Colostomy Bags are appliances that collect stools from the digestive tract through an opening in the abdomen (stoma). After the surgery, patients should receive information about the prescribed ostomy system and available supply options for their colostomy. Normally, the hospital provides the initial ostomy kit as part of the treatment service. Patients may continue with this system or explore other options; it is a matter of personal convenience.
Once at home, selecting a new bag for the first time could be overwhelming. Patients should consult an ostomy nurse to find an appliance that suits their needs and circumstances. Understanding the basics of pouching systems eases the process and induces self-confidence. Use this resource to learn more about the options available.
Learning the Terminology
“Colostomy is the exteriorization of part of the colon to the anterior abdominal wall. It is one of the most common life-saving emergency procedures done worldwide. A colostomy may be done for emergency or elective surgical conditions for the management of a wide range of congenital and acquired benign or malignant gastrointestinal conditions for two main purposes: diversion of the colon or decompression of the colon. Diversion is done to protect the contamination of the distal large bowel segment by stool and its attending complications. Diversion is done commonly for trauma or distal rectal elective surgeries. Decompression is done to relieve obstructed large bowel. Examples include sigmoid volvulus and malignant left side tumors.”1
Clarification on terminology may help patients understand how colostomy bags work. “‘Bag’ or ‘pouch’ refers to the part that collects waste. ‘Flange’, ‘barrier’, ‘wafer’ or ‘faceplate’ all refer to the part that sticks to your body. The general term ‘pouching system’ refers to the entire system (one or two-piece) that is used. The general term ‘appliance’ is also sometimes used. Pouches (or bags), whether they are one or two-piece can also come in ‘closed-end’ or ‘drainable’ models. A drainable pouch has a clip or velcro closing on the end that can be undone to release waste. A closed-end pouch has no opening or clip, and is removed and discarded instead of emptied. Many pouches are now made with filters near the top which allow gas to escape without odor. The material that the barrier (or flange) is made out of can come in different types, too. Some are called standard wear and others are extended wear. In general, a standard wear barrier is used when stool is semi-formed or formed. An extended wear barrier is usually used when a stoma drains urine or stool that is loose or liquid. The extended wear barrier does not break down like a standard wear barrier when it comes in contact with liquid waste.”2
“An ostomy pouching system consists of the odor-proof pouch, the skin barrier, and water-resistant tape. The pouch is available in several lengths and materials. A pouch with an integrated closure (built onto the bottom of the pouch) prevents issues such as loss of the closure piece. The skin barrier is a flexible hydrocolloid adhesive that is either precut or cut-to-fit at the skin stoma junction. A snug fit prevents the stoma effluent from making contact with the skin. The hydrocolloid adhesive erodes with moisture; pouch wear time is generally 4 days to prevent chemical irritation from leakage. The cut-to-fit skin barrier allows precise adjustments as postoperative edema recedes and the required aperture size evolves. In some settings accessory products, such as skin barrier paste or skin barrier rings, to enhance the seal are applied around the stoma.”3
What are the Available Choices for Colostomy Patients?
- Colostomy patients who do not irrigate have the same choices available for those with an ileostomy. However, colostomy patients produce more solid waste, so they lean towards closed ostomy bags.
- Additionally, colostomy patients might select charcoal filters to absorb odor and release gases. The odor is one of the top impediments that ostomy patients face before re-entering the social scene. Gases require evacuation to avoid a “ballooning effect”, where the bag inflates and becomes more evident.
- Colostomy patients who irrigate may replace bigger size ostomy bags for a stoma cap or a mini-pouch. Irrigation provides free movement and can make evacuation more manageable.
Considerations When Using A Colostomy Bag
- New colostomy bag users should consult with an ostomy nurse the right fit for your situation, in terms of stoma size, stoma shape (retracting, telescoping, flushing), and peristomal skin anatomy.
- For one-piece-colostomy systems, you must change the whole unit. Instead, with two-piece systems, you only have to change the wafer, so the whole system requires fewer changes. If there is a leak from under the wafer, change the bag/wafer.
- Replace the bag or wafer if there is pain or itch.
- In case of fever, the colostomy wafer will deform, requiring additional changes.
- The patient will require frequent changes when the surgery is recent (every two days or more) Never use the same colostomy bag for more than 7 days.
“A new ostomate initially needs to acquire the basic skills of emptying and changing the pouching system. Caregivers and loved ones are also encouraged to apprentice during teaching sessions. The technique initially taught to the patient should closely replicate how the patient will eventually empty the pouch following hospital discharge. The end of the pouch is held cephalad to the stoma, and opened and directed into the toilet between the patient’s legs to allow stool drainage. Once the pouch is emptied, the end is cleansed with toilet paper and resealed. Since water and detergents soften pouch adhesive and shorten wear time, washing the pouch is not advised. Since a heavy, over-filled pouch can pull away from the skin, the pouch may need to be emptied six or more times daily. Therefore, emptying the pouch is a critical skill to learn before discharge. Ideally, an initial demonstration of changing and applying the pouching system is provided the first day after surgery. Pain, apprehension, and preoccupation with viewing the stoma at first may limit knowledge recall after the first lesson, but by the second lesson, the patient ideally participates in and can demonstrate all steps. At home, the newly discharged ostomate applies stoma care techniques learned during inpatient teaching sessions. Home care nursing should coincide with pouch changes to help bridge toward independent self-care. The patient should be discharged with extra pouching systems with complete specific manufacturer ordering information including product numbers, web site URLs, and telephone numbers. Advise the patient to check with his/her insurance provider about reimbursement criteria.”4
Two-Piece vs One-Piece Pouching Systems
“A two-piece appliance is composed of two parts: the flange, which sticks to your skin, and the pouch, which snaps or sticks onto the flange. A one-piece appliance has the flange combined with the pouch.”5
- Most two-piece systems allow gas to escape. This is a useful feature for ileostomates and colostomates who find that filters spoil once dampened.
- The patient can switch to a smaller or larger pouch without having to change the entire flange
- Some systems have a ‘floating flange’. a type of flange with an extra flexible join at the circular ring. It is convenient for those with impaired hand dexterity and struggle snapping a pouch onto a flange; or for those with a tender abdomen, so pressing down to attach a pouch is uncomfortable.
- Two-piece systems are bulkier and more visible under clothing. New , thin and flexible flanges solve this problem.
- The convex models are rigid and more difficult to couple
- It may require additional appliances to match and purchase.
- Fewer components to purchase and wear
- Soft convex systems are now available
- They are lighter, more flexible and have a lower profile under clothing
- Does not evacuate gas
- One-piece closed-end systems might cause more expenses as they are disposable.6
“A variety of specialized stoma supplies are available, but all may not be necessary. In facilities where stomas are infrequently created, a “universal” cut-to-fit extended wear drainable clear pouching system with integrated closure accommodating stomas 22 to 64 mm in diameter can accommodate most ostomates while minimizing stocking costs and confusion. An essential accessory item to stock is a skin barrier ring that can be stretched and molded. This ring can be custom fit around the stoma or cut into small pieces to fill in irregular contours. Two may be stacked together to create a convex surface if the skin around the stoma is retracted or if the stoma lumen is not centrally located. These two items will allow for successful pouching in a large majority of patients with fecal stomas.”7
Considerations on Stoma Care and Colostomy Bags
“Excellent perioperative stoma care and education are essential for ostomates to feel confident in caring for and changing their pouching systems and to avoid dehydration. Many peristomal skin conditions are entirely preventable with meticulous skin and pouching system care. A variety of skin problems, some related to underlying disease and others related directly to issues with stoma care, require treatment either by a WOC nurse or an experienced physician. Those who create stomas should also be able to troubleshoot the issues their patients experience in the immediate postoperative period and beyond. Follow-up is critical for the patient with a new stoma both to educate the patient in correct stoma care and for early identification and treatment of peristomal skin conditions.”8
Finding the right ostomy supplies for your particular lifestyle and stoma condition improves your quality of life as a colostomy patient. You will find alternatives from different ostomy suppliers and brands. Consult with an ostomy nurse before purchasing, and select the one that suits your needs.
(1) Types and Indications of Colostomy and Determinants of Outcomes of Patients After Surgery. Engida, A., Ayelign, T., Mahteme, B., Aida, T. & Abreham, B. Ethiopian Journal of Health Science. 2016. https://www.researchgate.net/publication/301277428_Types_and_Indications_of_Colostomy_and_Determinants_of_Outcomes_of_Patients_After_Surgery
(2, 5, 6) A Handbook for New Ostomy Patients. Vancouver United Ostomy Association Chapter Inc. Southern Ontario Edition, 7th edition. 2017. https://www.ostomyhamilton.com/wp-content/uploads/handbook/A%20Handbook%20for%20new%20ostomy%20patients.pdf
(4, 7, 8) Intestinal Stomas—Postoperative Stoma Care and Peristomal Skin Complications. Steinhagen, S., Colwell, J. & Cannon, L.M. Clinics in Colon and Rectal Surgery. 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498169/pdf/10-1055-s-0037-1598159.pdf