Many new ostomates wonder how to deal with their output on hikes, as we usually have to empty our appliances every 4-6 hours. The answer is to dig a “cathole.” This is the term commonly used by backpackers for a hole to bury feces in. Because this is a very important skill for any outdoor enthusiast with an ostomy (or IBD) to have, I created a short video to cover some of the basics.
I am guessing that I have dug around 500 catholes in the backcountry in my lifetime. As an ileostomate, I am increasing that number at a rapid rate. Gone are the pre-ulcerative colitis days of having 1 or 2 bowel movements in a day. Now I consistently empty my pouch around 6 times in 24 hours. On the trips when I don’t use closed-end pouches, that equals 48 catholes on a 7-day trip! Knowing how to properly dig a cathole to protect the environment and water sources is crucial.
When digging your cathole, keep these things in mind:
- Carry a small plastic trowel with you. It is much easier to dig a good hole with the proper tool.
- Locate your cathole at least 200 feet (70 adult paces) away from water sources.
- Select a site that is not likely to be traveled over or camped on by future wilderness visitors.
- Dig a cathole in a sunny location if possible. The warmth from the sun helps with decomposition. Avoid the “rock and roll” method of moving a rock aside and then plopping it on top of your feces. This does not allow sunlight in and slows the breakdown of the waste.
- Avoid areas where runoff may wash over the human waste and carry it into a water source over time.
- Try to find a site with organic soil, as it will contain microorganisms that will help break down the wastes.
- If camping in the same place for several nights, spread your catholes out so they are not concentrated in one area.
It is a common practice for people to bury their toilet paper due to the belief that it is biodegradable. Toilet paper does break down under ideal conditions, but in some environments, such as alpine areas and deserts, it can take a very long time to go away. Also, animals often dig up feces and scatter the toilet paper in the process. Pair these things with the sheer number of people using the backcountry, and it becomes a recipe for a mess. This summer alone, I have come across over a dozen piles of TP in the wilderness.
When I was 16, I volunteered to build hiking trails in Rocky Mountain National Park as part of a Student Conservation Association (SCA) summer high school work crew. During the program, we lived in the remote wilderness for 3o days. Our leaders taught us how to dig catholes and pack out our toilet paper. I am so glad I learned how easy it is to do this early-on. Had I not, there would have been over 500 piles of toilet paper in the wilderness just from me over the years. Now with an ileostomy, I would leave at least 6 wads of toilet tissue out in nature each day. Yikes! It is easy to pack out toilet paper. Simply wrap the used tissue in several clean sheets, double bag it in a ziplock, throw it in your pack and dump it in the trash when you get home. Hand sanitizer or soap and water (away from a water source) takes care of any germs. There are actually regulations in many areas that require you to pack out your toilet paper. Whether or not it is the law, I always choose to carry my TP out of the wilderness and highly encourage other wilderness travelers to do the same.
Some popular wilderness areas with highly concentrated use, such as some of the heavily used climbing routes on Mt. Rainier and the Narrows area of Zion National Park, require that you not only pack out your toilet paper, but also your human waste. I can remember climbing the Grand Teton in Wyoming in the early 90s and seeing human waste behind just about every boulder on the outskirts of the popular “Meadows” camping area. It was disgusting, and I kept thinking of all the pikas and marmots that make their home up in those boulder fields. Biodegradable or not, the wastes of hundreds of climbers each week was not part of the natural ecosystem there. I am glad to hear that they are now requiring people to pack out their feces at some of the most heavily used camping areas on this route.
I had my first try at packing out my waste on a winter backpacking trip in Rocky Mountain National Park (see the detail in my Episode 5 and 6 videos). Because the snow prevented the digging of catholes, the National Park Service required that we carry out our waste. I soon discovered that packing out poop isn’t as big of a deal as one would think. It is a little heavy, but other than that, is pretty easy and mess-free. The land management agencies often provide, or can at least recommend, the supplies for doing this. The system I used this winter was the Restop 2, which included a handy bag complete with enzymes for breaking down the waste.
The apprehension people have for packing their human waste reminds me of the stigmas surrounding ostomy surgery. Their are so many unwarranted fears and misconceptions! In reality, packing out your poop in heavily impacted areas is simple, sanitary, doesn’t smell with the right supplies, and is very beneficial to the environment and the experiences of other wilderness visitors. Also, if your choose to use closed-end pouches on hikes and climbs, you will become very familiar with packing out your waste. These used pouches obviously cannot be left behind and must be carried out in a double-layered ziplock bag.
So don’t let a fear of dealing with your poop stop you from heading into the wilds with your ostomy. Learning to dig catholes is easy and will allow you to confidently travel away from bathrooms out in nature.
This leads me to my final observation regarding catholes. Even in my pre-UC days, I would sometimes feel that urge and barely have enough time to hike away from camp and dig, dig, dig before I REALLY had to go. As an ostomate– you always have time to create the perfect cathole! Now you can chuckle quietly to yourself as your tent-mate abruptly stands up after breakfast, frantically looks for the trowel and toilet paper kit and runs top speed into the forest. When it is your turn, you can simply go for a relaxing stroll and find the perfect spot with all the requirements as well as a gorgeous view. After digging a textbook hole, you might even have time to do a little birdwatching or wildflower I.D. before getting down to business. Having an ostomy oudoors isn’t always a picnic, but sometimes it does have its benefits!
Ostomy Outdoors 
If you were a thru-hiker, the trail name Badger would be appropriate for you. Hahaha.
How funny! My husband and I just got done with an 8 day backcountry adventure and were talking about what our trail names should be. I think Badger would be fitting with as many holes as I dug on that trip:)
Every 4-6 hours? Really? I’m in the washroom at least once every two hours, but usually more frequently, especially after meals. I try to eat small meals, but still need to go to empty within a half hour of eating. Is this not normal?
CHRISTINE , I CAN relate with your situation, if only I would empty every 4 to 6 hours.
I am trying everthing to slow the out put down. It is difficult to organize my day with the out put. i have had my iloestomy since March 10, 2011
I’ve had mine for 16 years and still empty multiple times per day. “Once every 4 to 6 hours” describes when I’m sleeping at night! And I try to not eat anything past about 5 pm to avoid having to get up more often!
Linda and Christine,
Sorry to hear you are having trouble with such high output. I am not sure if there is a normal with an ileostomy. I have read that 4-8 times a day is pretty average, but it seems like there is so much variation. I know I am very fortunate in that I only have to empty 5-6 times a day. I had a lot more output in the beginning, but it slowed down a lot at around 6 months post-op. In the beginning I also had to get up overnight to empty and now I do not (except when I am out hiking and backpacking all day which really changes my output pattern. Sometimes I have to get up multiple times at night during such trips). Also, I notice little change in my overnight patterns whether I eat at 5 p.m. or 8 p.m., so I just eat when I want. It is crazy how different all of our experiences and patterns are after surgery. Hope you find something to slow things down.
I usually have to empty every few hours, starting within half an hour of eating, and I try to start eating dinner no later than 5 as well. A couple of years ago I was mentoring a friend who got a temporary ileostomy as stage 1 of j-pouch surgery, and she was all worried about having to eat certain things to keep her output the consistency of applesauce all the time. I don’t remember ever being told that, I eat pretty much everything and don’t worry about the liquidity – or absorption of nutrition, since I eventually went up from a pre-surgery, anorexic looking size 6 to a solid size 10 lol
I don’t worry about the consistency either. Sometimes my output is liquid and sometimes it is thick… oftentimes after eating the same thing at different times.
Heide,
Do you take medication to slow your out put down.? I think it is great that you can do all the outdoor activities you do. I just have a difficult time with the amount of times I have to empty the pouch. I get really excited to do all the out door things, but I have to be realistic and realize I some times I spend more time trying to find place to empty the pouch.
I don’t take any medication to slow my output down. Sometimes if I have to change my appliance in a trickier spot (like in my tent), I will take an Imodium an hour before as my stoma is really unpredictable and likes to spew at the most inconvenient moments. The Imodium does help quiet things down for the change. However, I don’t take anything to slow my output down during other activities. I do find that my output naturally slows down when I am doing active things like hiking and running. It all comes out later then though:)
Would closed-end pouches be an option? They are very fast and easy to swap out compared to digging holes, and though you would go through several while doing outdoor activities, it is not like you would be using them every day. The downside is that they are heavy to pack out (especially with liquid or high output), but at least you would be able to get outside.
Thank you, Heidi for your comments. I hope my out put will slow down my surgery was in March .
Heidi, if you were to pick the top two concerns for an ostomate on an extended hike (like thru-hiking the AT?), what would you say they are? My roomie is the ostomate and she’s very well adjusted even though she has short bowel syndrome. Her skin care is excellent, almost never experiences leaks and if she’s careful not to eat too much fiber her blockage potential is minimal. However, we are training for a thru-hike (I’m 60 and healthy as a horse), she’s 53 and was very physically active but has had other medical issues slowing her down a bit. We used to day hike and camp often for about an 8 year “season” on weekends and vacations. We have our heart set on thru-hiking the AT. What advice would you have for her?
Hi Marian,
Thanks for writing. The AT sounds like an amazing trip! My first concern would be planning well so that I had enough supplies along and packed enough replacements in each resupply (without bringing too many). This isn’t a huge deal, just something that would take some careful planning.
My second concern would be staying hydrated. I find that I have to drink almost twice as much water with my ostomy so I tend to carry a lot on backcountry trips (which makes my pack heavy.) If there is a chance of there not being water on a stretch of trail (maybe more unlikely in the east than out west where I live) I filter a bunch when I can and carry extra.
Other than that, I don’t find my ostomy all that challenging on the trail now that I am used to it. Emptying a pouch outdoors is easy… there is a bathroom anywhere you can dig a hole! As far as foods, I do not seem to be prone to blockages so I can each just about anything. Even though I do eat things like nuts, jerky and dried fruit, I could definitely get by without these things if I had to. Many trail foods like rice, pasta, instant potatoes, oatmeal, crackers, protein bars are easy to digest. I do try to keep my pack as light as possible when backpacking but have carried up to 55 pounds with adequate training.
You both should definitely go for it and do the hike!
-Heidi