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.

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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.

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 full 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.

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.

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.

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.