Ostomy Basics: A Guide to Ostomy Type, Supplies, and Common Problems
If you or someone you're caring for needs an ostomy, you might be overwhelmed by the surgery, the lifestyle changes, and the wall of information you need to know to keep your ostomy healthy.
That’s okay! We’re here to help you understand what an ostomy is, and what supplies you may need to care for it. We also offer guidance for navigating common lifestyle changes and troubleshooting complications.
Let’s get started.
What is an ostomy?
An ostomy is a surgically-made opening that allows waste to pass out of the body. Ostomies are life-saving procedures, and a person needs an ostomy when disease, cancer, or injury prevent the urinary or digestive system from operating normally.
The opening created by an ostomy surgery is called a stoma. The stoma is created from the end of the small or large intestine, depending on the type of ostomy. During surgery, a surgeon secures a short length of the intestine to the outside of the patient’s abdomen.
After surgery, bodily waste moves out through the stoma and into an appliance called an ostomy bag. Ostomates (aka people who have an ostomy) then empty the bag once a certain amount of waste has collected.
Types of ostomy
The three main types of ostomy are urostomy, colostomy, and ileostomy.
A urostomy is a type of ostomy that allows urine to pass out of the body. Normally, the body moves urine from the kidneys down two small tubes called the ureter, to the bladder and then out through the urethra.
In a urostomy, urine still moves down from the kidneys through ureters. Surgeons remove a small section of the intestine then re-attach one end to the ureters and the other to the outside of the abdominal wall.
Urine collects in the urostomy bag, which is then emptied once the bag becomes about one-half to two-thirds full.
Ileostomy and colostomy
There are two types of ostomy that remove solid waste from the body. Both types perform the same action, the big difference between them is whether the stoma is formed from the small intestines or the colon.
Typically, food passes from the stomach, through the small intestine, and into the large intestine. Stool — what is left after the large intestine processes food — moves out through the anus and rectum.
- In the case of ileostomies, the “end of the line” for stool is now the small intestines, from which the stoma is created. Ileostomies are required when the colon is unable to process waste or has been removed from the body due to injury or disease, commonly colon cancer or irritable bowel disease.
- On the other hand, in a colostomy, a portion of the large intestine, or colon, remains after surgery. The surgeon then forms the stoma from the tissue of the large intestine.
Ileostomy output tends to be more liquid and less solid than the output from colostomies because the body removes the largest amount of water from waste in the large intestine. Colostomy output is typically thicker and more formed because the colon has removed water from the stool and made it available for the body to use elsewhere. Ostomates lose lots of water through output that the body would otherwise retain. So it’s very important, regardless of what type of ostomy you have, to watch your hydration and replace lost fluids.
A colostomate’s output tends to be thicker and more formed than that of an ileostomy. This is because the colon has removed water from the stool and made available for the body to use elsewhere.
If you have a colostomy, you may not need to empty your bag as often as someone with an ileostomy. Depending on the type of surgery you had, you may have the option of irrigating your colon once a day or every other day. Irrigation causes a bowel movement and empties the colon in much the same way a person with unaltered bowels might pass stool.
Ostomies can be temporary or permanent, depending on your medical condition. Sometimes a temporary ostomy becomes permanent. Your surgeon and your doctor will discuss your options for surgery with you.
The basics: ostomy bags and barriers
If you have an ostomy, you’ll need to learn to care for it. This includes changing your ostomy appliance, caring for your stoma and peristomal skin (peristomal skin is the skin around the site of the stoma), and managing your health and diet. We cover skin and stoma health, diet changes, and mental health farther down in this article.
The basic parts of an ostomy appliance are the ostomy bag and the ostomy barrier. Together the bag and barrier make up your ostomy system. While the bag collects waste that passes through the stoma, the purpose of the barrier is twofold: it protects the stoma and the surrounding skin and it allows the bag to adhere to the skin.
The ostomy bag and the barrier are not permanently attached to your skin. Both pieces need to be changed out regularly, typically every 4-7 days. Some people need to change it every day and some people may go up to 10 days between changes.
What kind of system should I choose?
Ostomy systems offer a lot of options and you can try different types to find a fit you like.
Here are some key points to know about choosing an ostomy system:
Depending on your preference and needs, you can use an ostomy system where the bag and barrier are combined together into a 1-piece system. Alternatively, you can use a 2-piece system, where the bag and barrier come separately and attach using a coupling device. A coupling device may be a snap-together lock, similar to the way Tupperware lids attach to containers, or it may be a type of adhesive.
Some benefits of 1-piece systems are that they have a lower body profile (less visible under clothes) and have fewer pieces to keep track of.
Two-piece systems let you change out the bag according to activity type, or, if the barrier is still good but the bag is not, simply put on a fresh bag.
Make sure the barrier supports your stoma away from the skin.
Some stomas are placed in a skin crease or are retracted. These stomas need help being lifted away from the skin to ensure output moves into the bag. A special type of barrier, called a convex barrier, can be used to support the stoma. If your stoma sits above the skin, like an “outie” belly button, a flat barrier will work.
Whether you choose an open or closed (aka drainable) bag depends on your ostomy. Ostomies that pass mostly liquid or have high volume output should use drainable bags. Colostomies, which have more formed output but fewer bowel movements,, can use a closed bag.
Your barrier should fit your snugly around your stoma. You have the option of cutting the barrier hole yourself or ordering barriers with a pre-cut hole.
Pre-cut holes offer convenience while cut-to-fit holes ensure your barrier always has the correct fit around your stoma.
Whatever you choose, your ostomy system should be comfortable and easy to maintain and change. We encourage you to keep trying different options until you find something that truly meets your needs.
Take our product quiz to determine what sort of bags and barriers could work for you. [link]
Read on to learn more about what to expect from an ostomy bag and barrier.
Ostomy bags collect waste that passes through the stoma. They are available with many different options.
The first choice you’re likely to make when choosing a bag is whether you want an open or closed bag. An open bag means the tail, or bottom, of the bag can be opened to drain the contents of the bag. To close the bag, the tail is rolled over several times and secured with a clamp or a hook-and-loop closure, similar to Velcro.
A closed bag does not have an opening to drain its contents. The bag can be removed by disconnecting it from the barrier, as with a 2-piece ostomy system, or by removing the whole system, as with a 1-piece ostomy system.
If you have a high amount of output and need to empty it frequently, a closed bag may not be practical for you. Urostomy bags are always open because they need frequent drainage.
You also have a choice in how your bag looks. Bags come with transparent, semi-transparent, and opaque covers that have a viewing window.
Transparent bags are useful in cases where it is necessary to see how much or what type of output is being produced because that can signal potential health issues. Alternatively, some people prefer opaque bags because they hide output and look more discrete.
An ostomy barrier protects and isolates the stoma. If you’ve never seen an ostomy barrier, it helps to imagine a very large adhesive bandage, about three or four inches wide, in the shape of a square or a circle. The bandage has a circular opening in the middle to allow the stoma to pass through.
Ostomy barriers must keep waste from touching the skin and keep the whole system — which sometimes includes a very full and heavy bag — securely attached to the skin.
There are two types of barriers:
Depending on your anatomy or the results of the ostomy surgery, stomas can sit flush with, or retract into, the skin. This type of stoma is called a convex stoma and needs a convex barrier to help the stoma push forward. It’s important to ensure the stoma doesn’t recede so output can’t collect the creases around the stoma.
Flat barriers work with stomas that don’t need help extruding from the skin. The barrier lies flush against the skin while the stoma pokes out through the center hole, sort of like an “outie” belly button.
It's really important that you consider the following when choosing a barrier:
- Barrier size: The size of the circular opening for the stoma is very important. Too small and the stoma or skin can develop wounds from friction between the barrier and stoma. Too big and output can injure the skin around the stoma, causing it to degrade. You can ensure that your barrier has the right-size opening for the stoma by measuring it before you order barriers. Barriers are available in cut-to-fit or pre-cut options. If your stoma is still changing or you are not sure what size your stoma is, a cut-to-fit barrier will always be the right size.
- Output type: Barriers are available as either standard wear or extended wear. The wear time refers to how well the barrier stands up to high-output stomas, such as with a urostomy or an ileostomy. It does not refer to how long a barrier can stay on the skin before it needs to be changed.
You should know different ostomy supply manufacturers have special names for their versions of standard wear (such as Stomahesive and FlexWear) and extended wear (Durahesive and Flextend). It can be confusing!
Changing your ostomy bag and barrier
There are several reasons your ostomy appliance needs to be changed regularly. The acidic nature of digestive and urinary waste of output breaks down the protective materials in barriers. Urostomy output is also a prime place for growing harmful bacteria, which can lead to infections and other complications.
How do I change an ostomy bag?
Getting comfortable changing your ostomy system will go a long way toward building your confidence as an ostomate.
After ostomy surgery, an ostomy or wound care nurse will show you how to care for your stoma and change your ostomy system. Often, the nurse will practice with you several times to help you learn the process.
However, hospitals are stressful environments and often you or your caregiver might not remember the details. If you forgot what they showed you, or are looking for tips and tricks, YouTube has some great videos, including this one:
The process of changing your bag can be summarized in a few steps:
- Prep an area for changing, including all your supplies and something to clean up messes
- Remove the old bag by gently pulling the edges of the barrier away from the skin
- Clean the area around the stoma to remove old adhesive residue and stool
- Apply the new barrier and bag
Problems changing an ostomy bag
The majority of ostomy barriers and bags work just like they are supposed to. Most of the time, you may only need to change the barrier when you feel like you need to. Other times your barrier or bag may develop a leak and will require that you need to change them right away.
Some common issues you may have when you change your bag:
It’s uncomfortable to remove the old barrier.
Some barrier adhesives, especially those that are tape- or acrylic-based, can be particularly tough to remove. Try using an adhesive remover by spraying or wiping over the barrier to loosen the adhesive.
The new barrier doesn’t stick well to your skin.
If this happens, ensure your skin is completely dry. Applying the barrier in a humid environment, such as in a bathroom after a shower, will make it more difficult for the barrier to stick. A protective film, available as a spray or wipe, can also help the barrier adhere better.
The stoma has a mind of its own and starts to dribble output.
It happens! Often the pressure we put on our abdomens during bag changes can stimulate our intestines to move waste down and out. Try changing your bag on edge of a sink to make clean-up easier. Timing your bag change to happen first thing in the morning, when the digestive system is typically quiet, can also help.
Ask other ostomates and they will tell you that unexpected bag changes are part of life with an ostomy. As you gain practice with bag changes and experience with your ostomy, you’ll be better able to tell when to expect problems.
Over time, you will develop your own specific practices for changing your bag. Some people prefer to change over a counter with a sink or over a flat surface, like a table or bed. Some ostomates prefer to change their barrier and bag after a shower. What you choose to do, and what products you choose to use, depends on your needs and preferences. Don’t be afraid to ask for samples and try different products!
Where can I get ostomy supplies?
The first place you’ll receive supplies is at the hospital after your ostomy surgery. Depending on the hospital, you may receive many samples of different brands of ostomy supplies or just a few. Policies vary from hospital to hospital, so you may want to contact them ahead of time to learn what to expect.
Once you get home, you’ll need to work with your insurance company to set up regular orders from a medical supply company. It is very important to do this as soon as you get home from the hospital; running out of supplies is inconvenient and stressful.
Better Health can take some of that stress away. We working with your insurance to get your supplies orders in place and off to a smooth start. Get started now. [onboarding insurance tool]
What do ostomy supplies cost?
The short answer is: it depends. Insurance limits usually dictate how many supplies you can order at a time and how much they’ll cost.
The good news is that many ostomates report that they are able to receive as many supplies as they need. If you find you need more supplies than your insurance allows, you may be able to get extra from ostomy support groups and supply donation exchanges.
Depending on your insurance company, you may have to pay a certain amount out-of-pocket for your supplies. Better Health can work with your insurance company to maximize your ostomy supply benefit.
How do I know what ostomy supplies to order?
An ostomy nurse can guide you on what to include in your first supply order.
While bags and barriers are the essential items, many ostomates find they are more comfortable and have a better experience when they incorporate these supporting items:
- Adhesive removers: Barrier adhesives can be damaging to the skin. Removers help loosen the barrier so it can be more gently removed.
- Protective skin sprays and wipes: These sprays and wipes create a very thin layer between skin and barrier to protect skin from output and adhesives.
- Barrier paste, rings, and strips: The items fill in creases and create an even application surface, which helps the barrier adhere properly.
- Barrier extender strips: Extender strips are applied around the edges of the barrier. They hold the edges of the barrier down and can help extend the life of the barrier.
- Support belts: A support belt secures and stabilizes the ostomy system.
- Deodorizing and lubricating drops and sachet: Modern barriers and bags do an excellent job managing any odors from the output. However, deodorant drops add an extra layer of protection and do double duty with lubrication that allows output to slide out more easily.
Living with an ostomy
Ostomates should be aware of ways health, diet, and hydration impact life with an ostomy.
Eating with an ostomy
Immediately post-surgery and while the bowel is recovering, medical advice is to eat a low-residue diet. A low-residue diet includes foods that are soft and easy to digest, such as mashed potatoes, scrambled eggs, white rice, smoothies, yogurt, puddings, avocados, and bananas.
Foods that contain a lot of fiber, such as fruits, raw vegetables, nuts, and red meat, are not low residue and are best avoided at the beginning. Certain foods, such as broccoli and cauliflower, can also create a lot of gas in the digestive system.
As you recover, you can try slowly re-incorporating certain food into your diet as you learn what your ostomy can and cannot tolerate. Some people can resume eating normally within days. Others might take a few months to work-up to a diverse diet.
Eat smaller meals more often throughout the day as opposed to fewer and larger meals. Some ostomates report being able to resume eating whatever they care to while others prefer to stick to low-residue foods.
If you have concerns about nutrition and what to eat, please speak with your medical provider.
Ostomates can experience a medical condition known as a blockage. Blockages occur when digestive waste is unable to exit through the stoma. High-residue and high-fiber foods, such as fruits and raw vegetables, nuts, and red meat, can cause blockages.
A blockage is very painful and needs immediate medical attention. Symptoms of a blockage include:
- Significant slowing or stopping of output
- No output for more than eight hours
- A swollen or enlarged stoma
- Pain or tenderness around the stoma site
Did you know that your body uses a large amount of water to digest food? In unaltered anatomy, the colon reabsorbs water during the formation of stool for reuse elsewhere in the body. With ostomies, the colon may be shortened or removed entirely, so that extra water the body needs is no longer available. Instead, it leaves the body through output.
This puts ostomates at special risk from becoming dehydrated. It is very important that you increase your fluid intake to compensate for the loss of water and electrolytes through output. Gatorade, Pedialyte, orange juice, or a glass of milk are good options to help replace nutrients.
If you become severely dehydrated or you experience unusual liquid output from your stoma, seek immediate medical attention.
Stoma health and skin care
Maintaining a healthy stoma and healthy peristomal skin are critically important for your ostomy. Stomas may occasionally bleed a little during a barrier change. This is normal and the stoma should repair itself.
Your peristomal skin — the skin that surrounds your stomach and that is normally covered by your barrier — should be whole and unbroken. Skin problems can occur when too much moisture accumulates on the skin or output is allowed to come into contact with it.
When you change your barrier, pay close attention to the skin. If there are any changes, such as macciation (rough, broken skin), redness, or irritation, take steps to protect the skin such as:
Gently clean and completely let dry the peristomal skin
Apply a protective skin barrier and/or stoma powder
Ensure the size of the stoma opening in the barrier shows no more than one-fourth inch of skin when the barrier is applied
If your skin isn’t responding to these steps or if you notice ongoing or unhealed wounds on or around the stoma, consult your ostomy or wound care nurse for treatment.
Mental and emotional health
Becoming an ostomate can have a big impact on the way you think and feel about your body. Many people with ostomies report a variety of emotions, from embarrassed, conflicted, uncertain, and depressed, to positive emotions, such as relief, excitement, and happiness.
It’s normal to have extreme and sometimes conflicting emotions. It’s also okay to share your feelings by joining a support group or seeking therapy to address the impacts of such a major change to your body. Most importantly, you should know that you’re not alone. The United States has more than an estimated 750,000 ostomates and more than 100,000 ostomy surgeries are performed here annually.
Finally, here’s a well-known secret among ostomates. Most people will not be able to tell that you have an ostomy just by looking at you. Modern ostomy supplies are designed to be very discrete and comfortable. You have control over who to tell about your ostomy.
We’ve covered a lot of ground in this article. Feel free to come back and reread anytime you need. If you have questions about supplies, insurance, or anything ostomy related, we can help! Ask us now by calling us at 415-475-8444.