An ostomy bag collects bodily waste (stool or urine) that can no longer exit your body the normal way. It attaches to an opening called a stoma, which a surgeon creates on the surface of your abdomen. Between 725,000 and 1 million Americans currently live with an ostomy, and roughly 100,000 new ostomy surgeries are performed each year in the United States.
Why Someone Might Need an Ostomy Bag
An ostomy becomes necessary when disease, injury, or a birth defect prevents your intestines or bladder from doing their job. The surgery reroutes waste so it leaves your body through the stoma instead of the usual path. Common reasons include:
- Colorectal or bladder cancer
- Inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
- Diverticulitis
- Intestinal obstruction
- Chronic bowel or urinary incontinence
- Spinal cord injuries or congenital conditions like spina bifida
The specific type of ostomy depends on where in your body the problem is. All three main types use an external pouch to collect what your body can no longer pass on its own.
Three Main Types of Ostomy
Colostomy
A colostomy reroutes part of the large intestine to a stoma. The consistency of what ends up in the bag depends on where along the colon the stoma is placed. A stoma higher up, on the transverse colon, typically produces pasty output. One placed lower, on the sigmoid colon, produces stool that looks much like a normal bowel movement. Right after surgery, the output is mostly gas and liquid, then thickens as you start eating solid food again.
Ileostomy
An ileostomy connects the small intestine to the stoma, bypassing the large intestine entirely. Surgeons use this approach when the colon can’t safely store or move digestive waste. Because the large intestine is where your body absorbs most of its water, ileostomy output tends to be looser and more liquid than colostomy output. You won’t have control over when waste exits the stoma. It flows continuously and collects in the bag throughout the day.
Urostomy
A urostomy redirects urine. Instead of traveling from the kidneys to the bladder and out through the urethra, urine exits through a stoma on your abdomen. Bladder cancer requiring removal of the bladder is the most common reason for this surgery. Other causes include bladder damage from trauma or radiation, urinary incontinence, a damaged urethra, and structural abnormalities that make urination difficult or impossible.
Temporary vs. Permanent Ostomies
Not every ostomy is lifelong. A temporary ostomy diverts stool away from a part of the intestine that needs time to heal, such as a surgical site, an area of inflammation, or a blockage. Once healing is complete, a colorectal surgeon can reverse the ostomy and reconnect the intestine so waste travels its original route again. A loop ostomy, where the surgeon brings a loop of intestine to the surface rather than cutting it completely, is the type most commonly used for temporary diversion.
A permanent ostomy is necessary when disease or treatment has destroyed normal intestinal or bladder function for good, or when the muscles controlling elimination have been removed or no longer work. In these cases, the ostomy bag becomes part of daily life from that point forward.
What the Stoma Looks and Feels Like
A healthy stoma is pinkish-red and moist, similar to the inside of your cheek. It has no nerve endings, so you can’t feel it being touched, bumped, or even scraped. That lack of sensation is important to know because it means you won’t automatically notice if the stoma gets irritated or nicked during a pouch change. Visual checks are the main way to keep tabs on stoma health.
Daily Care and Pouch Changes
An ostomy bag needs to be emptied when it’s about one-third full. Most people empty their pouch several times a day, depending on the type of ostomy and their diet. The entire pouch and its adhesive barrier are typically changed every two to four days, though your ostomy nurse may recommend a different schedule based on your situation.
Skin irritation around the stoma is the most common complication. Studies report that anywhere from 36% to 73% of people with an ostomy develop some form of skin issue, with contact dermatitis from the adhesive being the most frequent. Moisture-related irritation, where the skin becomes inflamed, red, and itchy from prolonged contact with output, affects roughly half of those who experience skin problems. Keeping the skin clean, dry, and properly fitted with the right-sized pouch opening goes a long way toward preventing these issues.
Living With an Ostomy Bag
An ostomy doesn’t put most activities off-limits. People with ostomies work, travel, play sports, and have active sex lives. Daily exercise is encouraged and helps your body function well. Swimming is safe with a pouching system in place, though you should empty the bag beforehand and eat lightly. Taping the edges of the adhesive barrier with waterproof tape can help keep the seal secure in the water.
The main precaution involves contact sports, where a hard blow to the abdomen could injure the stoma. Protective guards are available for people who want to stay in those activities. Sweating during workouts can loosen the adhesive, so specialized athletic pouches and ostomy support belts exist for exactly that problem. Clothing adjustments are minor: longer shirts, higher-waisted shorts, or workout pants that sit over the pouch are common choices that keep the bag secure and discreet.