What is pouching a colostomy?

If your bowel needs to heal after a health problem or part of your colon needs to be taken out because of a condition or disease, you may need a colostomy bag.

During surgery, the end of your colon is brought through an opening in your belly to form what's called a "stoma." This is where your feces (poop) will come out. Unlike your anus, your stoma doesn't have muscles or nerve endings. So you can't control when you move your bowels. Instead, a pouch, called a colostomy bag, goes over the stoma to collect your poop when it comes out.

Whether you'll only need it for a brief time or it's a permanent change, a colostomy bag can take some getting used to. But most people adjust and soon return to their normal lives.

One colostomy bag doesn't fit all. There are different types to choose from:

• One-piece system: This fits around your stoma and is attached with a gentle adhesive. When you need a fresh bag, you take the whole thing off and replace it with a new one. Some of these systems use flushable liners.
• Two-piece system: A base plate fits tightly around your stoma, and you attach a bag to it. You'll change the bag as needed; the base plate usually is changed every 2 to 3 days.
• Closed bags: These are best used with firm stools. You'll change it twice a day. Some have special liners inside that can be flushed down the toilet.
• Drainable bags: These are best if your stools are very liquid. You empty them through an opening at the bottom. They need to be changed every 2 or 3 days.
• Mini pouches: These are small bags you wear for only a short amount of time.

Your doctor or a nurse trained in stoma care will help you choose the one that's right for you and your lifestyle. Many times, it's possible to try one before you decide.

Your medical team will show you how to care for the bag. But here are a few tips to help you fit it into your daily life:

• Decide how to share your news. You may feel less self-conscious if you show your colostomy bag to loved ones or talk about it with friends. You also may decide to tell your boss or a co-worker in case you need their help or understanding at work.
• Get an honest opinion. Ask someone you trust if they can see your bag under your clothes or hear the noises it makes. You may realize you're worrying about your colostomy bag more than you need to.
• There are ways to hide it. For example, you can empty your bag once it's one-third full so it doesn't stick out under your clothes. A secure bag should not have leakage and should be odor-resistant.
• Wear what you want. A colostomy bag should fit under your normal clothes. If not, some companies make special high-rise pants and underwear with a special pocket to hold your bag. You also can find swimwear with a mesh lining or gathered fabric to hide any bulges.
• You can have a good sex life. While you might feel self-conscious at first, try to relax. Change your bag right before you're intimate. You can also take off the bag and temporarilyuse a small stoma cap instead.
• Stay active. You can still exercise. Talk to your doctor about when to wear a support garment or a hard plastic shield called a stoma guard.
• Give yourself time to get used to foods. Some are more likely to cause gas, diarrhea, or constipation. Try them at home one by one so you know how your body will react.
• Remember to laugh. Don't worry if you have an awkward moment or two while you're getting used to your colostomy bag. That's normal. You may handle it better if you can keep your sense of humor.

An ostomy is a hole made by surgery to allow stool or urine to leave your body through your belly. It’s a new exit route for waste if you can’t poop or pee the way you usually would. Your ostomy’s exact spot on your abdomen will depend on your reason for the surgery.

At the hole, a small open end of your ureter or small or large bowel sticks out through your skin. This is called a stoma, and it will look red or pink. It has no nerve endings, so it shouldn’t be painful. Your surgeon will connect a pouch, which collects urine or stool, to your stoma.

Your doctor might recommend ostomy to treat serious bowel problems or to let a body part heal after a surgery. You also might need an ostomy if certain organs are diseased or have to be removed.

The reasons include:

Two main kinds of ostomy help remove feces, and one type diverts urine:

Ileostomy. The bottom of your small intestine, called the ileum, is brought up through your abdominal wall to make a stoma. This is often done if you have rectal cancer or inflammatory bowel disease.

Colostomy. If you have part of your colon removed, a colostomy can attach the remaining colon to the outside of your body.

Urostomy. The tubes that carry urine to your bladder are routed to your stoma. You might get this if you have cancer or other diseases that cause serious bladder problems.

You have options besides traditional ostomy. One is putting a pouch inside your body to collect stool, which exits directly through the anus.

A temporary ostomy can be removed later. Even a permanent ostomy can sometimes be reversed.

You’ll be in the hospital and under general anesthesia, which means you won’t be awake or feel any pain.

Before the operation, your surgeon or specially trained nurse will find the best spot for your stoma, usually the flat front part of your abdomen.

The surgery will differ based on the type of procedure you need. Generally, your surgeon takes part of an internal organ, such as the bowel, and connects it to an opening in your abdominal wall.

A nurse or therapist will show you how to care for your stoma and how to empty your waste pouch.

You should be able to get back to your regular activities a couple of months after the surgery. You may need to avoid driving and heavy lifting for 2 or 3 weeks. After you’ve recovered, you’ll probably be able to go back to most activities except for contact sports like karate or football.

Common issues that come up later include gas, diarrhea, and constipation. Talk to your doctors if these problems are severe or don’t go away.

Sometimes, you might have problems after an ostomy surgery. They can include:

• Itchy, red, or irritated skin around your stoma
• Bleeding inside your body
• Infections
• Blockage in your small or large intestine
• Problems with your stoma, such as a hernia (weakening of the abdominal wall) or prolapse (when the bowel pushes through the stoma)
• A vitamin B12 deficiency
• An electrolyte imbalance
• Discharge from your bottom
• Problems absorbing water, vitamins, and other nutrients
• Feeling the urge to poop

Tell your doctor if you have any of these symptoms or any other problems.

It will take time to get used to going to the bathroom in a different way. After the surgery, your stool will come out through the stoma and empty into a disposable bag.

How often you’ll poop or pee will depend on what you eat, the type of procedure you had, and your bathroom patterns before the surgery.

You may need to change your diet to control your bowel movements for a little while after surgery. But you should be able to eat what you want once you fully recover.

You might worry about negative reactions from your friends, family, or sexual partner. When you’re out, your clothing will cover your ostomy, so most people won’t even know about it.

If you have a hard time with the social, emotional, and practical changes in your life, talk to your doctor, family, and friends. You might join a support group or work with an enterostomal therapist, who’s trained on the day-to-day issues of living with a stoma. It can be easier for you to adjust when you have support from others.

When you have to get a stoma or ostomy bag as part of your colorectal cancer treatment, it takes some getting used to. The surgery may change the way you feel about yourself, your body, and sex for a while.

If you’re curious about sex and intimacy after an ostomy, it’s a good sign that your body and mind are ready to move forward. These tips will help.

Take your time

Doctors often recommend waiting 3 weeks after the surgery, but it’s up to you. Some people head back to the bedroom as soon as they can as a way to connect with their partner and their pre-surgery life. Others may not think about it for months or years. It’s most important to be comfortable with your body and confident with your stoma first. Once it feels like part of you, the rest will follow.

Things may be different

After ostomy surgery, common sexual side effects may include erection problems, vaginal dryness, not being able to reach orgasm, and pain. But those problems may be temporary. So if you still have any of these issues after the first few times you have sex after your surgery, tell your doctor. Some medications can also lower sexual desire and cause ejaculation and erection issues.

Prep your pouch

You might feel less spontaneous about sex when you have a pouch. Before you head behind closed doors, empty and clean your pouch, and then make sure the seal is tight. If it makes you feel better, use paper tape for an added layer of security. Once you do that, focus on being present in the moment, not on the pouch.

Ease the odor

If you’re worried that the smell of your pouch might be a distraction, try a deodorizer. Various brands make them in tablets, drops, and sprays. There are also pills you can take to curb the odor of your own waste. See what your doctor recommends.

What to wear

A “passion pouch” is smaller than a regular bag and has a closed end instead of a drain. (You’ll need to switch back to your regular pouch later.) You can also use a pouch cover to camouflage things a bit. You can find clothing that gets you in the mood and hides your pouch at the same time. Special boxer shorts and cummerbunds for men and crotchless lingerie help hide a pouch, for instance.

Take sides

Get creative with positioning that doesn’t hurt and keeps your pouch out of the way. Try the side position on the same side as your stoma.

Talk it out

Just like in any relationship, communication is key. As much as you’re comfortable, share any fears and physical issues with your partner. Talk about what you like, don’t like, and what you’re willing to try. Being open is just as important as being a good listener when it’s your partner’s turn to talk.

When it’s time to stop talking and start trying, it’s not unusual for anxiety to follow you into the bedroom. Take a deep breath and remember, nothing’s sexier than a good attitude and a sense of humor about whatever comes up along the way.