A colostomy is a surgical procedure that creates a new pathway for waste to exit the body. This process involves bringing a section of the large intestine through an opening in the abdominal wall, known as a stoma. Since the stoma does not have a muscle to control the release of stool, an external collection device, called a pouching system or colostomy bag, is required to manage the output. Routine emptying is necessary for hygiene and comfort.
The Primary Rule: Determining When to Empty
The frequency of emptying a colostomy pouch is determined not by a fixed schedule but by the volume of contents inside the bag. The primary rule is to empty the drainable pouch when it is approximately one-third to one-half full. This optimal fill level prevents the pouch from becoming too bulky or noticeable under clothing, which can impact discretion.
The rationale behind the one-third to one-half rule is directly related to the integrity of the adhesive seal. As the pouch fills, the increasing weight of the stool exerts downward tension on the skin barrier, which can pull the appliance away from the skin. If the pouch becomes too heavy, the seal may loosen or break, leading to leaks and potential skin irritation around the stoma. Emptying the bag also helps to manage gas buildup and reduces the risk of the pouch ballooning, which can also stress the seal.
While most emptying occurs during waking hours, individuals with a high output may need to wake up to empty the pouch overnight. Emptying should also be performed immediately following any large bowel movement to prevent the pouch from rapidly reaching a full state. Establishing a routine around this fill level helps maintain a secure seal and protects the skin from prolonged exposure to effluent.
Step-by-Step Guide to Emptying the Pouch
Prepare the area by sitting on or next to the toilet, or by sitting backward on the toilet seat, which provides a clearer view and better aim. Placing a few pieces of toilet paper in the toilet bowl water before starting can help prevent splashing when the contents are released.
Next, the closure at the bottom of the pouch, often called the tail or spout, must be carefully unrolled and opened. The end of the pouch is then lowered and directed into the toilet bowl. Gently sliding fingers down the length of the pouch helps to push out all the stool, ensuring a complete drain.
Once the pouch is empty, the inside and outside of the tail must be cleaned thoroughly using toilet paper or a disposable wipe to remove any residual stool. This step is important for preventing odor and maintaining a secure closure. Finally, the tail is resealed by rolling or clamping it shut, depending on the system’s design, and then tucked away for discretion.
Factors That Influence Output Frequency
Diet plays a significant role, as the consumption of high-fiber foods, gas-producing vegetables, or large quantities of fluid can increase the volume and looseness of the output. Conversely, foods like bananas, rice, or starchy carbohydrates can help thicken the stool, which may reduce the number of times the pouch needs to be drained.
Medications, such as laxatives or certain antibiotics, can also temporarily increase bowel activity and output volume. Stress and anxiety are known to influence digestive function, which can lead to changes in the frequency of stoma output. The specific location of the colostomy along the large intestine also affects stool consistency, with a descending or sigmoid colostomy typically producing firmer output that requires less frequent emptying, often one to three times a day.
Distinguishing Emptying from Changing the System
It is important to understand the difference between emptying the pouch and changing the entire pouching system, as these tasks occur on different schedules. Emptying, or draining the contents, is a routine task performed multiple times daily whenever the pouch reaches the one-third to one-half full mark. This process does not involve removing the adhesive part of the appliance from the skin.
Changing the system, however, involves completely removing the adhesive skin barrier, or wafer, and replacing it with a new one. The wafer is the part of the system that sticks to the skin around the stoma, providing a protective seal. This full change is typically done less frequently, often every three to seven days, to prevent irritation from frequent adhesive removal and to maintain skin health.