A colostomy is a type of surgical operation to remove part of the colon, usually due to damage, and create an opening in the abdominal wall called a stoma. This opening makes a passage from the large intestine to the outside of the body in order to allow stool and gas to leave the body without going through the rectum [1].

Following this type of surgery, the waste leaving the large intestine through the stoma needs to be collected in a pouch or bag that is worn on the outside of the body - this pouch or bag is what is referred to as a colostomy bag or colostomy pouch (or stoma bag/pouch).

According to the Australian Department of Health, there are around 50,000 people living with a stoma.

In this article, we explain what a colostomy bag is and how it works, as well as ways to manage living with one. Continue reading for more information!

As mentioned above, a colostomy bag is a pouch worn on the outside of the body that collects waste leaving the body through the stoma following colostomy surgery. It can be a temporary solution for some, but for others, it may be permanent.

Some people will only need a temporary colostomy for conditions such as [2]:

• Serious infection in the colon

• Acute inflammation of the bowels

• Acute injury to the colon

• A blockage in the colon or anus

• An anal fistula

• A partial colectomy (partial removal of the colon)

Other people may require a permanent colostomy, due to conditions such as [2]:

• Bowel cancer

• Total colectomy (complete removal of the colon)

• Crohn’s Disease

If the colostomy is temporary, it will require another surgery at a later date to close the stoma and reattach the large intestine to the colon [2], and there will no longer be a need to use a colostomy bag. However if the colostomy is permanent, it will require the permanent use of a colostomy bag.

After having a colostomy the bowel still moves, and when it does, wind and waste come out through the stoma [3]. Since the gastrointestinal tract is made of smooth muscle (the muscle that moves involuntarily), it is not possible to be able to control when it happens, which is why the colostomy bag is required after this surgery [4].

The colostomy bag is leak-proof, odour-proof, designed to protect the skin around the stoma (peristomal skin) and able to be worn under clothing. They can come in different shapes and sizes, but there are two main types [1]:

• One-piece pouches that attach directly to a small adhesive cover over the stoma, called a skin barrier

• Two-piece pouches which involve a separate pouch that is able to detach from the adhesive skin barrier

The pouch itself can be drainable (able to be emptied) or closed (disposable), and the type that is best depends on the consistency of waste matter [3].

A stomal therapy nurse will be able to assist you in choosing the type that best suits your body shape, the stoma and your needs. They will also be able to explain how to attach it securely and give any ongoing support and advice required.

You may also be eligible to access the Stoma Appliance Scheme which provides free stoma supplies through stoma associations, so be sure to check your eligibility.

A stomal therapy nurse will explain in depth how to change and empty or dispose of the pouch, as well as give advice tailored to your situation on how often to change it.

But there are a few general pieces of information to keep in mind [5]:

• Your pouch will need to be emptied into the toilet when it is about one-third full, or before you change it

• Wash your hands thoroughly with soap and water, then dry with a clean towel (or paper towels) before and after changing the pouch in order to prevent infection

• Make sure to thoroughly clean and dry the peristomal skin during a pouch change to prevent infection or irritation

• Ensure to check your skin and the stoma to make sure nothing has changed

• Never flush disposable pouches in the toilet

It’s essential to call your doctor if you notice any of the following when changing a pouch [5,6]:

• The stoma is swollen or has changed in size, shape, or colour

• The peristomal skin is weepy, bleeding, broken or discoloured

• The peristomal skin is itchy, stinging or burning

• There is an odour coming from the stoma or you notice pus or blood

Whether permanent or temporary, living with a colostomy bag will likely require some adjustments to your lifestyle, which might include the following [7,8]:

• Avoiding certain bathing or skin products, such as those that contain alcohol or oil

• Diet alterations (in some cases)

• Keeping supplies for the pouch with you at all times

• Getting used to emptying and changing the pouch

• Adjustments to medications (only with doctor's advice)

It is important to remember that most people with a colostomy bag have no changes to their level of activity (including exercise) after healing from the operation [7] - but make sure you check with your doctor for medical advice unique to your situation before returning to exercise.

The majority also don’t require any dietary restrictions after healing and can enjoy a wide and varied diet, but it is encouraged to keep a food diary in order to make a note of foods that cause excess wind, diarrhoea or constipation (eg spicy foods, legumes or dairy).

Since a colostomy bag is made to fit closely to the body, you can continue wearing whatever clothing you like - some clothes (such as belts or tight-fitting pants) may be less comfortable depending on the stoma’s location [8].

While many feel concerned about whether others will be able to notice, rest assured that it is hidden under clothing and the odour-proof pouches prevent any odour leakage [8].

While it can be life-saving, having colostomy surgery can still be a distressing experience.

There have been qualitative studies and assessments of the mental wellbeing of patients with colostomy bags, which show that it can have a significant impact on mental health.

A 2021 Greek study into the experiences of patients living with a permanent colostomy pouch reported a variety of mental health challenges, including [9]:

• Difficult emotions such as anger, anxiety, fear, sadness and denial

• Social isolation and loneliness, with many participants reporting a self-imposed restriction on social activity

• Struggling with body image, confidence and self-esteem

• Feelings of overwhelm related to the recovery and adjustment period

While the above were experienced by patients in the study, it is important to note that the severity of these feelings lessened over time.

If you are experiencing negative mental health impacts from adjusting to living life with a colostomy pouch, it’s important to continue to engage with your support network and those close to you as well as let your GP know about these feelings so they can offer advice based on your situation and referrals to appropriate services.

There are ostomy support groups, too, which can be beneficial to join in order to reinforce that you aren’t alone in your experiences and foster a sense of community.

If a loved one or someone you care for is struggling with their mental health post-colostomy surgery, there are many ways you can support them, including:

• Educating yourself on their condition and the related equipment/supplies they use

• Offering emotional support by listening to and acknowledging their thoughts and concerns

• Encouraging open communication and being non-judgemental to foster a safe, comfortable environment for them to share their feelings

• Offering help with errands or tasks

• Accompanying them to support groups

• Respecting their privacy by being non-intrusive and keeping conversations confidential

• Encouraging them to see their GP for a referral to a psychologist

While having a colostomy requires a period of adjustment and learning how to manage a colostomy pouch, keep in mind that the majority of people with a colostomy bag do lead normal lives without restrictions in their social life, activity or diet.