Most ostomy patients worry about life after an ostomy. What will it be like? Will I have to change a colostomy bag in public? How do you manage life with a bag attached to your belly?
Whether your ostomy is temporary or permanent, there’s a lot to learn. But within a few weeks, most patients are pros.
After an ostomy, you can do everything you did before. You just have to learn some of the basics covered here. "You should be able to live the same life," says colorectal surgeon Charles Friel, MD.
Stomas, and Pouches, and Wafers, Oh, My!
So, you have a stoma — that raised, pinkish-reddish opening on your belly that connects part of your colon to the outside world. A sturdy colostomy bag hugs your belly. It’ll hold poop and fluids that come through the stoma until you can get to a toilet.
Common pouching systems have a flat or curved baseplate called a wafer. This firm surface connects to the pouch and sticks to your belly. You can get pouch covers or belts for extra support.
At UVA Health, we provide a support team and a class to get you started. It’s OK if it still feels a little weird. But as Friel notes, most people tell him, "It's not as bad as I thought it would be."
Who Needs to Know?
Tell your healthcare providers and pharmacists about your ostomy. It affects treatment plans and changes how your body absorbs medicines and nutrients. Your providers may recommend diet tweaks or options like time-release capsules.
After that — beyond your spouse and family — it’s up to you. You may tell a few trusted friends. Most pouches are odor-free and invisible to others.
You can tell curiosity-seekers you had abdominal surgery, without details. You might choose to join friendly support groups. Some people reach out to encourage and educate others in person or online. You decide what you’re comfortable sharing.
A Good Fit
Newbies know your stoma-bump can poke through a pouch-opening called a wafer. Of course, pouching-styles vary. And some stomas shrink as they heal. If yours does, make an appointment with your ostomy nurse for a refitting.
You shouldn’t need another refit unless you gain or lose weight. Tell your providers if you have changes or challenges, such as discomfort or leaking.
Emptying Your Pouch
Pouch-emptying steps depend on your pouching system and type of ostomy. Follow your nurse’s instructions closely. Ask questions until you’re comfortable with your routine.
After a colostomy, you may have one or more bowel movements a day, with some fluids. Some ostomy types have high liquid-waste outputs. You empty them more often.
When properly fitted, ostomy pouches prevent leaks. Even so, it’s best to prevent over-filling. Emptying more often also helps prevent skin irritation or leaking.
- Try to empty the pouch when it’s about a third of the way full.
- Empty your bag first thing in the morning and check it throughout the day.
- Get in the habit of emptying your bag before you leave home.
- Empty the bag before you go places where you can’t easily reach a bathroom.
Wash your hands with soap and water. Dry them well before you empty the pouch. If you have a bag with a clamp on the bottom, you can sit on or near a toilet, or stand. Remove the clamp and slowly drain the pouch into the toilet.
Some bags detach and have an opening at the top. Others have a rolled or folded “tail” with adhesive. Once you open the bag, slowly empty fluids and waste into the toilet.
Clean the bag with wipes, toilet paper, or paper towels. Then, replace the clamp or close it, using adhesive or other types of closures. Toss or flush disposables. Wash your hands thoroughly with soap and water.
How to Change a Colostomy Bag
Most people change an ostomy bag every 3 to 5 days or longer, depending on the pouching system and type of ostomy. Organize supplies in ways that work for you. Every pouching system is different. Your care team will show you how yours works.
Gather Supplies
Typical supplies include:
- Disposable plastic bags
- Ostomy wipes
- Soft cloth or paper towels
- An old towel to stand on
- Toilet paper
- Tissues or cups to catch stoma drainage
- New pouch
- Stoma powder or paste, and ostomy skincare products
- Clean hand-towel or paper towels
- Scissors, if needed
- Stoma ring seal, depending on your pouch style
- Stoma-measuring cards and pen, depending on your pouch style
Change Your Pouch
Use soap and scrub up.
- If you have a ring-seal around your stoma, remove the ring.
- Remove your pouch. Keep the clip if it has one.
- Put the pouch in a bag and throw it in the trash.
- Clean the stoma and surrounding skin with warm water and a clean cloth.
- Pat skin dry with a fresh towel.
- Throw disposables in the trash.
- Wash and dry hands well … again!
When the Doctor Becomes the Patient
He's treated people with colorectal cancer for years. Then it was his turn.
Examine & Treat the Area
Your stoma should be pink or red and moist. A little bleeding is OK. Tell your provider if you see black, blue, or purple skin; a sore; or a rash. Your care team will tell you when to contact your provider. Your nurse will teach you about pouching systems and where to find them.
If it’s a one-piece pouch:
- Measure the stoma with a measuring card from your nurse or suppliers.
- Select the circular “ring size” cut-out opening that fits your stoma. Mark it with a pen.
- Using that circle as a stencil, trace it onto the wafer area on the back of your pouch.
- Cut the traced line to create a wafer opening to fit around your stoma.
- Remove your wafer’s backing to expose the adhesive.
- If you’re using a protective barrier-ring between your wafer and belly, remove the backing on both sides to expose its adhesive.
- Stretch the barrier-ring to fit the hole before sticking it to the back of your wafer.
- Place the pouch on your belly so your stoma pokes through the wafer.
- Hold the pouch down for about 30 seconds until it’s firmly attached to your skin.
- Remove the backing from the border-tape around your wafer and press it down.
- If your pouch opens at the bottom, make sure it’s closed before rolling or folding the hanging “tail” upward.
- Some styles have Velcro, adhesive, clips, or other ways to close the bag.
Ostomy Clothing
You can keep most of your favorite threads. Unless you wear clingy tops, a pouch isn’t noticeable. Some people prefer baggy clothes or clothes with a higher waistband. For added support, you can wear stretchy underwear that holds the pouch in. Lined swimsuits also conceal a pouch (yes, you can still go swimming with an ostomy bag!).
You can shop for post-ostomy underwear, swimwear, and sportswear. They’ll provide extra support and a slimming appearance.