Managing Frequent Colostomy Bag Leaks and Overflows

My wife had a colostomy 3 months ago, and we've never had a full week without a leak of some sort. As she has regained her appetite, the quantity of fecal matter has increased, but the bag can remain empty for 2-3 days and suddenly, without warning, a large quantity of poop (much larger than the capacity of the bag) will force the bag to become unstuck. There will be poop covering the inside of her clothes, and they will have to be changed as well as cleaning her and replacing the bag. On one occasion a few days ago, she got up from an armchair to go to bed, and there was a trail of poop all the way to the bathroom. The only way to clean her was to help her into the shower, remove her clothes, and give her a shower. The poop was under her arms, on her breasts, completely covered her stomach and sides, and even in her trouser pockets.

I've no idea how I would cope with this if it happened outside of the home, and I fear leaving home with her.

Any advice would be appreciated, please.

Hi colin7,

  Sounds like your wife needs to learn to irrigate.  Being an ileostomate that's totally out of my league, but there are a number of folks on here that do it religiously and it tends to prevent what you're describing and should give your wife some sort of 'regular' schedule of sorts.  Others should be seeing your post and chiming in any time now.  In the meantime you can search online for "colostomy irrigation" and you should get tons of info!

;O)

It is dangerous to let the bag get completely full as you have found out. Change once it gets to half.

As I understand it, she is getting infrequent bowel movements but when she gets one it's huge and overflowing the capacity of her bag quicker than you can react and get the bag emptied. 

I haven't had this exact problem but come close a few times. It is certainly possible to have a bowel movement larger than the capacity of the bag. I have a couple ideas

1) At least temporarily, switch to an larger capacity bag designed for ileostomies. One of the ileostomates here can probably advice on those. 

2) She should not be going so long between bowel movements. After 3 months she should be off the low residue/soft foods diet by now. Start adding in more fiber but go slowly at first to avoid cramping. Also a fiber supplement may help. My husband uses miralax effectively when he is constipated (I have the opposite problem). If she is still using opiod pain meds she needs to transition off asap, those cause bad constipation. 

After she is more regular with her bowel movements, you should be able to control the leaking better. She will need to learn to be vigilant in keeping track of how her bag is filling.  Never let it be more than 1/3 full without emptying (or changing if using closed end bags. Though I think large, drainable bags are the best choice until you get the constipation under control.)

Btw, even if the stool is loose, she is technically constipated if she is going 3 days without output.

Also, irrigation that was suggested may be an option. I don't know enough about it. 

You are an wonderful husband to be helping her so much. You are definitely "one of the good ones". 

Hello, I myself have an ileostomy, yet struggle with explosions about 1X /wk.

Mine isn’t from the output filling the bag, it’s all gas. And my stoma has begun retracting, which causes the gas to seep under the appliance. It’s ridiculous, and my poor husband is a saint!! He jumps right in to help and clean everything. It’s definitely making me nervous to go out for the day, but I’ve been stuck at home for about a year now and I just think I am going to risk it. Eventually.

I agree with others here, adding fiber helps for 2 things: constipation + diarrhea. If there is too much fiber, it could worsen each condition, so you need to evaluate her diet as well. Does she drink at least 3 liters of water per day? Is she consuming caffeine regularly? Or chocolate? These can dehydrate.

My output is fairly liquid 99% of the time. I drink ensure extra protein, eat applesauce, very limited animal protein (personal preference), pasta/starches. Could she be having a new reaction to dairy?? I’ve heard some develop new intolerances after these surgeries.

Sorry to ramble on and on, and I’m not sure if I even helped lol 

Best of luck, Happy New Year 🎊 

Words of Encouragement from Ostomy Advocates I Hollister

I have a colostomy and it seems your wife is dealing with chronic constipation (CC). Regularity and reduced constipation is a function of the physical effects of fiber in the large intestine.

In the large intestine, well-controlled trials revealed there are only two mechanisms by which a fiber can provide a reduced constipation benefit, and both require that the fiber resist fermentation to arrive intact in stool:
1. a coarse insoluble fiber (e.g., coarse wheat bran) mechanically irritates the digestive mucosa
2. a viscous gel-forming fiber (e.g., psyllium) traps water in the gel, which resists dehydration throughout the large intestine.
• Psyllium is 3.4 times more effective than wheat bran for increasing stool output, making it the gold standard fiber for laxation.

• Psyllium (e.g., Metamucil, Konsyl) increases stool frequency in patients with CC .

I think you should get CC under control with psyllium before considering irrigation.

Irrigation is not an option for everyone with a colostomy — it's only an option for those with a descending or sigmoid colostomy. It is not a solution for the CC.

Basically, her system is holding everything in, and then it comes out all at once. I usually experience that about once a week. I'll go a couple of days with very little output, and then I'll have a lot 2-3 times in a matter of a short time frame (like an hour or so). On other days, I have some output and empty as needed, but it's never full. Does she take care of herself, or are you the caregiver because she can't physically empty it herself? If she's taking care of it herself, she's simply going to have to get up and empty it when she feels it filling (which is easily felt when it comes out so fast) and stay on emptying it until it's done. If she can't take care of it herself, then you or whoever is watching her will have to check the bag regularly and empty it when needed. The leaks are coming from the pressure all the output is creating. By the way, I pay no attention to when or what I eat, and I eat at all times of the day/night because I work afternoons and overnights. However, I do pay attention to when I haven't gone for a while because I know I'm going to have a lot of output when I do. I should add, I'll get a slight stomach ache right before the dam breaks, so I usually know about when it's going to happen.

What setup do you use, and who is the manufacturer?  

I have a colostomy, 2 years post op.  I go days without nothing coming out.  When it does begin to flow, I only let the bag get 1/2 to 3/4 full, then empty right away.   I've never had a leak or bag blowout.  I have had a few close calls.  One time, stuck in traffic and the bag starts filling.  Fortunately I was able to get home just as the bag looked ready to blow. 

I use a 2 piece system from Hollister. The wafer is separate from the bag.  The bag can hold a lot of poop.  After I install the wafer, the bag securely snaps on.  I like it because I can change the bag at any time.  Only takes a minute.  I leave the wafer on for 7 to 12 days, depends how lazy I am.  I wear a Nu-Hope Corp support belt all the time.  The belt has a plastic centerpiece that fits over the bag flange, securely holding everything in place.  I wear the belt because I developed a parastomal hernia.  Happens alot to Ostemates.  Hopefully prevents my hernia from getting worse.  So far, so good.

Hi beachboy!

Which Nu Hope support belt do you wear?

Thanks!

Hello,
I wear these Nu-Hope belts:

A 3-inch wide, Nu-Form support belt, in regular elastic. Regular elastic is a solid, plush back material. Latex-free. Catalog number: BG6302-C. This number means the belt is 3 inches wide, beige color, regular elastic Nu-Form. Large length: 36 to 41 inches. The belt plastic center piece will precisely fit over a 3 1/4 diameter bag flange.

A 4-inch wide Nu-Form support belt in cool comfort elastic. This elastic is free to form around hernias and other body bulges more naturally. Cool comfort is a breathable, lightweight, mesh material. Latex-free. Catalog number: BG6412-C. This number means the belt is 4 inches wide, beige color, Cool Comfort Nu-Form. Large length: 36 to 41 inches. The belt plastic center piece will precisely fit over a 3 1/4 diameter bag flange.

I also have a 4-inch wide belt with a prolapse strap. After the belt is put on, the flap goes over the bag/stoma to gently push it down. You can easily adjust the strap; it uses a Velcro closure. I use this belt for formal type occasions. I wore it to a wedding, out to dinner, and sometimes to church. It diminishes my stoma bulge. Catalog number: BG6312-P-C.

A 2-inch wide Nu-Comfort support belt. Regular elastic, latex-free. Catalog number: BG2624-C. This number means the belt is 2 inches wide, beige color, regular elastic, Nu-Comfort. Large length. The belt plastic center piece will precisely fit over a 3 1/4 diameter bag flange.

I wear a 4-inch wide belt for a few days, then switch to a 3-inch wide belt for several days, then a 2-inch wide belt. Works really well for me. If I catch a cold and start coughing or sneezing, I wear the 4-inch wide belt, kind of tight, until the cold passes.

Your catalog number will most likely be different than the ones I used. Belt width, length, belt ring opening... will have different numbers if you order a medium-length belt, or one with a smaller belt ring opening.

The box for all the belts states: "For hernia support and hernias that no longer reduce." My hernia reduces (flattens out if I lay on my back, or use a belt).

You can call Nu-Hope for assistance with getting the catalog number for your specific need and answer questions. 1-800-899-5017.

You will need a prescription from your doctor. Then order a belt from your ostomy supplier. This way, insurance will cover the belt cost. Hopefully.

When I had regular medical insurance through my employer, ordering a belt and receiving it was easy. Then I retired and went on Medicare. I spent 4 months trying to get one belt. I finally gave up.

You can buy the 2-inch wide belts from Nu-Hope Corp. on their website.

I discovered a company that sells 3 and 4-inch wide Nu-Hope belts. You don't need a prescription, though I do pay for them myself. But they are delivered in a week. Parthenon Corp. 1-800-453-8898.

In my experience, the belts run a little small on length. So I always order a large length.

I have the same problem! I have gastroparesis also, so I tend to get all my output at night and a lot of gas too. I got these waterproof shower covers for my bag, and I wear them at night because then if it does leak or explode, it at least keeps it contained inside the bag. It also is easier to clean up that way because you can just wash the bag like a reusable diaper, just rinse it out then machine wash. I hope everything works out and you find a solution 💕

That’s actually a great idea! Thank you!

Beachboy,

Thank you so much for all of the info!

This is so helpful. I believe the 4” belt with prolapse strap would be good for me as I too have a parastomal hernia so that sounds perfect but I will check all of them out and again, thanks a million for sharing and taking the time to respond.

Have a great weekend 😊

BB, shouldn't the belt length you are referring to be 36 to 41 inches instead of 36 to 104 inches 🤔

Hee hee. Yes, you are correct. Belt length stated by Nu-Hope is in metric. I converted to inches... but incorrectly. Edit coming up.

Thank you all for your replies. I'm touched by your kindness and helpfulness.

I'll try to respond to all comments and questions in my reply below.

1. My wife has Alzheimer's and is not able to empty her bag on her own. I check the bag at least every hour and empty it if it is up to a third full or more. Sometimes it can fill up or overfill withing that hour.
2. I believe that we eat plenty of fibre and eat regularly through the day. For breakfast she has Rice Crispies with some wheatgerm and soya based milk (we eat very little dairy), a chicken and salad sandwich followed by fruit and a soya yogourt for lunch and white meat of fish for dinner with  vegetables. I'm a below average cook so for dinner we often have a stew which lasts for 2/3 days and sometimes a frozen prepared meal from the supermarket. I struggle to get my wife to drink more than a litre of water per day but she has 5/6 large cups of decaffeinated coffee and a glass of diluted rosé wine in the evening.
3. She has not been taking any form of painkiller since leaving hospital in mid-October 2024.
4. As my wife's poop is always soft I would not have thought that she is constipated but from the comments and suggestions made I know realise that technically she is, and that this is where I should investigate further. I'd never hear of Psyllium but will definitely research this further.
5. The bags are a one piece design with drain manufactured by Coloplast but, as we live in France, this might not be a well known make. A nurse changes the bag every morning.

In conclusion I think that CC is the problem and needs resolving. Meanwhile I will also look into larger bags, a belt and a waterproof shower cover for the bag. These should prove useful until the CC is cured or at least improved.

Thank you everyone for your suggestions.  

If I eat a lot of fiber, I get lots of output. 🤷‍♂️

So do I and so does my wife. The problem is that my wife's output is not regular and is difficult to manage - as I said in my original post. Not everyone is the same.

I definitely agree with Susan T. on all her suggestions. And, Miralax is something you need to look into with your G.I. surgeon and/or ostomy nurse if they haven't suggested it. I use it daily… a cap full. Many insurances cover it as an OTC necessity, because it is for us! I have had blowouts similar to hers the first few months until my system adjusted after surgery. Eating small meals and chewing a lot helped with regularity and flow. Less is better. Just maybe eat bits more often if she's hungry. It is not possible to go back to eating large portions at one sitting without a bad outcome… at least not for a while. It is so important for her to keep having a steady output.
When that bag is 1/3 full, drain it. I used to use disposable bags until it was costing me too much, even with the copay. I now use drainables and still empty them when they reach 1/3 full. Clean the end and use it again and again.
I understand and my heart goes out to both of you. I had many crying jags and freakouts in the beginning while my husband patiently cleaned up me, the toilet, the floor, etc. It's definitely a trying experience until you work things out. But I promise, you will figure it out. It may take time unfortunately.