An ostomy pouch (colostomy bag) is a medical device used to collect bodily waste after a surgical procedure diverts a part of the colon to an opening in the abdominal wall called a stoma. The pouching system adheres to the skin around the stoma, providing a secure way to manage output. The goal of a colostomy is to allow the digestive system to function while the body heals or to manage a permanent condition.
Standard Guidelines for Emptying Frequency
The most important rule for colostomy management is to drain the contents of the pouch when it is approximately one-third to one-half full. Waiting until the pouch is fuller than this significantly increases the risk of complications. The sheer weight of a full pouch can create tension, pulling the adhesive skin barrier away from the abdomen and potentially leading to leakage.
Regular emptying also prevents the pouch from bulging noticeably beneath clothing, contributing to discretion and comfort. For a typical colostomy, where the output is usually more formed and predictable, the frequency of emptying may range from one to three times per day. However, depending on the individual’s routine and output volume, some people may find they need to empty the pouch six to eight times daily.
Factors Influencing Output and Emptying Needs
The nature and frequency of colostomy output are influenced by several factors. The location of the stoma in the colon is a major element, as waste becomes progressively firmer the further it travels through the large intestine. An ascending or transverse colostomy, positioned earlier, typically produces softer, more liquid waste requiring more frequent drainage than a descending or sigmoid colostomy.
Dietary choices and hydration levels play a substantial role in determining both the volume and consistency of the output. Foods high in fiber, gas-producing items, or those with a laxative effect can increase output, necessitating more frequent emptying. Conversely, foods like rice, bananas, and starchy items can help thicken the stool, potentially reducing the need for drainage.
Certain medications or illnesses can cause a temporary or chronic increase in output. A high-output stoma, defined by an output exceeding 1.5 to 2.0 liters per day, is a serious condition that dramatically increases the frequency of emptying. This excessive, watery output is often associated with rapid transit through the digestive system and carries a risk of dehydration and electrolyte imbalance.
The Process of Emptying the Pouch
Emptying the pouch is a routine procedure requiring simple supplies like toilet paper and possibly a disposal bag for used wipes. Positioning is a matter of personal comfort, but adopting a stance that provides a clear view and minimizes splashing is recommended. Options include sitting far back on the toilet seat, standing over the toilet, or sitting backward on the toilet.
The drainable tail or spout at the bottom of the pouch must be unrolled or unclipped over the toilet bowl. Placing a small amount of toilet paper in the toilet water beforehand can help prevent splashing during the drainage process. Contents are gently squeezed out of the pouch, running fingers down the sides to ensure complete evacuation.
After the pouch is empty, the inside and outside of the tail must be carefully wiped clean with toilet paper or a moist wipe. This step is important for preventing odor and maintaining a secure seal when the pouch is closed. The tail is then securely re-rolled or re-clamped, ensuring the closure is flat and watertight.
Distinguishing Emptying from Full Pouch Changes
Emptying refers to draining waste through the opening at the bottom of the pouch, a process done multiple times daily that does not involve removing the adhesive barrier from the skin.
A full pouch change involves removing the entire system—the pouch and the skin barrier (wafer)—from the abdomen. This maintenance task is performed less frequently, typically every three to seven days. The purpose of a full change is to maintain the integrity of the skin barrier, preventing adhesive breakdown and protecting the skin around the stoma from irritation.