Having an ostomy requires psychological preparation and adaptation, but also creating new habits and adjusting to new daily tasks, such as cleaning your stoma or emptying your pouch. Not emptying an ostomy pouch in time is uncomfortable and risky in terms of leakage. It can also be painful because its weight will pull your skin down. Although emptying your pouch becomes an everyday duty, you will constantly find new tips to make it easier, faster, cleaner and safer.
“Ostomy surgeries such as colostomy (large bowel), ileostomy (small bowel), and urostomy (bladder), which require the use of an ostomy bag either temporarily or permanently, may result in a change in health-related quality of life as patients adjust to life with their ostomy.”1
Although emptying, cleaning and changing the ostomy pouch can be time-consuming, it also allows you to keep up with work and healthy social life. Having professional assistance at first may help you understand the emptying process. Proper guidance is important to begin adapting to the pouching system. “Without professional assistance, people with ostomies may have difficulty correctly fitting their pouching system. Accessories such as paste, rings, and adhesives may be used to ease fitting problems.”2
Aside from having professional assistance, you can follow these tips on how to empty your ostomy pouch.
Useful Tips for Ostomates
- Put toilet paper inside the toilet before you empty your bag to prevent unwanted splashes.
- If the stool is too thick, add some water and move your pouch a little to soften the stool and facilitate the emptying process.
- Carry a hand sanitizer or wet wipes with you to clean your hands after using water and soap, or if no soap is available at the time.
- Use thick toilet paper at home. If you use delicate thin ones, you will have to use more paper sheets.
- Watch your diet. “Dietary advice is an important aspect of patients with a stoma. The ostomy diet is necessary to keep stools normal following surgery since the amount, frequency and consistency of stool is influenced by the diet. It is important for healthcare professionals involved in the care of patients with a colostomy, ileostomy or urostomy to appreciate that stoma surgery changes the body’s usual processes of nutritional absorption and excretion; so that informed support and advice on the diet can be provided. Patients undergoing gastrointestinal surgery resulting in stoma formation are at particular risk as a result of the potential for preoperative malnutrition caused by the effects of their underlying disease and prolonged periods of fasting during the immediate pre- and postoperative period. Screening and monitoring of the nutritional status of individuals with a stoma should be an ongoing process, beginning preoperatively and continuing after discharge from hospital.”3
When to Empty Your Pouch?
“Wear time should be discussed with the patient. Wear time, the amount of time between pouch application and removal should be predictable. The factors that contribute to wear time are the type of stoma, the amount and volume of stoma output, the peristomal planes, the type and shape of the solid skin barrier, and the patient’s preferences. Most clinicians agree that minimal acceptable wear time is 3 to 4 days, but this may not always be achievable. Wear time can be evaluated by examination of the solid skin barrier. When the solid skin barrier is removed, the adhesive side is examined for erosion and possible undermining. If the solid skin barrier adhesive side appears intact, with little wear and no undermining, wear time can be extended. The same examination is performed at the next change until maximal wear time can be established.”4
What Time is Appropriate to Change the Pouch?
“Choose an appropriate time to change the pouch – avoid meal times and visiting hours to avoid loss of appetite or embarrassment. Ensure that the pouch is changed before mealtimes or well after administering bowel stimulating medications to minimize drainage occurring during the procedure. If possible, take the patient to the toilet to undertake this procedure. This reduces embarrassment and also supports learning to care for the appliance as they would at home. Provide Privacy. Position the patient appropriately – either lying down or standing upright (if possible), which helps to secure a tight adhesion of the seal and pouch to the peristomal skin.
Emptying a drainable pouch is done when the pouch is between one third and two thirds full of gas or excreta so that the weight of the bulk of the pouch does not break the seal around the stoma, which would allow excreta to contact the skin. Drainable pouches are left on the stoma for four days at a time unless there is leakage under the seal. If the patient must remain in bed or the amount of fecal material is to be measured, sit the patient over the toilet or the bedpan. Lift the tail of the drainable pouch to prevent spillage of the contents and release the clamp. Place the tail into the bedpan or the toilet and empty the contents. Remove any fecal matter from the outside of the tailor pouch using a disposable towelette or gauzes. Dispose of these into a moisture-proof bag. Reclamp the tail to the pouch if the appliance is still well adhered to the skin and there are no signs of skin irritation. If the appliance is to be changed, proceed as below. An air freshener may assist with any unpleasant odors.
One-piece, closed appliances must be removed daily (or following each bowel evacuation) to be emptied. To remove the pouch (and seal), peel the adhesive wafer off the patient’s skin while holding the skin taunt to minimize discomfort. Empty the contents of the pouch and fold the pouch over on itself to prevent leaks. Dispose of the pouch into a moisture-proof bag. Place gauze or tissue over the stoma to absorb any liquid that emerges.”5
Beware of any leakage inconvenience in or out of your house, ensure you empty your pouch when it is 1/3, max 1/2 full.
How to Empty Your Pouch
Sitting or Standing
- Press and push the outtake down towards the bottom of the bag, then fold the pouch slowly towards the bottom.
- Remove the clamp to open the bag and face that end into the toilet, between your legs if sitting down.
- Press and push all the stool carefully out of the bag and into the toilet. (Remember to put toilet paper in the toilet before you pour the content to prevent any splash.)
- If the stool is thick, have a bottle of water in hand to pour some into the bag to help loosen the stool and make it easier to empty.
- Use your hand to control the amount of stool coming out, not letting it wide open at once and provoke some unwanted splashing.
- When you finish pouring the content into the toilet, clean the tip with toilet paper or wet wipes. If using toilet paper, you can use some water to clean it thoroughly.
- Unfold the bag, stretch it and close the end back.
Caring for your Ostomy Pouch and Stoma
Learning how to empty your pouch is more relevant than you may think. It will give you independence and feelings of self-sufficiency that you may have lost after the surgery.
“One of the primary changes in ostomy care is related to stoma care. Pouching systems are more effective, and adhesive technology more advanced. These improvements include a wider variety of sizes and shapes of skin barriers, depths of convexity from shallow to deep, and degrees of flexibility […]
With an ostomy requiring a pouching system, a secure seal to prevent leakage of the effluent and protect the skin around the stoma (peristomal skin) is vital to helping patients resume normal activities an accept the changes in their bodies as a result of surgery. It is also a very important factor in facilitating the emotional adjustment to the ostomy. In addition to the stress of illness and surgical recovery, patients with ostomies face body changes, fear of social rejection, concern about sexual function and intimacy, and the need for help with personal care.”6
The ostomate should receive all the guidance and advice required to adapt to this new lifestyle, either by stoma specialists or other ostomates who have similar experiences.
“Most patients are encouraged to become independent in ostomy care from the time of the surgery. As health deteriorates, continued self-care may require simplifying pouching systems and accessories. Often, however, self-care activities become compromised and it is necessary to have caregivers assist with care. The stoma specialist may need to identify caregivers who are able and willing to assist and then provide critical training, such as the required to manage pouching systems or drain a continent diversion. The advanced disease also may create new complications even in those whose course has been stable for a long time. Changes in the peristomal plane (the area under the solid skin barrier and tape of the pouching system, extending out approximately 4 inches (10cm) from the base of the stoma may evolve, requiring stoma care adjustment to prevent bleeding, leakage, and peristomal irritation. The development of constipation, diarrhea, or bowel obstruction may require special attention. In a worst-case scenario, the progression of the disease may result in the need for emergent ostomy surgery near life’s end.”7
Adjusting to life wearing an ostomy pouch is defying. Nevertheless, multiple sources of information and ostomy support groups exist to offer a safe space for ostomates to discuss their experiences, including how to empty their pouches. Talk to your doctor to find a support group near you.
(1) Rouholiman, D., Gamble, J. G., Dobrota, S. D., Encisco, E. M., Shah, A. G., Grajales III, F. J., & Chu, L. F. (2018). Improving Health-Related Quality of Life of Patients With an Ostomy Using a Novel Digital Wearable Device: Protocol for a Pilot Study. JMIR research protocols, 7(3), e82. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891667/
(2) Erwin-Toth, P., Thompson, S. J., & Davis, J. S. (2012). Factors impacting the quality of life of people with an ostomy in North America: results from the Dialogue Study. Journal of Wound Ostomy & Continence Nursing, 39(4), 417-422. Available online at https://nursing.ceconnection.com/ovidfiles/00152192-201207000-00009.pdf
(3) Akbulut, G. (2011). Nutrition in stoma patients: a practical view of dietary therapy. International Journal of Hematology and Oncology, 28(4), 061-066. Available online at http://www.uhod.org/pdf/PDF_452.pdf
(4) Colwell, J. C., Goldberg, M. T., & Carmel, J. E. (2012). Fecal & Urinary Diversions-E-Book: Management Principles. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?hl=es&lr=&id=sglasEE3eqEC&oi=fnd&pg=PA1&dq=Fecal+%26+Urinary+Diversions:+Management+Principles+Por+Janice+C.+Colwell,+RN,+MS,+CWOCN,+Margaret+T.+Goldberg,+RN,+MSN,+CWOCN,+Jane+E.+Carmel&ots=L0aPG62-1V&sig=0QVimO4Ke4q4vkLBhI5LruIGCxI&redir_esc=y#v=onepage&q&f=false
(5) Tollefson, J. (2012). Clinical psychomotor skills: assessment skills for nurses PDF. Available online at https://books.google.com/books?hl=es&lr=&id=bgWpBQAAQBAJ&oi=fnd&pg=PR5&dq=Clinical+Psychomotor+Skills:+Assessment+Skills+for+Nurses+PDF+Joanne+Tollefson&ots=ZkdXtQkAaA&sig=ZzSg4MaVNDSJmL9lG-oHNBuKbpw
(6) Perry, A. G., Potter, P. A., & Ostendorf, W. (2015). Nursing Interventions & Clinical Skills-E-Book. Elsevier Health Sciences. Available online at https://books.google.com/books?hl=es&lr=&id=6TocBgAAQBAJ&oi=fnd&pg=PP1&dq=Clinical+Nursing+Skills+and+Techniques+-+E-Book+Anne+Griffin+Perry,+Patricia+A.+Potter,+Wendy+Ostendorf&ots=p70N0bM9-d&sig=d0oeNMmhzYvKcB3xs809l4ps86I
(7) Barr, J. E., Cherny, N. I., & Christakis, N. A. (2011). Oxford textbook of palliative medicine. Oxford university press. Available online at https://books.google.co.ve/books?hl=es&lr=&id=Fk9uBAAAQBAJ&oi=fnd&pg=PP1&dq=stoma+therapy+in+palliative+care+jane+ellen+barr&ots=faB6xmulMD&sig=Vc09e8EsBGtvWQFQiH8YFLFw31k&redir_esc=y#v=onepage&q=stoma%20therapy%20in%20palliative%20care%20jane%20ellen%20barr&f=false