Several questions may arise after an ostomy surgery, about intimacy, hygiene or how to empty and clean an ostomy bag. Unless your ostomy nurse tells you differently, emptying and cleaning your pouch is an easy task you can perform on your own, but it requires practicing an appropriate technique for you.
“An ostomy can be deﬁned as any surgical procedure resulting in the external diversion of feces and urine through a stoma. The most common ostomies are a colostomy and ileostomy for diversion of the fecal stream, and urostomy for diversion of the urinary stream. Persons living with ostomies require specialized care and management to sustain physical health and quality of life (QOL). The provision of specialized ostomy care begins preoperatively and continues throughout the postoperative and rehabilitative period and throughout the patient’s lifetime with an ostomy. Ongoing stoma and ostomy appliance sizing, the treatment of peristomal skin complications, ostomy appliance modiﬁcations, access to ostomy products and financial assistance, dietary consultation, and emotional support are just a few of the health management issues that require ongoing management following creation of an ostomy.”1
Adapting to Living With A Stoma is The First Step
”Once the ostomate is discharged home, the actual learning-to-live-with-the-stoma process begins. All advice is general and may need to be specifically tailored for the individual ostomate. If in doubt, the stoma specialist nurse can be contacted for further advice by the community nurse or the ostomate. Some ostomates have problems adjusting to life with a stoma and the community nurse will possibly be the person contacted or who notices the problem. It is ideal when visiting and assessing an ostomate in the community to try and ensure that holistic care is provided. However, this is not always easily achieved when there are limited resources and a lack of familiarity with stoma care can result in caution on behalf of the nurse.”2
“Most ostomy bags are disposable, but some are reusable. To reuse a bag, drain the fecal material (or urine from a ureterostomy) by placing the clamp end of the bag over a bedpan. Then release the clamp and allow the fecal material to empty into the bedpan. Wash the inside of the bag with soap and water and allow it to dry before reapplying the bag. Most people use a second bag while the first bag is drying.”3
Emptying a Kock Pouch
“One special form of ostomy is Kock continent ileostomy. A reservoir (the Kock pouch) fitted with a stop valve is brought out as a shallow ostomy in the abdominal wall. The valve prevents continuous leakage of stool, thus rendering the patient continent. The pouch is emptied by self-catheterization, enabling the patient to live without an ostomy bag. Literature reports show that patients with a Kock pouch are much more satisfied and have a greatly improved quality of life. However, it has to be mentioned that the creation of a Kock pouch is associated with an elevated revision rate; in some cases, the pouch even has to be removed.4
Emptying and cleaning ostomy bags involves numerous steps. The following are some tips that you can apply at home or elsewhere.
Tips on How to Empty and Clean a Drainable Ostomy Bag
- Always carry a new pouch and wafer with you for replacement. Use toilet paper or a clean cloth or wiper to clean the bag. If you are out, also have a toilet seat cover as part of your ostomy kit.
- When you are ready to empty the bag, choose a position that is comfortable for you. You can stand, sit or kneel in front of the toilet to let the pouch contents out, depending on your personal preference.
- Do not place an excessive amount of toilet paper on the toilet because this may cause it to overflow. Also, try to avoid toilet water splashing on you or your clothes.
- Clean your pouch outlet with toilet paper or a dry cloth to prevent soiling your abdomen and hands.
- If you are quantifying bag content, place an appropriate container beneath the bag outlet. Otherwise, empty the output straight down the toilet. Place the bag between your index and middle finger and slide fingers down until stool comes out of the bag. You can also use clips to empty the bag. Once you finish quantifying, empty the content into the toilet, wash the container and store it.
- When the bag is empty, fill it about one third with water and gently stir it. Rinse once or twice. Wipe the inside of the bag with toilet paper before adding a deodorant, if desired.
- Wipe the pouch outlet with toilet paper or a clean cloth and seal it again. Discard the toilet paper. Avoid filling up the bag with air, this often causes leakage, which implies more cleaning. Do not forget to thoroughly wash your hands again before leaving the washroom.
Cleaning the Pouch
“Most pouches are odor-proof if cleaned properly. Each time the pouch is emptied, put on gloves and follow these directions.
- Remove the pouch from the appliance attached to the skin.
- Fold back the end of the pouch (like a cuff) before emptying to prevent additional fecal material from collecting at the bottom, causing odors.
- Empty contents into the toilet.
- Rinse inside of pouch with warm water.
- Wipe the last 2 inches (10cm) of the pouch with toilet tissue to remove any fecal material.
- Uncuff the end of the pouch and put on the clamp.”5
When to change the pouching system
“It’s best to have a regularly changing schedule so problems don’t develop. Different pouching systems are made to last different lengths of time. Some are changed every day, some every 3 days or so, and some just once a week. It depends on the type of pouch you use.
There may be less bowel activity at certain times in the day. It’s easiest to change the pouching system during these times. You may find that early morning before you eat or drink is best. Or allow at least 1 hour after a meal, when the digestive movement has slowed down. Right after surgery, ostomy output may be thin and watery. As the output gets thicker, you’ll be better able to find the best time for changing your system.”6
Changing the Ostomy Appliance
- “Wash hands and put on gloves.
- Empty the appliance prior to changing it.
- Remove the old appliance using the “push-and-pull method,” in which you gently push the skin away from the appliance while pulling the wafer (the adhesive part of the ostomy appliance, which is attached to the skin) in the other direction. Place the used appliance in a disposable bag.
- Cleanse the skin surrounding the stoma with a wet washcloth or paper towel. Do not use creams or alcohol-containing products. Dry well.
- Assess the skin around the stoma.
- Measure the stoma using the stoma measuring guide. The stoma should be measured every time the ostomy appliance is changed during the first eight weeks after surgery, during which time the stoma size will decrease. Using the measuring guide, outline the size of the stoma on the wafer.
- Cut the wafer to match the measured size of the stoma.
- Warm the ostomy wafer by placing it under your arm and against your body for 30 seconds, or longer on cold days. (This step may be unnecessary with some appliances. Refer to the manufacturer’s recommendation.)
- Place the wafer over the stoma and against the skin. Ensure that the end of the ostomy appliance is closed.
- Dispose of any soiled materials; remove gloves and wash hands.”7
Adapting to life with an ostomy is challenging. But with adequate guidance, information, and experience, cleaning the pouch will be effortless. Now, you are ready and have a few tips on how to empty and clean an ostomy bag.
(1) Recalla, S., English, K., Nazarali, R., Mayo, S., Miller, D., & Gray, M. (2013). Ostomy care and management: a systematic review. Journal of Wound Ostomy & Continence Nursing, 40(5), 489-500. Available online at https://www.researchgate.net/publication/251568692_Ostomy_Care_and_Management_A_Systematic_Review
(2) Burch, J. (2011). Resuming a normal life: holistic care of the person with an ostomy. British journal of community nursing, 16(8), 366-373. Available online at https://pdfs.semanticscholar.org/20fe/fe3fae8a1edf50a6defe7b668b09e4aa556b.pdf
(3) Simmers, L. M. (2008). Diversified health occupations. Cengage Learning. Available online at https://books.google.co.ve/books?hl=es&lr=&id=5egFAAAAQBAJ&oi=fnd&pg=PT3&dq=Diversified+Health+Occupations+Por+Louise+M+Simmers&ots=9i1hk44eX0&sig=2QSMYgauPeR4VI-vQ-VdjLO3w9M&redir_esc=y#v=onepage&q=Diversified%20Health%20Occupations%20Por%20Louise%20M%20Simmers&f=false
(4) Ambe, P. C., Kurz, N. R., Nitschke, C., Odeh, S. F., Möslein, G., & Zirngibl, H. (2018). Intestinal Ostomy: Classification, Indications, Ostomy Care and Complication Management. Deutsches Ärzteblatt International, 115(11), 182. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913578/
(5) Birchenall, J. M., & Streight, E. (2014). Mosby’s Textbook for the Home Care Aide-E-Book. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?id=HLjwAwAAQBAJ&pg=PA283&dq=cleaning+an+ostomy+bag&hl=es-419&sa=X&ved=0ahUKEwi7g5TlqJviAhUoVd8KHWg2BBkQ6AEIMDAB#v=onepage&q=cleaning%20an%20ostomy%20bag&f=false
(6) United Ostomy Association of America (2019). Caring for a Colostomy. American Cancer Society. Available online at https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/colostomy/management.html#references
(7) Kirkland-Kyhn, H., Martin, S., Zaratkiewicz, S., Whitmore, M., & Young, H. M. (2018). Ostomy care at home. AJN The American Journal of Nursing, 118(4), 63-68. Available online at https://journals.lww.com/ajnonline/Fulltext/2018/04000/Ostomy_Care_at_Home.35.aspx