How Often Does an Ostomy Bag Need to Be Emptied? (w/ video)

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A question I get asked often is, “How many times should I be emptying my ostomy bag?”.

 

Introduction

Of course, just like with other questions about what’s normal when you have an ostomy, the answer may vary for each person.

In this post, I’ll go over various factors that can influence how often an ostomy bag may need to be emptied, as well as go over when to empty it.

If you are newly out of surgery, keep in mind that things will be a little crazy and your stoma may not be as consistent or predictable as it will eventually become with time.

Video

https://youtu.be/TOxfHPDJ_SQ

When Should You Empty Your Ostomy Bag?

Most ostomy nurses, supply manufacturers, and health websites will recommend that you empty your bag when it’s between 1/3 and 1/2 full.

when to empty an ostomy bag_small
This handy graphic should help to visualize when to empty your bag.

I happen to agree, although I often get lazy and empty my bag when it’s more than 1/2 full. I don’t recommend waiting until your bag is too full because there are plenty of reasons why this could cause problems:

  • It gets heavy. The weight of a bull ostomy bag is unwieldy and uncomfortable.
  • It gets bulky. Full ostomy bags are hard to keep concealed.
  • Leaks are more likely to happen. Really full bags can cause leaks because of pressure and tugging.
  • Emptying will be more difficult. I think most will agree that emptying 1/3 of a bag full is much easier than emptying 3/4 of a bag full!
  • Pouch deodorants will fail to work. There’s only so much a few drops of liquid pouch deodorants will be able to do. If you’ve got a really full bag then expect more odor from it.
  • Shit bombs aren’t fun! Ever have a two-pound bag of crap detach from your two-piece appliance and hit the floor? Let’s just say that it won’t be your proudest moment.

For me, the most difficult times to empty my bag are in the middle of the night because I can’t actively check my output while I’m asleep (no kidding, right?).

There are a few strategies to consider if you find yourself with a full bag at night or in the early morning.

  • Don’t eat or drink too late at night. Some people swear by the, “don’t eat after 6 pm” rule, but the results will be different from person to person and it depends a lot on your “transit time” (the time for food to pass through your entire digestive system).
  • Consider setting an alarm. Some ostomates will set an alarm to ring in the middle of the night so they can empty their bag before it gets too full. The disruption of your sleeping pattern may not be desirable.
  • Wear a larger bag at night or use a night drainage bag.
  • Consider medication to slow down your bowel movements. This should be discussed with your doctor, but you might be able to take something that will slow bowel movements for you at night.

Size Matters

Ostomy bags come in many different sizes, from teeny-tiny stoma caps (which really aren’t meant to hold any amount of output) to large, overnight drainage bags which are designed to hold several LITRES of output.

small to large ostomy bags_small
From left to right: Coloplast Stoma cap, B. Braun Flexima 3S (midi size), Hollister New Image (maxi size), Coloplast Magnum.

Obviously, the smaller the bag, the more often it’ll need to be emptied.

Many “large” bags (which are about 12″ in length) can hold about 650ml of liquid, but keep in mind that’s at maximum capacity. Smaller bags measuring 7″ may only hold 400 or 500ml of output at most, so at 1/3 full you’re looking at just over 130ml of output, which isn’t much.

I usually recommend wearing the largest size that’s comfortable to manage. That means if you’re only emptying your bag once or twice a day (i.e. you have a colostomy), there’s no reason to wear a large or XL-size bag.  At the same time, if you find yourself constantly needing to empty your appliance, perhaps a small or medium bag is just not enough.

Type of Ostomy

Generally speaking, the higher up on your digestive tract your stoma is, the more output you should expect.

So someone with a jejunostomy would have more output than someone with an ileostomy. Likewise, someone with an ileostomy would have more output compared to someone who has a colostomy.

If you have a “short bowel” or have had a large part of your bowel resected, then your output frequency may be higher than normal.

Why does that happen? Well, mostly because fluids get absorbed further down (like the colon), so the more you’re missing the higher the volume of fluids will be passing through your stoma. This is why someone with an ileostomy or jejunostomy will usually have liquid output and a colostomate will often have a drier stool.

Some common expectations for various types of stomas follow below.

Colostomy

If you have a colostomy and irrigate your bowels, you might not need to empty your bag for a day or two! That’s pretty convenient! But if you aren’t irrigating your bowel then you may be emptying 1-3 times a day (or however often you would have been going to the bathroom before your surgery).

Ileostomy

Most ileostomates will empty their bag 4-10 times per day, but some may need to empty more often if they have liquid output. I find myself emptying around seven or more times per day, but I also let my bag fill up past the 1/3 mark.

Urostomy

A urostomy bag may need to be drained several times a day depending on the capacity. The volume of urine collected throughout the day should be closely matted with the volume of liquids you consume. A urostomate who drinks several liters of water should expect several liters of output in a 24h span.

Visit my “What is an ostomy?” page for more information about types of ostomies.

What You Eat and How Often You Eat It

“What goes in must come out” is a nice adage that perfectly illustrates this point.

If you’re a coffee drinker, you may already notice that your stoma will be more active than when you aren’t drinking coffee. This may also true for people who drink red wine or fruit juice. Consider cutting back on foods and beverages that cause excess output if it’s something that worries you.

It also goes without saying that the greater the volume of food and beverage you consume the more output you will have. This is especially true if you’re eating fibrous, plant-based foods (like I do). If you find that eating plant-based foods cause your stoma to go wild, cut back on the amounts you’re eating in a single meal to help spread things out.

Some ileostomates and colostomates may change their diet a little to include more starch-based foods (i.e. potatoes, rice, etc.) to help slow down their bowel movements. This can be used as a long-term solution, provided you’re eating healthy foods and not only potato chips.

For a list of foods that may increase your output, check out THIS article.

Other Factors

Several other factors could influence how often you’re emptying your appliance.

For example, if you are on antibiotics, you may notice that your bowel frequency is increased along with a change in the consistency of your output. This is considered a normal side-effect that often resolves itself after you’ve finished taking them.

I also tend to get a huge change in the frequency and consistency of my output when I have the flu or a cold.

Some, or all of these, may cause a change in your bowel habits:

  • Stress.
  • Cancer treatment.
  • Antibiotic use.
  • Food poisoning.
  • Medication or supplement side-effects.
  • Active disease.
  • Motility disorders.

Should You Worry?

There are a few instances where I would be concerned about the frequency of my output.  Of course, always talk to your stoma nurse or doctor if you have any concerns.

Emptying Too Often

If you find yourself emptying your bag far more than have been in the past, check to see if your diet has changed recently. Even small changes in our diet can influence our bowel transit time – at least in the short-term.

If it hasn’t, I would generally wait to see if things settle down after a day or two. Sometimes, frequent stoma output tends to resolve itself without me even knowing the cause.

But if bowel movements have been increased over many days or weeks, I’d schedule a Dr’s appointment to investigate this further.

Not Emptying Enough

When I notice that I’m not emptying my bag as often as I should be in relation to the amount of food I’m consuming, the first thing I’ll do is make sure I’m getting enough fluids. Dehydration can slow things down considerably.

I’ll also try to note whether I have any pain or discomfort around my stoma, which often indicates a partial blockage.

Sudden Changes

Most short changes in bowel frequency aren’t usually a cause for concern, but if you notice any unusual or sudden changes that seem to be persistent then it’s important to monitor things more closely.

Always let your doctor or stoma nurse know of sudden changes to your bowel habits as it may indicate disease activity, which is something you’ll want to be addressed quickly.

Conclusion

As you can see, there are many factors that play a role in determining how often you’ll be emptying your ostomy bag.

While there are certain things that can make it more predictable, such as the volume of food you’re eating, expect to find your new normal after several months past surgery.

Question: What type of ostomy do you have and how often do you empty your ostomy bag?
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12 thoughts on “How Often Does an Ostomy Bag Need to Be Emptied? (w/ video)

  1. Hi Eric,
    Thanks so much for sharing this info! Your links have given me a wealth of detail.
    I just recently had a total pelvic exenteration done because of uterine sarcoma.. so I now have a wet colostomy – both urine and stool coming out of a single stoma coming out of the end of my large intestine.
    I am still trying to figure out what works best for me.. I have tried coloplast flanges and their urostomy bags – which are quite conveniently large and also capable of expelling solid waste.. and now I am trying convatec just for the incredible advantage of mouldable flanges.. in convatec and coloplast, I find that the colostomy bags get full really fast, because of my wet colostomy and I end up draining every hour or so during the day, and every two hours at night, which is quite irritating.
    So I recently tried the convatec high output bag – that’s a bit better.. but I keep wondering – if the bag is bigger, doesn’t the increased weight of a corresponding third of the bag cause greater tugging on the flange?
    What bags do you recommend for a wet colostomy? Also what do you think of bigger bags and their tugging on flanges?
    Thanks a ton again for the great info!

  2. I’ve had an ileostomy for 19 years. It’s a part of me and yeah, sometimes I have a blow out but all in all it was the best thing that happened to me after 10 years of ulcerative colitius. I empty every time I go to the bathroom unless very little is in there. It’s just a routine that I always do. I usually eat late (after 7 or 8 pm) so I get up once in the middle of the night to go to the bathroom and empty. No big deal. Just part of the routine.

  3. I am up late. My appetite is large and I am never full. I ante a salad (not very large–would NEVER DO PANERA!!!WHAT A MESS THST WOULD BE AND THEIR SALADS ARE TOO LARGE EXCET FOR THE SIDE SADLAD IN YOU PICK TWO)
    I have tried everything except keeping a notebook log and I have enough trouble doing what I need to.
    My surgeon told me to do Metamucil and I do so my output is thicker during the day. I am afraid to take it before I go to sleep.
    I have been very upset in light of what happened in the US and the crap coming out of 45’s mouth supporting White Supremacists and my bag is puffy which I assume is gas.
    I sleep through the night but I am on Disability and cannot work so my sleep patterns are irratiic and I am very hungry late at night.
    I am trying veggies but my Stoma Nurse said nothing raw, and peeled and steamed well if fresh and very steamed if frozen.
    I do have a delima. I eat thickeners, peanut butter, bananas & mashed frozen potatoes from Trader Joe’s that are thick circles and you can make as many as you want.
    Because I cannot eat flaxseed meal, chia seeds, hemp hearts, and raw nuts and big salads I am going nuts but I do not want a blockage.
    Also, I hardly ever left my large Hollister bag (12″) get more than a third full. I was drinking Gatorade as it was recommended fir the potassium & electrolytes but cut back due to the Cook County (Chicago & suburbs in Cook Cpunty) sweetened beverage tax and a penny an ounce. I do drink a lot of water. I am thirsty, especially in the hot weather.
    I do not know how to eat like I did and I cannot lose the weight I gained.
    Sorry this was long and your BIRTHDAY IS DURING THE ECLIPSE ON MONDAY!! How auspicious!! Congratulations!
    Any suggestions?

    • Hi Susan,

      Thank you – the eclipse coinciding with my “stomaversary” certainly is interesting!

      You’ve got a lot going on, and I think it would do you good to speak with your stoma nurse to come up with a plan.

      Re: replacing Gatorade (which I can certainly understand is quite expensive), have you considered making your own electrolyte mix? I share a basic recipe from the Cleaveland Clinic in my article about hydration: https://www.veganostomy.ca/keeping-hydrated-with-an-ostomy/

      Is your hunger being caused by any medication you might be on? Like steroids? If so, then it can be quite a challenge and changing your eating habits alone may not help much for hunger. If it’s not related to medication then you may have better luck eating higher protein foods as they tend to be natural at curbing appetite. For me, that might be something like tofu, or “textured vegetable protein” added to meals, or even beans.

  4. Changing my schedule won’t work for me because of a very good reason, I am back to work! I’d rather have the increased output when I’m at home and sacrifice some sleep. It’s bad enough that after lunch I’ll be in the ladies room frequently.

    Also I am trying a new food each weekend to see how my output is affected. So far so good, I just miss Panera salads. Once I’m healthy that’ll be the first thing I eat. :-)

  5. Thank you for highlighting this! My emptying amounts vary. I’m doing much better at night lately because I don’t eat after 7. I’ve actually had nights with 3-4 solid hours of sleep without interruption!

    • I’m glad that been working for you! Some people will move their largest meals to breakfast and have smaller meals for lunch and dinner. That strategy may work for you, but it does take some adjustments as you may not like big breakfasts!

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