For those who have an ostomy, the stoma opening marks a significant change in their lifestyle. There are different types of ostomies, and each may require a specific stoma bag to manage the bodily waste excreted from the stoma. How do you know whether to use a urostomy, ileostomy, or colostomy bag?
What is an Ostomy Bag?
An ostomy bag is a medical appliance with an inner waterproof and odour-proof layer that allows it to retain waste matter excreted from your stoma. It features a skin barrier (or wafer/flange) that adheres to the skin around the stoma and protects it from potential leaks that could cause skin irritation or other issues. The waste collects into the bag for disposal, and some bags may feature a viewing port so you can check their contents. Ostomy bags are available in various forms and must be replaced periodically.
The type of ostomy surgery you undergo will also influence the ostomy bag you use, including how frequently you must change it, which activities you should limit, and more. It can take some time to adjust to life using one throughout your daily activities, but with the support of a stoma care nurse and doctor, you will gradually become familiar with handling your ostomy bag.
Key Differences Between Ostomy Bags
There are three different types of ostomy procedures, each of which uses a different part of your digestive tract as a stoma.
What is an Ileostomy Bag?
An ileostomy diverts a part of the small intestine (ileum) to the abdominal wall as a stoma. Because the output tends to be more liquid-like, ileostomy bags are primarily designed to hold larger volumes of semi-solid or liquid output.
An ileostomy bag is made of a soft, flexible, and durable material that helps prevent leaks over long periods, while the adhesive seal connecting the stoma to the wafer is also stronger, providing more secure bag placement and handling. High-output ileostomy bags are also available, allowing people with high-output stomas to have more peace of mind on busy days.
What is a Colostomy Bag?
A colostomy involves creating a stoma from part of the large intestine (colon). The output from a colostomy is generally thicker and more formed compared to an ileostomy, as the colon is responsible for processing food waste into faecal matter for excretion.
A colostomy bag is either a single-use closed bag or a drainable one for softer, semi-solid stools. Stool consistency may change over time after your colostomy procedure, influenced by your colostomy type, emotional state, dietary adjustments, and medications you take. Regardless, bags should be emptied several times a day once they are full, depending on bowel movement frequency and the type of bag used. Odours are mostly present if there is a leak, necessitating a bag replacement. If your bag continues to present an unpleasant odour even when empty, you can place deodorants in the pouch.
Some people may opt to learn to irrigate their colostomy by flushing the colon with water through the stoma, eliminating the need for use of a colostomy bag. Used bags should be replaced every so often for your hygiene.
What is a Urostomy Bag?
A urostomy involves diverting the ureters (which carry urine from the kidneys to the bladder) to a stoma, allowing urine to be drained from the body. The stoma is typically formed as part of an ileostomy, so a urostomy essentially allows the ileum to serve as a conduit for urine removal.
Urostomy bags have a tap at the bottom that can be used to drain urine into the toilet, and must be cleaned regularly to prevent unpleasant odours or leaks. Some bags also feature a breathable stoma bag cover that prevents condensation to protect your skin.
At night, you will need to connect your urostomy bag to a larger drainage container, so urine can drain while you sleep.
Who Needs Each Type of Ostomy Bag?
Temporary ostomies are reversible and will require a short-term ostomy bag while you recover and await the reversal procedure. Permanent stomas may present different use cases for each ostomy bag type.
You may require a colostomy bag if you have:
- A form of digestive tract cancer (such as colon cancer)
- Chronic bowel incontinence
- Severe trauma to the digestive tract
- Diverticulitis
- Crohn’s disease
You may require an ileostomy bag if you have any of the following:
- Gastrointestinal motility disorders
- Crohn’s disease
- Ulcerative colitis
- Certain cancers
Lastly, a urostomy bag is recommended if you may have:
- Bladder cancer
- Chronic bladder infection
- Spinal cord injuries that affect bladder function
- Certain birth defects affecting bladder function
How to Use and Change an Ostomy Bag
Preparations
First, prepare all necessary supplies so you have everything on hand and avoid mistakes or misplaced items. Ensure that your changing area is clean and well-lit.
Some bags may need you to cut the flange to size. If so, carefully measure your stoma and cut the opening to fit it perfectly. It should not feel too tight or too loose. If you use pre-sized bags, ensure you find one that is the appropriate size for your stoma.
Bear in mind that your stoma’s size can change over time after the ostomy procedure. In most cases, the stoma will shrink over time until it stabilises, so your bag will need frequent adjustments for a good fit.
The stoma’s shape can also influence your ostomy bag’s fit. For example, some stomas may appear flush against the skin, making it tricky to fit the flange properly. Some bag models feature wafers that are designed for such stoma positions and shapes.
Removing the Old Bag
If you are wearing the old ostomy bag, gently remove it from your skin. Take it slow to prevent leaks or spills, and then dispose of the old bag in a proper disposal bag or container.
Clean Your Skin
Use warm water and a soft cloth or skin-friendly wet wipes to clean the stoma area and the surrounding skin. Look out for signs of common stoma complications skin redness, itching, or infection, as these indicate a need to properly adjust your new bag to prevent future leaks. Such leaks can gradually cause skin irritation or damage.
Dry your skin thoroughly after cleaning to ensure the flange adheres properly. It may help to use barrier film wipes or sprays to protect your skin from drying out or irritation.
Applying the Bag
For bags with a barrier ring, carefully apply it around the stoma to ensure a good fit that protects your skin from output leaks or irritation. Remove the adhesive backing from the wafer, carefully centre the flange over the stoma, and ensure it is a snug fit to prevent leaks. Press down gently to remove wrinkles and maintain a good seal.
For two-piece systems, once you apply the wafer to your skin, you will then need to attach the bag to the wafer. Double-check the attachment point to ensure that it is fitted properly.
Cleanup
Seal the disposal bag and dispose of it properly in accordance with local regulations. Finally, wash your hands thoroughly using soap to maintain your hygiene.
How to Choose the Right Ostomy Bag
Choosing the appropriate ostomy bag requires an understanding of how your stoma works.
Closed vs. Drainable Bags
If your output tends to be in liquid or soft semi-solid form, a drainable bag offers a convenient way to drain a bag’s contents via the included drainage tap. It enables you to quickly drain the bag in a nearby toilet without having to rush home, but it does require proper hygiene to avoid unpleasant odours.
Closed pouches are recommended for more formed output, but may also be suitable for those with regular toileting patterns or who know how to irrigate their colon (for colostomies). Two-piece closed ostomy bags (which we will discuss next) are also an option that offer easier bag removal and disposal, which some people may find more favourable.
One-piece vs. Two-piece Systems
In one-piece systems, both the flange and the bag are attached to each other. This means you will need to remove and dispose of both when replacing an old bag. While affordable, simple, and convenient to use, some may find it causes skin irritation because you need to replace the one-piece system so often.
Two-piece systems separate the wafer from the bag, allowing you to remove the bag while the wafer remains on your skin and in position. This means your skin is less irritated, making bag changes straightforward, while also offering versatility by accommodating a range of ostomy bags, including high-output bags suitable for extended periods.
Sozo Wound & Stoma Care is a nurse-led clinic that provides comprehensive stoma care and support. Visit our website today to learn more about our services.