What Is an Ostomy Bag?
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Medically reviewed by Kumkum Sarkar Patel, MD
An ostomy bag is a waterproof pouch you wear on your skin to collect waste products like stool (poop) or urine. You may need an ostomy bag either permanently or temporarily after an ostomy surgery, which changes the way waste leaves your body.
During an ostomy surgery, the surgeon creates a new pathway for your waste by connecting an organ inside the body, such as the intestines or bladder, to the outside through a new opening called a stoma. You might need ostomy surgery when a digestive disorder, cancer, or other condition affects your bowel or bladder in a way that the organ no longer works properly.
After the procedure, stool or urine comes out of your body through the stoma, which is generally located on the lower abdomen (belly). The ostomy bag, also called an appliance or pouch, fits over the stoma to collect the waste products while keeping the skin around the stoma clean and healthy.
How Does an Ostomy Bag Work?
An ostomy bag collects waste that exits through your stoma. Unlike an anus or urethra (the tube through which urine leaves the body), a stoma has no muscle to control when or how much waste is let go. An ostomy bag sticks to your skin and covers the stoma so that whenever waste leaves the opening, the feces or urine gets collected.
As the waste collects in the ostomy bag, it moves toward the bottom of the pouch due to gravity. An ostomy bag can generally hold a good amount of waste—usually enough for a few hours, depending on your output. Once the bag is a third of the way filled, you need to empty the contents. You need to change the bag every 1-4 days.
The pouches used for ostomy bags are designed to prevent odors. Companies offer disposable and reusable options, so you can choose what works best for your daily routine. You can get ostomy supplies from medical supply stores or have them delivered to your home. Most health insurance plans cover the cost of these supplies.
Different Names
Ostomy bag is the overarching name. The exact name of the device you use will depend on the type of ostomy surgery performed:
Colostomy bag: During a colostomy, a stoma is created from the colon (part of the large intestine). Solid waste from the colon collects in the colostomy bag.
Ileostomy bag: An ileostomy involves creating a stoma from the ileum (part of the small intestine). The waste that passes from the intestines to the pouch is usually liquid or pasty.
Urostomy bag: A urostomy stoma allows urine to bypass the bladder and flow directly into the urostomy bag.
Types of Ostomy Bags
There are two ostomy bag systems: a one-piece and a two-piece. Both systems have a pouch that collects waste as well as a skin barrier (also called a flange, wafer, or baseplate) that sticks to the skin.
A one-piece pouch has the collection bag and skin barrier connected as one. To change it, you remove the whole unit and put on a new one. This system can be simple to use because there are fewer pieces to handle.
In a two-piece system, the skin barrier and pouch are separate. The skin barrier stays on your skin until it needs to be changed. The pouch connects to the skin barrier, like how a lid fits onto a container. You can remove the pouch without taking off the skin barrier, which is helpful if you need frequent changes.
Some pouches have an opening at the bottom that you can unroll or unclamp to empty the waste into the toilet. These are called drainable pouches. Other pouches, known as closed pouches, don't have an opening. When they're full, you remove the entire pouch and replace it with a new one.
Choosing the Right Product
After your surgery, you may be referred to an ostomy nurse who can help you choose the most suitable ostomy bag. They can discuss the different types, sizes, and colors of ostomy bags available.
The following factors will be considered when selecting the right type of ostomy bag since they can impact the pouch's fit:
Your stoma's size and shape
The firmness of your stomach
The stoma's location
Any scars or skin folds close to the stoma
Your height and weight
Ostomy bags come in different sizes, such as small, large, and even a mini pouch. While the size of the ostomy bag depends on the amount of output you produce, personal preference can come into play as well. For instance, the mini pouch is less noticeable under clothes and may be handy during intimacy and exercise.
Personal preferences may influence the type of ostomy bag you choose. For instance, you may prefer a colorful bag you can't see through rather than a clear bag. Maybe you want a pouch that comes with pre-cut holes that fit around the stoma so you don't have to cut out holes in pouches yourself.
You may also want to select an ostomy pouch that:
Sticks well to your skin and can last up to three days
Blocks odors
Protects the skin around the stoma
Is nearly invisible under your clothes
Is easy to apply and remove
As you heal, you may need to try different types or brands of pouches to find the one that works well with your body and lifestyle. You can ask for samples to test before buying.
Related: What I Wish I Knew About Ostomy Surgery for My Crohn’s Disease
How To Use an Ostomy Bag
An ostomy nurse or other healthcare provider will show you how to remove, clean, and apply an ostomy bag.
Removal
To remove the ostomy bag:
Wash your hands well with soap and water, and dry them with a clean towel.
Empty the used ostomy pouch into the toilet.
Gently pull the removal tab down and away from your abdomen while supporting the skin with your other hand. Slowly peel the adhesive off, working from top to bottom. An adhesive remover can help make the removal process easier.
Place the old pouch in a disposable bag, and throw it away.
When the ostomy bag is off, check the stoma skin color. It should be pink or red. If the skin is purple, black, or blue or has a rash or open sores, notify your healthcare team. If the stoma looks normal, you can apply a new ostomy bag.
Application
To apply an ostomy bag:
Wipe around your stoma with a warm, damp cloth or oil-free wipe to gently clean the area. Pat dry.
If your ostomy bag is not pre-cut, use a measuring card (an index card with different-sized holes on it) to find the circle size that matches your stoma, making sure it fits snugly around your stoma. The opening in the skin barrier should fit snugly around your stoma, with no more than a 1/8-inch gap (about the thickness of two dimes put together). If the opening is too big, the waste could irritate the surrounding skin.
Trace the measured stoma size on the back of the skin barrier, then carefully cut along the line.
Make sure your skin is completely dry before applying the skin barrier.
Remove the paper backing from the skin barrier’s adhesive.
If using a drainable bag, close the bottom of the pouch with the clamp or Velcro before applying it to avoid any mishaps.
Center the barrier over the stoma, and press the adhesive to the skin, holding for a few minutes. Run your fingers over the skin barrier to ensure the adhesive seals.
For a two-piece system, attach the pouch to the barrier, making sure it adheres in place. A one-piece system comes preassembled, and you will not need to attach the pouch separately.
Wash your hands with soap and water.
Your ostomy bag will generally need to be changed every 2-4 days. A one-piece system may need to be changed every 1-3 days. An ideal time to change your bag is when your stomach is empty, such as first thing in the morning.
Some people, especially those with ileostomies, may choose to wear a belt to help hold the pouch in place and feel more secure.
Common Issues
Living with an ostomy bag can greatly benefit your quality of life since it can help with any hardships you might have had before the surgery, such as the urgency to use the bathroom. Still, it can have its challenges. You may be able to troubleshoot some of these issues yourself, but you may need help from a healthcare provider.
Here are a few common issues with ostomy bags and what to do about them.
Irritated Skin
The skin around the stoma can get irritated when waste gets on the skin or when tape and barriers pull off the top layer of skin.
What you can do:
Check that the barrier fits snugly around the stoma without exposed skin
Apply a light layer of skin barrier powder if the skin is irritated or wet, and brush off any extra powder before applying the pouch
Use skin barrier paste or a moldable ring to fill any gaps between the stoma and the barrier
Measure your stoma size each time you change the pouch for the first three months after your surgery, as the stoma size will likely change during that time
Barrier Won't Stick
The barrier might not adhere properly because of residue on the surrounding skin, sweat, or the incorrect barrier type based on the type of stoma.
What you can do:
Wash the skin around the stoma with soap and water, making sure there's no leftover residue
Let your skin dry completely before applying a new ostomy bag
Warm the barrier with a hair dryer on low for a few seconds before applying
Trim any hair on the surrounding skin
Use a light amount of skin barrier powder to soak up sweat
Try using a support belt or emptying your pouch more frequently
When To See a Healthcare Provider
You might have some complications with an ostomy bag. Call your surgeon or seek emergency medical care if:
Pus comes out of your stoma.
Your stoma color changes from bright red to dark purple, which could mean poor blood flow to the stoma.
You notice more than four tablespoons of blood in your urostomy bag.
You have chills or a fever of 100.4 degrees or higher.
You have ongoing nausea, vomiting, diarrhea, or signs of dehydration.
Your stool is looser than usual.
The surrounding skin is breaking down severely.
You have a lot of belly pain or bloating.
You haven't passed gas or stool for four hours.
The amount of stool in your pouch is significantly more than usual.
Living With an Ostomy Bag
As you adjust to life with an ostomy bag, be patient with yourself and lean on your healthcare team for guidance. Support can help you adapt to your new normal and lead an active life.
Feeling discouraged or alone is common. Start by talking to your partner, close friends, or family during your recovery. Consider joining a support group or talking to someone with an ostomy.
People with ostomies participate in a wide range of activities, including running, swimming, and skiing. Ask your surgeon about any activities that may not be safe. Many healthcare providers recommend avoiding contact sports due to the risk of injury to the stoma.
Ostomy surgery can affect intimate relationships, and you may feel self-conscious about your stoma. Your partner may also be concerned about hurting you or dislodging the equipment. Talk openly with your partner. Consider wearing intimate clothing like open panties or cummerbunds to secure the pouch and feel more comfortable.
Traveling
All methods of travel, including cruises and air travel, are possible with an ostomy bag. The key is to plan ahead:
Pack enough supplies to last the entire trip, plus some extras
Before long trips, find out where you can get supplies when you reach your destination
Wear seat belts comfortably and store your supplies in a cool area of the car
Pack your ostomy supplies in your carry-on luggage when flying.
A Quick Review
An ostomy bag is a pouch that collects waste from the body through an opening (stoma) that has been surgically created in the abdomen. You can choose from a one-piece or two-piece system, drainable or closed pouches. Choosing the right ostomy bag depends on the size and location of your stoma and your lifestyle.
Many ostomy bag-related issues can be self-managed, though some concerns, like severe skin breakdown, may need medical attention. With the right support and care, living with an ostomy bag can become a natural part of your daily routine, allowing you to enjoy your activities and relationships.
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