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.
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.
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.
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.
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.
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:
I then close the pouch outlet, flush the toilet, and wash my hands. Done!
Special Considerations When Emptying
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.
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 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.
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 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.
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 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:
- 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.
- 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).
- 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.
- If the toilet has a sensor on it, cover it with toilet paper to prevent it from flushing without your consent.
- 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.
- Place enough of that cheap, thin toilet paper on the inside of the toilet to prevent splashing.
- Take up your desired position and empty your pouch. I almost always squat while using a dirty washroom.
- Use the toilet paper you’ve set aside to clean the outlet of your pouch.
- Close your pouch, discard and toilet paper you’ve placed on the floor or toilet sensor.
- Flush again (almost always necessary).
- Wash your hands. PLEASE, WASH YOUR HANDS!
- 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!
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!!
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!