pouch is, the more often it will need to be emptied.

Colostomy specialists will assist in deciding which type of colostomy bag suits the individual needs of a person. Factors that will be considered in helping a person choose the right kind(s) of bag for them include: 7

• Where the stoma is in relation to the rest of the person’s digestive tract. This helps determine the volume of waste output. The higher up the digestive tract the stoma is, the greater the volume of waste output will be.
• What kind of procedure the person had and how much of their gastrointestinal system will still be functioning as normal when the bag is in use, which will help determine the volume of waste output and the expected firmness of stools. In general, the smaller the section of the colon that is removed, the firmer a person’s stool will be.
• Their lifestyle, including diet and physical demands of daily life, as well as any environments or activities that may require a particular size or style of pouch. For example, a person wearing tight-fitting clothing may prefer a less bulky option.

All colostomy bags are designed to be changed and replaced regularly, but some types need to be changed more often than others. Choosing which type of colostomy bag to use is largely a matter of preference. Many people swap between different types, depending on their day’s activities.

The two main types of colostomy bag, both of which come in a wide range of sizes and capacities, are:

These are designed for one-time use. They are often fitted with a filter designed to reduce gas buildup and prevent odors. Changing a closed-end pouch can be done as often as a person wishes and involves discarding the used pouch in a disposable bag, which is often provided with the pouch, and attaching a new pouch to the stoma.

Many people who have undergone a colostomy choose to use closed-end pouches every day. Others choose to use them at certain times, e.g., for going to the beach or before sexual activity, when having a fresh/empty pouch may be considered ideal.

Rinse-and-reuse drainable pouches are suitable for people who have had all types of colostomy and ileostomies. They can be emptied into the toilet as needed and can be cleaned with water if necessary and resealed with a clip or velcro fastening.

Many people prefer drainable pouches to single-use, closed-end pouches, as they do not need to be changed as often, and are therefore more economical and environmentally friendly.

Drainable pouches are usually fitted with a filter to reduce odors and drain gas. A drainable pouch should be discarded and replaced with a new one every three to four days. The functionality of the filter may decrease after this time, increasing the possibility that the bag could begin to smell. Furthermore, although it is easy to keep the outer parts of drainable pouches clean, changing the appliance regularly reduces any potential buildup of bacteria and minimises the risk of infection around the stoma.

Good to know: People who have undergone an ileostomy often choose to use a drainable pouch in everyday life and a closed-end, single use pouch for particular occasions only. This is because a high volume of liquid stool is normal following an ileostomy. Many people find changing a single-use bag on a frequent basis costly and inconvenient.

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: 8

1. Thoroughly wash your hands using antibacterial gel or soap.
2. Gently ease the pouch from the stoma, using adhesive remover to help if necessary.
3. 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.
4. Clean the stoma with warm water and mild soap and thoroughly dry with a dry wipe.
5. Prepare the new pouch by removing the protective cover from the flange.
6. Place the flange over the stoma, ensuring there are no creases.

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.

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: 9

• 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, such as 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.

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
• Specially designed swimsuits

A healthy sex life is generally possible for people 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 person’s requirements. When running low, the prescription can be taken to a doctor or pharmacy for replenishment of all essential items.

Good to know: It is usually possible to obtain a certain amount of free supplies on a long-term basis on prescription from one’s national healthcare provider. The National Health Service (NHS) in the U.K. recommends a monthly allowance of 30 to 90 single-use bags or 15 to 30 drainable (ileostomy) bags, and around 15 flanges. 10 Medicare in the U.S. offers a policy that covers around 80 percent of the cost of a person’s supplies after a doctor has confirmed the specific items and quantities required. 11

• Stoma bag
• Ostomy bag

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. 12 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. This is 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
• 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 with their previous experiences of managing Crohn’s disease. 13

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.

Q: How can I learn to be comfortable with the idea that using a colostomy bag will be part of my life on a long-term or permanent basis?
A: There are many support groups, online and in real life, that exist specifically to help people who are new to using a colostomy bag adjust to the lifestyle changes that it necessitates. Social networks that help people connect with others who use colostomy bags are specifically designed for sharing tips and techniques to help people overcome any misgivings that they may have and to promote awareness that it is possible to live a normal, happy life after a temporary of permanent colostomy.

Dedicated websites and forums, such as More Than Your Bag, Coloplast and Living with a Stoma encourage people with all types of colostomy bags to share success stories. These personal narratives are intended to inspire others to feel positive about the improvements that their colostomy and use of a colostomy bag have brought to their health, rather than feeling disappointed about needing to use one.

Furthermore, over the past few decades, an increasing number of celebrities with colostomy bags and ostomies have spoken out about their usefulness. 14 This has further helped to normalize the idea that a person may require colostomy surgery during their lifetime. Furthermore, these stories help to show that everybody who undergoes a colostomy can go on to use their bag without problems and with a positive mindset, embracing the freedoms it offers.

Q: What is a colonoscopy bag?
A: There is no such thing as a colonoscopy bag, but it is very understandable to get confused, because colostomy and colonoscopy are such similar-sounding words. However, the definitions of these two procedures and their outcomes are very different. Simply put:

• A colonoscopy is a scanning procedure, in which a thin flexible tube with a camera on its end is inserted into the bowel via the anus and rectum. The only function of a colonoscopy is to provide images of the inside of the bowel. No changes to the body are made.
• A colostomy is a surgical procedure, in which an ostomy is created to provide an alternative means for waste to exit the body, temporarily or permanently. After a person has undergone a colostomy to create their ostomy, they will need to collect waste using a colostomy bag.

Situations in which a person may undergo a colonoscopy include:

• Diagnosis: Doctors may wish to see the inside of the bowel in order to find out more about what might be causing a person’s symptoms.
• Before surgery: It is standard practice for surgeons to perform a colonoscopy in the run-up to many kinds of colorectal surgery. People who undergo a colostomy very often have a colonoscopy beforehand.

Read more about preparing for a colonoscopy »

Q: Is it safe to wear a colostomy bag during a magnetic resonance imaging (MRI) or computed tomography (CT) scan?
A: Yes, in some cases. When undergoing an MRI scan, it may not be possible to wear certain types of bag and flange which use magnets in their mechanism of attachment. This is because bringing magnets into the scanner can disrupt the imaging process and, furthermore, can compromise the magnetism of the device. However, it will be possible to check with your doctor and the radiology team in advance of the scan whether your colostomy appliances are suitable.

People who use a colostomy bag and who are undergoing a CT scan with the use of contrast material should inform the person who will be performing the scan in advance. For all types of imaging scan, people who use a colostomy bag, are encouraged to bring spare supplies with them on the day of the scan in case a fresh bag is required.

Q: What is a colostomy bag cover?
A: Feeling positive about the way that your colostomy bag looks is a key means of eliminating any negative impact it may initially have on your lifestyle or choice of activities. There are many companies which make attractive covers for colostomy bags out of different materials, and it is possible to order covers that are custom-made from the material of your choice.

Covers can be useful in situations such as going exercising or to the beach. If you would prefer not to display the bag itself, which may be visible in swimwear or sportswear, wearing a cover removes the need to wear extra clothing for this purpose.

Many outlets specialize in colostomy bag covers for specific types of activity, for example, purpose-built swimwear or underwear-style covers for intimate occasions. These can easily be purchased online. It is also possible to make colostomy bag covers oneself, using a sewing pattern to ensure accurate sizing.