What is An Ostomy Pouch or Bag?
An ostomy pouch, which can also be referred to as an ostomy bag, is the most important part of an ostomy appliance. It’s used to collect waste, urine, and even mucus from something called a “mucus fistula” as it exits the body, and it’s what’s attached to the wafer stuck to your skin.
Commonly made from plastic, ostomy pouches come in a variety of styles and sizes. Depending on whether or not a pouch is permanently attached to a wafer, the appliance can either be referred to as a one-piece or two-piece. I explain all the differences in THIS article, but regardless of the style, the appliance functions in the same way.
Most manufacturers will offer a drainable and close-ended pouch. Most ileostomates and urostomates will use a drainable pouch, which allows them to empty the contents of the pouch when they like and without having to replace the pouch or change their appliance. By contrast, a colostomate my prefer a close-ended pouch as it can be discarded and replaced when it gets full. Each brand will have their own unique closure for the outlet on a drainable pouch, but the most common types are:
- Clips. These are made of hard plastic and are separate from the pouch. While many ostomates use this type of closure, they are bulky and prone to getting damaged compared to outlets with built-in closures. You can find newer clips that are slimmer and more secure.
- Velcro/velcro-like closure. A modern alternative to clips, these are built into the bottom of the outlet and can easily be opened and closed, however, some closures are more difficult to secure and ostomates with mobility challenges my find them hard to work with. Some ostomates may even find that Velcro closures tend to get soiled and are difficult to clean.
- Spouts/Valve outlet. Most common on urostomy and high-output ileostomy bags, spouts allow you to empty liquid from your pouch while offering more control compared to wide-mouth outlets.
Filters are sometimes also found on pouches. They allow gas inside of your pouch to exit without creating odor. Colostomates tend to have better luck with filters, since dry, infrequent stool is less likely to clog filters compared to liquid output. Many ostomates with liquid output will find that filters tend to clog within 48 hours of wear.
Most manufacturers offer both opaque and clear pouches. Opaque pouches are usually lined with a thin, cloth material that hides the contents of your pouch; clear pouches allow you to see inside of your pouch, which can come in handy to inspect your stoma. Some brands feature opaque covers with a “window” that allows you to examine your stoma and pouch contents freely.
I explain more about the differences between pouch opacity in THIS article and video.
Pouches come in many sizes, and manufacturers tend to give each size their own unique name (just like how Starbucks likes to name coffee cup sizes). The most common of these are as follows:
- Small or mini. These pouches have a very small capacity and are best used in situations where you don’t expect much output in a short period of time (i.e. during intimacy). Colostomates who irrigate their stoma may use these smaller pouches more regularly. People with a “mucus fistula” may also use these smaller bags. (see photo below).
- Medium pouch (7″ in length and approx. 400 – 500ml capacity). This one offers a compromise between size and capacity.
- Large pouch (12″ in length and approx. 600-650ml capacity). A common size that is ideal for most ileostomates.
- X-Large. “Magnum” from Coloplast is one example of an XL pouch and has a capacity of approx. 1200ml. These are larger than large, and are used for high-output stomas. They can come in handy for ileostomates with short bowel syndrome or jejunostomates, and I find that they are useful when staying in hospital or if you need to do some special bowel prep. These tend to have a spout outlet since they handle mostly liquid output.
- Night drain bags! Intended for overnight use, these bags are HUGE, and boast a capacity of nearly 2000ml! Ostomates with high-output stomas might want to look into these bags since they could help to get a full night’s sleep.
While many pouches are very plain, some manufacturers have gone out of their way to offer features that are unique. Some of these features include:
- An inspection window that allows you to see inside your pouch through the cloth covering (i.e. Coloplast Sensura Mio, Coloplast SenSura 1-piece drainable with soft outlet)
- Velcro mid-way up the pouch that allows the bag to be folded in half (i.e. Coloplast Sensura Mio)
- Vent hole to manually allow gas to be released, in a similar way to the Osto EZ-Vent (i.e. Oxmed ZenSiv Colostomy bag w/ vent). Be forewarned, that unlike filters, these vent holes do NOT deodorize.
- Replaceable filters (i.e. both Hollister and ConvaTec offer products with this feature)
How Ostomy Bags Usually Are Sold
Most pouches are sold in boxes of 10 or 20, but some brands include more than that in a single box. For two-piece appliances, it’s important to get the size and brand that is compatible with the flange part of your wafer or you’ll have a very hard time getting the two pieces to fit together!
If you have a two-piece appliance, you can also swap between different sizes or styles of pouches, provided they are the right brand and size for your wafer. This is common when someone might need a night-drain bag, but prefers to wear a smaller size during the day.
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How to Use an Ostomy Bag
On a one-piece appliance, you don’t have to do anything special, since your pouch is already attached to your wafer, you simply apply your wafer and you’re done.
When it comes time to change your appliance, you remove and discard both the wafer and pouch at the same time.
Two-piece appliances offer many options for connecting the pouch to the wafer. There are two ways in which pouches can be attached to your appliance: a mechanical or adhesive coupling. Mechanical couplings allow the pouch and wafer to snap together, while adhesive couplings allow the two pieces to stick together. I get into more details in THIS article.
Because a two-piece system allows you to replace pouches without having to change your wafer at the same time, you might find that replacing your pouch when your filter stops working will keep ballooning at bay and will help to extend the life of your wafer.
Tips When Using an Ostomy Bag
- If your pouch has a filter, you may need to cover it with a sticker (usually found in the box of pouches) if you plan on getting your appliance wet.
- Some ostomates wear their pouch at an angle or horizontally. They do this in order to accommodate certain accessories, but also for comfort.
- If you develop a tear in your pouch (cats are most often to blame for this), replace it with a new one, as repairs can often lead to leaks or odors.
- I know of ostomates who wear two-piece appliances who rotate between two pouches, washing one when the other is not in use. This can help save a considerable amount of money if you’re ok with spending the time to properly clean and dry each pouch.
Are Ostomy Bags Vegan-Friendly?
With the exception of one-piece appliances that have wafers containing animal ingredients, pouches are not a concern for vegans. Refer to my list of vegan/non-vegan products if you’d like a list of confirmed products.
Pouches are nothing without the wafer, so you can check out my mini guide to wafers HERE.