Tips for Managing an Ileostomy or Colostomy Bag (2025)

An ostomy bag is an appliance used to collect stool (feces/poop) from an opening in your abdomen after undergoing ileostomy or colostomy surgery. Ileostomy and colostomy are sometimes needed when a diseased and dysfunctional part of your intestine needs to be removed or bypassed.

Although it can take time to adjust to having an ostomy bag, learning how to use it properly—and care for the surgical opening (called the stoma)—can allow you to maintain a normal, active life. This not only includes learning how and when to change an ostomy bag but also understanding how diet and lifestyle can affect the consistency and frequency of elimination of stool.

This article offers you everything you need to manage an ostomy bag, including the different bags that are available and how to deal with problems like leakage, odor, and mess.

Types of Ostomy Bags

Ostomy surgery is used to redirect the poop when a part of the intestine needs to be removed due to diseases like colorectal cancer, bowel obstruction, severe diverticulitis, or severe inflammatory bowel disease (including Crohn's disease or ulcerative colitis).

There are two different types of ostomy:

• An ileostomy connects the last part of the small intestine (called the ileum) to the wall of the abdomen.
• A colostomy connects the longest part of the large intestine (called the colon) to the wall of the abdomen.

To create the opening (stoma), the end of the intestine leading from the stomach is pulled through the abdominal wall and stitched to the skin of the abdomen.

An ostomy bag (also known as a pouch) is then worn over the stoma to collect the waste, after which the bag is either thrown away or emptied into the toilet throughout the day.

There are several different ostomy bags that vary in their application and uses:

One-Piece Ostomy Bags

One-piece ostomy bags are all-in-one units that consist of a bag, a protective skin barrier that prevents poop from getting on the skin, and a peel-off adhesive backing. When the bag needs changing, the entire system is removed and replaced.

One-piece ostomy bags have a slimmer profile than two-piece systems, making them more practical for people with active lifestyles.

Two-Piece Ostomy Bags

Two-piece ostomy systems consist of a bag with a circular rimmed opening (called a flange) and a separate skin barrier with a complementary flange.

The skin barrier is affixed to the abdomen with a peel-off adhesive, which can be kept in place for three to five days. The flange of the bag locks into the flange of the skin barrier, making the bag ear easier to replace and reducing skin irritation caused by the repeated removal of the adhesive.

Closed Bags

Closed bags, also known as closed-end pouches, are simply those that are sealed at the end and cannot be cleaned. Once the pouch is full, it is disposed of and replaced.

There are closed bags for both one- and two-piece ostomy systems. Closed bags are ideal for people with solid rather than loose stools.

Drainable Bags

Drainable bags are reusable bags that have an opening at the end (either a sealable flap or a drain and plug) that allows you to empty the contents into a toilet. The bags are more often used in people with an ileostomy who tend to have loose or watery stool.

As with closed bags, drainable bags are available for both one- and two-piece systems.

Mini-Pouches

Mini-pouch are smaller bags measuring around 7 to 8 inches in diameter that hold less poop than a regular ostomy bag. Although these bags need to be changed more often, some people prefer them because they are discreet.

Mini-pouch are not only available as one- and two-piece systems but are also offered with closed or drainable bags.

How to Change a Full Ileostomy or Colostomy Bag

After ileostomy or colostomy surgery, your care team will teach you how to apply and change your ostomy bag. They will also discuss which system is best suited to your lifestyle and personal preferences.

Other factors will weigh in on the decision, such as how much of your intestine was removed or whether you had an ileostomy or a colostomy. This is because the colon is responsible for removing water from stool, and the more of it that is removed, the more watery your stools will be.

The same applies to an ileostomy which almost invariably causes looser stools due to its location high up in the intestine.

Once you have chosen the suitable system, the changing of the bag is a relatively straightforward process. To change an ostomy bag:

1. Start by washing your hands with soap and water, including under the fingernails.
2. For a one-piece system, gently peel away the adhesive backing from your skin.
   
3. Clean the skin around the stoma with soap and water and pat dry with a paper towel.
4. Check the skin. It's OK if it's pink or reddish, but call your provider if it's purple, black, or blue.
5. Wipe around the stoma with the disposable peristomal wipe to fully cleanse the skin.
6. If there is any skin "weeping" or rawness, apply some barrier powder and lightly pat it into the skin with the disposable wipe.
7. Allow the skin to dry fully.
8. Peel the adhesive backing off the ringed seal of the new bag.
9. Place the seal evenly around the stoma. Hold it in place for a few minutes to ensure it fully sticks.
10. Wash your hands again with soap and water.
11. Dispose of the used ostomy bag, double-bagging it in a regular plastic kitchen bag to avoid smells.

If you have a two-piece system and don't need to remove the adhesive flange on your belly, gently hold the skin around the stoma with one hand and remove the bag with the other with a slight twist.

If you have a drainable bag, your care team will show you have to clean and reuse it. These products vary from one manufacturer to the next—with some systems using clamps to seal the bag and others using a valve and plug similar to a beach ball—so speak with your care team or call the manufacturer if you are unsure how to use it.

When to Change an Ostomy Bag

Generally, you can expect to change a colostomy bag one to three times daily and expect to change an ileostomy bag as much as five to six times daily.

The bags should removed when they are one-third full. You don't want to overfill the bag because the very weight of poop can cause the adhesive to pull against your skin, causing irritation and damage. You can minimize this problem by supporting the bag with an elastic ostomy belt.

Overfilling also increases the risk of leakage. This not only creates an unpleasant mess and odor but also causes skin irritation due to the digestive enzymes in feces.

Over time, exposure to feces can compromise the barrier function of the skin, allowing bacteria to access underlying tissues and establish an infection. For this reason, any poop on the skin should be removed immediately and washed with soap and water.

To avoid leakage at night, empty the bag before going to bed, Time your meals so that you take nothing by mouth several hours before bedtime. You should also avoid sleeping on your stomach which can cause leakage, instead using bolsters or pillows to keep you on your back or side.

Factors that Affect Stool Output

On average, adults produce around 130 grams (roughly 1 cup) of poop a day, although the range can be as low as 50 grams (1/3 cup) or as high as 800 grams (6 cups). Similarly, the frequency of poops can vary, with some people going three times a day and others waiting days between poops.

When you have an ostomy, the volume of poop won't necessarily change but the consistency and frequency may. Oftentimes, your stool will be less solid and even mushy due to the loss of fluid absorption in the colon.

If you had an ileostomy, not only will you have looser stools but you may even become malnourished because the ileum is where many of the nutrients from food are absorbed.

Because there is less intestine to traverse, the frequency of poop will also increase, sometimes to as much as 15 times per day following the surgery (although this tends to decrease over time).

One of the ways to deal with all of these issues is by changing your diet as diet can affect the frequency of when an ileostomy or colostomy bag is full of poop. Most gastroenterologists offer the following dietary guidelines for people living with an ostomy:

• Eat smaller meals: Eating three or more snack-sized meals—spaced out evenly every three to four hours—can help ensure you go to the bathroom regularly.
• Limit hard-to-digest foods: These include nuts, seeds, corn, popcorn, mushrooms, and raw vegetables that can block you up. If you do eat these foods, chew them to a fine pulp.
• Avoid constipating foods: These include applesauce, bananas, cheese, peanut butter, oatmeal, Cream of Wheat, white rice, pasta, tapioca, saltines, and white bread.
• Avoid foods that promote diarrhea: These include alcohol, baked beans, fried foods, grape juice, high-sugar foods, prune juice, artificial sweeteners, and spicy foods.
• Manage your fluids: Ostomies can increase the risk of dehydration. To overcome this, drink between10 to 12 glasses of fluid per day and drink a glass of water every time you empty a pouch. If drinking alcohol or caffeine, replace each glass with an additional glass of water.

To help minimize odors, some experts recommend foods like buttermilk, cranberry juice, parsley, and yogurt.

Summary

An ostomy bag is used to collect stool from an opening in your abdomen after a colostomy or ileostomy. There are different types of bags (pouches) that can be used, including one- and two-piece pouches, closed and drainable pouches, and even mini-pouches.

Colostomy bags may need to be changed one to three times daily, while ileostomy bags may require changing up to six times daily. The bag should be changed when it is one-third full. Any leakage should be cleaned immediately to avoid skin irritation.

Eating smaller meals, getting ample hydration, and avoiding foods that promote diarrhea or constipation can help keep you keep you regular if you have an ostomy.