The Art of Emptying an Ostomy Bag (w/ video)

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One skill that every ostomate has to learn is how to empty a bag. While it might seem pretty straightforward, I’ve come to learn of a few techniques to get the job done, I’d like to share those with you in this post.

Intro

This article is aimed at helping people who use conventional DRAINABLE appliances.  If you use a closed pouch or flushable liners, then this information might not be super useful to you, but it may come in handy for those times when you are forced to use a drainable pouch.

To see the various styles of pouches, including different drainable bags, please visit THIS guide to ostomy pouches.

Emptying An Ostomy Bag

Before I get to the many ways that we can position ourselves over a toilet, let’s go over how to actually empty an ostomy bag. Note that this will often be a matter of personal preference, but here’s what’s worked best for me.

Basic Technique

Once I’ve positioned myself over a toilet, I always make sure to drop several sheets of toilet paper over the toilet water and up onto the front of the toilet. This will prevent splashing, and “skid marks” along the inside of the bowl.

Ostomy toilet trouble

Ostomy toilet prep overview

Once that’s done, I tear away several sections of toilet paper, and I place them on my thigh for easy access. I find this to be easier than tearing toilet paper after I’ve emptied my pouch, especially if I’m in a public washroom where the dispensers often require two-handed operation! If I’m kneeling or sitting, I’ll place the toilet paper on top of my leg, but if I’m standing to empty my pouch, then I’ll keep the toilet paper in one hand.

Ostomy guide to toilet prep

When it comes time to open the pouch outlet, I make sure to keep it pinched closed and pointed up slightly, just so I can direct the flow into the toilet bowl. When I’m ready, I point the outlet downwards and allow the stool to empty. With loose or liquid output, the contents of my pouch will come out quite easily, but thicker stool requires some help.

Because my output tends to be thicker, I hold my pouch on both sides between my index and middle finger (as you can see in the video later in this article), then I slide my fingers down towards the outlet. I might have to do that several times until my bag is empty. If the stool has ended up near the top of my pouch (around the filter), I will manually “squeegee” it with my fingers (from the outside of the pouch!).

The name for when stool gets stuck up there is called “pancaking”, and I’ve put together some tips to help prevent this from happening HERE.

Optional step: Some people like to rinse the inside of their pouch with water. While there’s no real need to, I also do this from time to time, and it helps to really clean out any stool that might be “gummed up” in the pouch. To do this, I simply take a bottle that has been pre-filled with warm water and squirt in enough to fill about 1/2 of the pouch. Then I pinch the outlet and give the bag a little shake. After that, I simply empty the contents into the toilet.  ** This may or may not affect your wafer’s wear time, so use caution if you find yourself prone to having leaks **

Once I’ve emptied the contents of my pouch, I’ll take some of the toilet paper to wipe the ends of the outlet. It usually takes two or more times to get the end clean, but it also depends on the brand I use (some are easier than others to clean). Next, I’ll roll up some toilet paper and stick that about 3″ into the end of my pouch outlet, then I’ll give it a turn. I can repeat this a few times, but this really helps to clean out the last bit of the outlet and prevents any odor or stool from seeping out after I’ve closed my pouch.

You can see this technique in the video below:

Optional step: At this point, I can add in any pouch deodorant or gelling products that I use.

I then close the pouch outlet, flush the toilet, and wash my hands. Done!

TIP: Some pouch outlets may be difficult to open easily (i.e. Hollister New Image pouches), but creasing it will help to open it more easily.
TIP: Some pouch closures use fabric material for the Velcro hooks to grab onto (i.e. Coloplast Sensura Mio).  If you are not careful, you may soil this fabric material while emptying your pouch. It’s not easy to clean, but you can try running it under water in the event that it gets soiled.  If you can’t get that fabric portion clean, you may need to replace your pouch or risk odors.

Special Considerations When Emptying

Liquid/Loose output

Liquid output tends to come out of your pouch really FAST, and you’ll have very little flow-control because of that.  You should exercise caution, and place some extra toilet paper onto the toilet water to further minimize splashing.

While my output is usually thicker, I do experience liquid output during extended fasts, bowel prep, or hospital stays, and I find that using a gelling product in my pouch can make things a lot easier when it comes to emptying my pouch.

For more help on dealing with liquid or loose output, check out THIS article.

Thick output

Thicker output tends to be less problematic compared to liquid output, but it can pose a different challenge: it can be hard to drain from your pouch!

If thick output is normal for you, or if you have a colostomy, you might find some benefits in using lubricating products, which you’d add to your pouch every time you empty it.

I have more tips on dealing with thick output in THIS article.

Sit, Stand, Squat or Kneel?

Now that we know how to empty our pouches, let’s consider how to actually get it over the toilet. One of the conveniences of having an ostomy is that we can decide not to sit on a toilet if we want! Yes, some of us sit, some stand and others kneel at the toilet; there’s no right or wrong way to do it!

Sitting

Empty ostomy pouch Sitting faceing out
Sitting is a very common way to empty an ostomy pouch.

Sitting is the most common way for ostomates to empty their pouch. It’s more natural to some, and it’s probably how your stoma nurse explained how to empty your pouch.

Empty ostomy pouch Sitting facing in
Some may find it more comfortable to face inwards.

You can either sit facing the front or back of the toilet and depending on how long the seat of your toilet is, you may prefer one way over the other (I hear some countries have much larger bowls than others!).

It’s important to remember that your aim will be CRUCIAL, and if you’re sitting while wearing your pants, you may risk staining your clothes if anything splashes up or hits them on the way down!

For this reason, I’d suggest lowering your trousers and underwear. If you’ve got a mini or medium size pouch, this is even more important, since you can’t hang the bottom of your pouch further down into the toilet.

I use to sit to empty my pouch for several months after my surgery, but once I had my rectum removed, sitting on the toilet became nearly impossible since it would interfere with the wound VAC I had attached to my butt. So…. I adopted the kneeling technique.

Kneeling

Empty ostomy pouch Kneeling
My preferred method is kneeling, which I started doing when my wound VAC made it impossible to sit on the toilet.

Kneeling is my preferred method because it minimizes the risk of splashes, means I can keep my trousers on, and it’s pretty comfortable. I kneel with one knee down since it’s the most convenient for me, but you can do it with both knees on the ground if you like. The reason I find kneeling with one leg to be more convenient is because it gives me a free spot on my thigh where I can lay down some toilet paper for easy access when I need it.

If you use this method and have sore knees, you might want to invest in a small foam cushion or carpet to keep by the toilet.

Standing

Empty ostomy pouch Standing
Many ostomates like to stand and empty their pouch – but beware of splashing!

Because standing is the least comfortable (at least for me it is!), and has a tendency to create more of a splash, I usually reserve this method for public washrooms and portapotties (where I’d rather not be touching ANYTHING with my ass or knees!).

Depending on how tall you are, you may need to bend a bit, but many ostomates just stand up straight with their pouch over the toilet.

Squatting

Empty ostomy pouch Squatting
I squat when I’m in a public washroom and don’t want to sit or kneel.

Squatting is a compromise between kneeling and standing, and it helps to prevent splashing caused by standing, but it’s also more uncomfortable.

I would only suggest squatting if you’re in good physical shape, or if you can empty and clean your pouch quickly.

If I’m in a public washroom, and the floors are too filthy to kneel, I will squat!

BONUS: Tips if you have mobility issues

If you have mobility or flexibility problems then sitting, squatting and kneeling at a toilet may not be a viable option for you.

One reader said that he uses a small, two-cup container to collect his output and then dumps the contents into his toilet. Once he’s done, he rinses the container clean (and disinfects it once a week).

He said that this can be quite useful when he travels since bending isn’t very easy for him.

This method of emptying your bag is similar to the one I describe below in the section “Post-op Considerations”, but it’s probably more convenient because of the small nature of the two-cup container.

BONUS: Public Washrooms

Emptying your pouch in a public washroom can be very different from doing it at home. The toilet (and floor) may be soiled and peed on, the toilet paper is often thin and close to useless, the toilets tend to be “auto-flushing”, and you often have limited space to move around.

My approach to using a public washroom goes like this:

  1. Find the most accommodating stall in this order: private, accessible bathroom -> family washroom (usually has a change table and a locking door) -> accessibility stall (larger than regular stalls, and sometimes comes with extras to make things like pouch changes easier) -> regular stall.
  2. Clean what you can. Yes, other people are disgusting, and their aim sucks! If there’s urine on the toilet seat, use toilet paper to clean it up. I only clean areas that I think me or my trousers might come in contact with (the front of the bowl and seat).
  3. If you’ll be kneeling (assuming the floors aren’t covered in unidentifiable liquid), drop some toilet paper on the floor where your knee(s) will be touching.
  4. If the toilet has a sensor on it, cover it with toilet paper to prevent it from flushing without your consent.Toilet sensor Toilet sensor fix
  5. Tear several lengths of toilet paper and set them aside. I usually stick them in my pocket so they are hanging out a bit for easy access.
  6. Place enough of that cheap, thin toilet paper on the inside of the toilet to prevent splashing.
  7. Take up your desired position and empty your pouch. I almost always squat while using a dirty washroom.
  8. Use the toilet paper you’ve set aside to clean the outlet of your pouch.
  9. Close your pouch, discard and toilet paper you’ve placed on the floor or toilet sensor.
  10. Flush.
  11. Flush again (almost always necessary).
  12. Wash your hands. PLEASE, WASH YOUR HANDS!
  13. Rejoice and high-tail out of there!

Some public washrooms are worse than others, but those steps work in 99.99%* percent of the places I’ve used.

*This figure has not been verified by a 3rd party :p

Reader Bonus: One reader suggested bringing toilet seat covers along to put on seats. While I’ve seen several publich washrooms that provide these, it’s a great idea to keep some in your ostomy supply kit when going out.  Thanks for the tip, Krishnapriya!

Post-op Considerations

If you are still in hospital or are recovering from your surgery, you may be asked to measure your ostomy output (and urine output) using a collection container that’s meant to be placed over the toilet. Some people might find that putting this container in the sink is easier, especially if they are sore, weak and hooked up to an IV pole! If you do that, just be sure to watch your aim!!

Hat-style Specimen Collector
These are commonly called a “Hat-style Specimen Collector”

Final Words

As you can see, there are many ways to empty an ostomy bag, but there is no right or wrong way; you’ll have to try different positions and techniques until you find one that works best for YOU. Also, don’t be afraid to use a different technique when you’re in a place like a public washroom or airplane.

Some ostomates with special challenges may need to use a collection pan, rising toilet or opt for something like a pouch liner, but there will always be a way to empty that pouch!

QUESTION: What technique do you find works best for you?
Illustrations Credit
I’d like to thank Amber (a.k.a. Colitis Ninja) for her beautiful illustrations. If you’d like to use her for her artistic talent, she is available for commissioned work and can be contacted through her website: http://colitisninja.com/
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LK
Member

I always sit forward to empty the bag and because of my bladder disease I usually have to tinkle at the same time anyways. I always use to carry a full water bottle with me too, but now I fill at the sink if it is in small stores as in our small town area I am going to a place like Walmart, I do not want anything much to do with the sinks so I carry a full one there. I wash my hands at the sink but use paper towels to shut the taps if they have handles, and take two for the door handle, then when I get out I will use hand sanitzer also. Large stores in our area (Canada) have the sensor for turning water on these days. I LOVE the tip for the auto flush toilets, that is great, they freak me out when they suddenly flush! Silly I know, but man, some of them have a such a huge attitudes! Walmart store is always busy in the washroom. I would like to see a sink and toilet in the handicap washrooms, just because sometimes we need the water to clean at the same time as a sudden bag change or empty. Such great tips. Thank you.LindaK

Sydneychic
Member

I carry a 330ml water bottle with me (I’ve started to carry it filled so people don’t look at me filling a water bottle before going into a cubicle).  I sit sideways facing the cistern, fill the toilet bowl with some paper and then empty the bag.  Rinse it out with the water, dry with some more paper and reseal.  Some people have said that you shouldn’t use water in the bag but my dr and nurse recommended flushing the bag out.  If you don’t want to touch the stoma with water then just flushing the neck of the bag gets out any residue and cleans the opening.  I also carry a travel size mouthwash and put a few drops in the bowl before emptying for any smell.  I am in Australia and our toilets aren’t filled with water, there is only a small amount in the bottom before flushing.  I have wondered how I will cope with the US toilets and splashing.  What do you do?

Marie Tucker
Member
Marie Tucker

Oh my yes indeed! I know for myself, I also use toilet paper for the most part or those toilet seat papers work too! Eric has posted some great visual aids above in this article too but that’s what I do as well! I don’t know if you caught those or this comment came through the other methods for posting so this is the link to the article: https://www.veganostomy.ca/how-to-empty-ostomy-bag/

Hey – the mouthwash is a great idea! That certainly can have a strong enough scent too! I like that & they come in travel sizes as well! Thanks for sharing Sydneychic!

john68
Member

Hi, may be here in the UK our toilets are a little bigger I don’t know but I sit forward as normal just a little further back and their is plenty of room. It’s the way I have always done it🚽😀

LK
Member

I’ve learned that when I go to a public washroom to grab a few paper towels, enough to toss on the floor in front of toilet. When they hit the floor you will see if its wet. I leave them there till I am done and trash them before I leave. I use layers of toilet paper to line the seat and I also place some in the front of the toilet bowl, hanging in and over the edge to avoid that area as much as possible. I have gone as far as rolling the cuffs of my pants up to avoid as much of the floor as possible. Gas station WRms are the worst nightmare for me. I always “slowly” release contents to avoid splashing. Keep hand sanitizer handy to clean the outside of the bag if need be, I have used it on a toilet seat. We all know the only place to put our equipment should we have a change issue, is to balance it on the TP roll, my supplies are in a roll down type bag, with a loop and I carry those sticky back plastic hooks ($ store) with me to place on walls at the right height, then hang my pocketed bag from there. I carry the deodorant separate from those. I have been speaking to managers in stores about the fact that his washroom is not only used by those in a wheelchair, those with prosthetics and US too. I will lift my shirt to show them my stoma and pouch, then show them the supplies we need. It is a learning curve for them some are trying to solve the issue. If you have time, please join me in this effort. Compliment a manager when you find a clean facility and explain why. I have had to do a bag and clothing change in a very small WRm…it was a bit traumatic! Needless to say I spoke to the manager and asked about using his private washroom next time. Amazing how clean it was, I always assure them I will leave it just as clean as I found it. You can ask for a permission note if you live in the area, for his staffs sake. I do carry a small spritz bottle of a cleanser in my supplies for cleaning and have had to use it too. Also, if handle flush, use TP for that too. Make sure not to over fill the toilet with paper so flush two, three times if needed. Wow…did I ever edit. Be well.Linda K

Marie Tucker
Member

Great job in educating Linda! We certainly are the ambassadors who know first hand!

I also do the “prep” of the washroom area and for me that means carrying a travel size Yankee Candle spray or Fabreeze as well as an empty water bottle too for rinsing my pouch. Most times I can get warm water (not always) however, even if I don’t, I at least rinse the bottom of the bag and that makes the clean up easier than not doing it (I carry wet wipes too). I believe this practice of rinsing has also given me many more days in between wafer changes, though I try not to fully rinse unless I have warm water to use.

All the best!

Verna Cox
Guest
Verna Cox

Thank you. Got more helpful information from this article than I got from my ostomy nurse. Emptying an ostomy bag can be quite messy. Will try your helpful hints.

Marie Tucker
Member
Marie Tucker

Great article! My colon was removed on November 8 and I have learned how to do some of these methods by trial and error! I actually am not comfortable emptying on the toilet because my leg was injured during my surgery so I’m usually wearing a brace to keep my leg locked so it just doesn’t “fit” well when I’m on the toilet. Instead, I stand in front of my bathroom sink – which is fairly low – and use an old Tupperware container, lined with some soapy water, to empty my contents into and then flush that down the toilet as well. Of course I couldn’t stand when I first got out of surgery but I’m strong enough now that I can in my locked leg brace. I have also comment about sitting and using a bucket as well below.

My occupational therapist actually asked me if I thought I could use a Ziploc bag because often I’m emptying in the middle of the night and if I get up and do not have my brace or can’t make it to my wheelchair in time, I usually fall but I wasn’t sure that would actually work (can I actually hold the bag and empty at the same time?) so we set up a bucket next to my side of the bed with trash bag liners and I’m able to sit on the bed and empty if need be without getting up. Right next to it is my camping Porta potty as well with a built-in reservoir. I like the fact that you had in there about mobility issues because that’s where I’m at right now.

Thanks so much for all the great information and comments everyone!

Ira Trachtman
Guest
Ira Trachtman

Excellent illustrations and technique. Most helpful.
Thank you for this..Ira

Krishnapriya
Member
Krishnapriya

Thanks for the tips, Eric!
Another thing I found might be useful in public toilets is to have a couple of toilet seat covers in your carry bag.. Not all toilets have this facility. So, if you are sitting to empty your bag, like I do, it feels so much better to be sitting on a cover and it also helps with the splash. I even carry a small roll of toilet paper with me. Lol, I am particularly fussy when it comes to public toilets!

Ross Wilson
Member

well I am having my colon cancer operation on august 30/17 and have been reading all the information on you website. I am not looking forward to using a ostomy bag but will have no
choice. I am grateful for finding your website and thankful that you are helping me to understand
whats ahead.

Ross Wilson

oriharakaoru
Member
oriharakaoru

“but if I’m standing to empty my pouch[…]”

oh my god WHAT. lol, sorry, that terrifies me. Also might show the difference between how men and women use the washroom… Like, it would never occur to me to do anything BUT sit on a toilet, like, ever. But, hey, if it works for you!

Also can’t recommend the toilet paper in the bowl before emptying enough! Learned that one the hard way…

Also, I use clips (Holister) to close my pouch opening, and have found them extremely handy to help move stool out of the bag (the same way you use your fingers).