A recent colostomy surgery may cause concern about the proper care of your ostomy pouch and stoma. Questions arising often are: how to handle a pouch when bathing or showering? What should I know about bathing with a colostomy bag?
Knowing how to bathe with a colostomy bag and learning proper stoma hygiene can help patients avoid peristomal skin complications. “Peristomal skin disorders represent the most common post-operative complication in ostomates, the incidence of which ranges from 15–65%. It has been estimated that these events account for more than a third of stoma care clinic visits resulting in a substantial economic burden on the patient and the health care system. Peristomal skin is constantly exposed to a number of substances including urine, feces, medicaments, ostomy pouch systems, and stoma skin care products such as barrier films and adhesive paste/removers. The above can result in a variety of peristomal events, including physical skin abrasion and/or infections, dermatologic conditions (pyoderma gangrenosum, psoriasis etc.), and contact dermatitis. Bodily fluids are known to be an important cause of peristomal dermatitis. To protect the peristomal skin, medical professionals recommend applying stoma skin care products designed to prevent peristomal irritation”.1
Another consideration when bathing with a colostomy bag is understanding that its location will vary according to the segment of colon where it originates. “It may originate from: The sigmoid colon, the descending colon, the transverse colon or the ascending colon. A colostomy is named according to where in the bowel it is formed: It may be an ascending, transverse, descending, or sigmoid colostomy. The type of effluent is dependent on the location of the bowel used. The type of effluent in cecostomy (ascending colostomy) is liquid to mushy and foul odor. The type of effluent in right transverse colostomy is mushy to semiformed. The type of effluent in left transverse colostomy is semiformed and soft. The type of effluent in descending or sigmoid colostomy is soft to hard formed.”2
Types of Colostomies
The name of the type of colostomy is indicative of the location in the colon where the stoma is formed.
- Descending Colostomy: The surgical opening created in the descending colon is brought to the surface of the abdomen. It is usually located on the lower left side of the abdomen.
- Transverse Colostomy: The surgical opening created in the transverse colon resulting in one or two openings. It is located in the upper abdomen, middle, or right side.
- Ascending Colostomy: A relatively rare opening in the ascending portion of the colon. It is located on the right side of the abdomen.
- Cecostomy: The surgical construction of an opening into the cecum. It is performed as a temporary measure to relieve intestinal obstruction in a patient who cannot tolerate major surgery.
- Sigmoidostomy: The most common location of an ostomy is in the sigmoid colon. A sigmoidostomy is the surgical construction of an opening into the sigmoid colon, and is commonly referred to as a sigmoid colostomy.3
Unless your doctor or ostomy nurse tells you otherwise, ostomates can normally have their bath or shower with or without the colostomy bag (pouch). How you want to do it, it’s a matter of personal preference. The following are a few points you should know on how to bathe with a colostomy bag:
Can I get my pouching system wet?
“Yes, you can shower, bathe swim or even get in a hot tub with your pouching system on. It is a good habit to empty the pouch before showering, bathing and other water activities. You can bathe or shower every day. On the day you plan to change your pouching a system you can either leave it on or you can take the whole thing off to take your bath or shower.
Some people may choose to shower or bathe without their pouching system. Because the stoma has no muscle, urine or stool may drain from your stoma while showering or bathing.
Water won’t hurt your stoma or go inside you. If the water pressure is strong, do not let it hit your stoma directly. Only use a gentle spray of water on your stoma.
Check your pouching system before and after water activities. If you are in the water for a long time, the pouching system may start to loosen up from your skin. Some people may find it helpful to wait an hour or so after changing their pouching system before swimming.
Pouching systems are waterproof. However, you may feel more secure if you wear an ostomy belt or put tape around the edges of your skin barrier when you are in the water. Some people will secure the edges of the skin barrier with waterproof tape. Other prefer to use paper tape and then wipe the paper tape with a skin sealant to make it more waterproof. […]
Some people wear tight biking style shorts when swimming to keep their pouch close to the body and help keep it from floating.
Gas filters do not work after they get wet. Therefore, it is best to protect the filter with waterproof tape before water activities. After bathing or swimming, you may use a towel or hairdryer on the coolest setting to dry the tape and cloth backing of the pouching system to prevent skin irritation from wetness.”4
Water Does Not Affect the Pouch or Hurt the Stoma
New ostomates are afraid of hurting their stoma, or damaging their pouch and wafer when they shower. Pouch systems are usually waterproof and thus unaffected by water. In fact, warm water can improve the initial adhesive properties of wafers.
Generally, the pouching system attaches to your abdomen. Showering with it will not damage it or make it fall off. However, frequent long hot baths can affect wafer’s wear time because they lose adhesive properties, particularly at the sides.
Will The Pouch Leak or Smell While Bathing?
Not generally, unless the adhesive comes off. “A common concern that many people have about ostomy pouches is that they will leak or smell bad. This is not the case. Ostomy pouches are generally odor-free. If you do experience problems, there are several things that you can use to eliminate odor, including pouch deodorizers and oral medications. As far as leaking, as long as you empty your pouch regularly, you should not encounter this problem.
Of course, you will need to learn how to take care of your ostomy pouch and the skin that surrounds the stoma. But with the assistance of your doctor and your ET nurse, you will probably find that, after the initial adjustment, life with an ostomy is not difficult.
If you are having problems with the pouch system you are using, talk to your doctor or ET nurse right away. There are many pouch systems available, and there is no reason that you should use one that isn’t working for you.”5
After your bath or shower, dry your pouching system with a towel or a hairdryer
The type of pouching system influences drying time and method. If you wear a non-tape border wafers and uncovered bags, dry them with a towel. For tape wafers and covered bags, you may use a hairdryer set on cool.
Some accessories can keep your appliances dry during a shower -they generally do not work well for baths. Pouch covers, plastic wraps, and aprons to maintain your pouch system dry. Some stoma bags have pouch covers that are practical for showering and swimming, and the user can dry it with a towel.
Simple, routine actions can help protect and care for your stoma while showering. “People with stomas can bath normally, with or without an appliance in situ. Many stomas (particularly colostomies) settle into a fairly predictable pattern of action as normal eating and other activities are resumed. This enables most people to bath when their stomas are less likely to act. They should be informed that stomal action during bathing is not harmful (although it may be inconvenient), and that water will not enter their stoma if they are enjoying a good soak without their appliance. Well-secured modern stomal equipment will not be affected by water and dries quickly, so bathing, swimming and water sports of any type may be enjoyed.”6
On your programmed pouching system change day, remove the appliance before you bathe or shower. Do not let hot water directly hit your stoma. Also, do not use anything heavy moisturizers your skin, since this will affect the adhesive properties of your new wafer once you come out of the bath or shower. Most importantly, enjoy bathing or showering with a colostomy bag and ask your ostomy nurse any additional questions you have.
(1) Cressey, B. D., Belum, V. R., Scheinman, P., Silvestri, D., McEntee, N., Livingston, V., … & Zippin, J. H. (2017). Stoma care products represent a common and previously underreported source of peristomal contact dermatitis. Contact dermatitis, 76(1), 27-33. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523875/
(2) Bhzeh, N. M., Teleb, S. M., Mahmoud, M. A., & SOLIMAN, A. M. (2013). Colostomy: Developing Nursing Care Standards for Patient with Colostomy. The Medical Journal of Cairo University, 81(2). Available online at http://erepository.cu.edu.eg/index.php/MJCU/article/view/1280
(3) Lynch, S., Lavoie, K. (2013). Ostomy Overview: Care of the Patient with an Ostomy. Available online at https://lms.rn.com/getpdf.php/1913.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.com/books?hl=es&lr=&id=sglasEE3eqEC&oi=fnd&pg=PA1&dq=Fecal+%26+Urinary+Diversions:+Management+Principles&ots=L0aPHa31-Y&sig=-CeSxRkvbPLgDrMV0_mk2bWhkQw
(4) Potter, C. (2003). Coping With Crohn’s Disease and Ulcerative Colitis. Available online at https://books.google.co.ve/books?id=Ll036rYpOz8C&pg=PA2&lpg=PA2&dq=Coping+With+Crohn%27s+Disease+and+Ulcerative+Colitis+Christina+Potter&source=bl&ots=1aggDDZVJm&sig=ACfU3U34x6wIUi6DykL6HqYrDCF_GKnqxQ&hl=es-419&sa=X&ved=2ahUKEwjBmprzpKPiAhXFwFkKHSbcAYoQ6AEwBnoECAgQAQ
(5) Breckman, B. (Ed.). (2005). Stoma care and rehabilitation. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?id=F7NE_iXpEvgC&pg=PA57&dq=adhesive+spray+ostomy&hl=es-419&sa=X&ved=0ahUKEwiGou7G36XiAhVpqlkKHew5BSoQ6AEINDAC#v=onepage&q=ostomy%20tape&f=false