How to select ostomy pouch styles for the outdoors

Last weekend I was reminded why I love using closed-end ostomy pouches on hikes and climbs. I was up on a long ridge between between Loveland Pass and Mt. Sniktau in Colorado. Though it was a gorgeous 75-degree day down in Denver, up at 13,000′ it was blustery and frigid. We left the house at 4:15 a.m. so that we would be done with our climb and back to the car before afternoon thunderstorms came in. I emptied my appliance before leaving the house, but by the time we reached the summit of Mt. Sniktau at around 9 a.m., my pouch was reaching its 1/3 full point. This is typically when I like to empty it.

Problem was, no ideal place to empty a pouch could be found on the entire ascent. The wind was howling and shelter was non-existent. On top of this, there were many feet of snow on the ground. The few places where there was exposed earth, it was frozen solid.  There was also no way to go off of the ridge to empty away from the trail. Precarious cornices sat 50 feet to the east of the route and dangerous avalanche slopes could be found 50 feet to the west. Emptying would have meant draining my pouch in the snow close to the area where people travel. Once the snow melted, fecal matter would have been left on top of the ground in a popular area. This was one of those instances when wearing a two-piece ostomy system and using closed-end pouches was almost a necessity.

The ridge between Loveland Pass and Mount Sniktau provided few places to empty a pouch.
The ridge between Loveland Pass and Mount Sniktau provided few places to empty a pouch.

If you are just finding out that you will be having an ostomy, or are recently out of surgery you may find the sheer number of ostomy appliance choices to be overwhelming. Closed-end, drainable, one-piece, two-piece — what do all these mean and which ones are best suited for various outdoor adventures? A lot of these choices come down to a matter of personal preference.  The goal of this post is to share some information on the basic types of appliances and explain how I utilize the various options on peaks and trails. I’d also like to hear what you’re using in the outdoors.

First, ostomy appliances come in one- or two-piece options. With a one-piece appliance, the wafer (also sometimes called a skin barrier) is permanently joined to the bag and cannot be separated–you’re literally stuck with this pouch until you remove the whole thing. The benefits of this style is that it has a low profile and sits very flat against the abdomen. The disadvantage is that because the wafer and bag cannot be separated, you lose the flexibility of being able to swap out different types of pouches unless you take the whole system off your belly. I used one-piece drainable pouches for the first five months after surgery, and on one of my very first major outdoor trips as an ostomate: a three-night early spring backpacking excursion. The ground was snow-covered and frozen on this adventure and I ended up trying to drain my pouch into plastic bags so that I could pack out my waste. It didn’t go well and I got output all over my pants and all over the outside of the bag I was trying to drain into. From that point on, I recognized that a two-piece system would be a better option for my outdoor trips.

In a one-piece ostomy system, the wafer is permanently attached to the pouch. Because of this, swapping out different pouch styles on the same wafer is impossible.
In a one-piece ostomy system, the wafer is permanently attached to the pouch. Because of this, swapping out different pouch styles on the same wafer is impossible. Pictured is a Coloplast SenSura X-Pro drainable one-piece appliance.

With a two-piece appliance, the wafer and pouch are separate and attach to each other with a plastic ring that snaps together much like Tupperware. Once the wafer is on your belly, different styles of pouches can be put on or taken off this ring. These systems are a little higher profile because of the plastic ring. However, there is much flexibility in using them because you can swap out different types of pouches depending on your activities. Due to this, a two-piece appliance is my clear choice for outdoor adventures. Also, I find that even with the plastic ring, two-piece ostomy systems are undetectable under my clothing.

There are also choices for the pouch portion of an ostomy appliance; they come in drainable or closed-end versions. Drainables have a tail that unfolds so that output can be emptied out of the bottom. Once the tail of the pouch is wiped clean, it rolls up and closes with either a clip or a Velcro strip until it needs to be emptied again. A person with an ostomy may use the same drainable pouch for multiple days.

Closed-end pouches have no tail. Once they fill up, they are designed to be thrown away full. Due to their simpler design, they cost less per bag than drainable pouches. However, most ileostomates don’t use them the majority of the time. Due to output coming directly out of the small intestine having higher water content, those with ileostomies usually have to empty their pouches six times a day or more. Even though closed-end pouches have a cheaper per-pouch cost, going through so many  in 24 hours makes them impractical and not cost-effective. Generally closed-end pouches are better suited for those with colostomies who may only have to empty a few times a day. That said, there are occasions when closed-end pouches are the perfect tool for those with ileostomies too.

With a two-piece system, the pouches can be separated from the wafer. On the right is a drainable pouch and on the left a closed-end one.
With a two-piece system, the pouches can be separated from the wafer and swapped out. On the left is a drainable pouch and on the right is a closed-end one. Pictured clockwise is a Convatec Sur-fit Natura drainable pouch with an Invisiclose tail, a closed-end pouch, and a Durahesive cut-to-fit wafer.

Drainable pouches are my preference most of the time, even on wilderness adventures, as long as I can find a good place to empty. Packing out full closed-end pouches can be heavy due to the high water content of ileostomy output. In fact, I once weighed the trash bag that contained a day’s worth of full closed-end pouches after an all-day climb and it came in at 3.5 pounds! Multiply that for trips that may be several days long and you can see why I use closed-end pouches only when necessary.

However, my hike on the ridge is an example of an ideal time to use a closed-end pouch. I also like using closed-end pouches in other places where it is impossible to empty: on cliff faces when climbing, on rocky peaks where it is impossible to dig a cathole, and on crowded urban trails. Though I haven’t been on a river trip with my ostomy yet, I can also see them being very useful in these situations when one cannot get far enough from a water source to empty. Also, it takes longer to dig a hole in the ground and properly drain my pouch when in the wilderness than to swap out a pouch. There have been a few times when I have been caught in storms and have decided to swap to a closed-end pouch instead of draining in order to minimize my exposure to lightning, high winds, cold rain or other dangerous elements.  Both drainable and closed-end options also come in smaller sizes if one wants a tinier pouch for some activities such as swimming.

It is also worth mentioning that there is one other style of two-piece ostomy appliances; they are called adhesive coupling systems. Instead of having a plastic Tupperware-like ring like traditional two-pieces, the wafer has a smooth plastic area and the pouch affixes to this with a sticky adhesive ring. The benefit of these is that, without a plastic ring, they are very flat on the belly. You can still swap out pouch styles by peeling off the old bag from the wafer and sticking on a new one. However, I find that adhesive coupling appliances don’t work well on my outdoor trips . When I peel off the full pouch, a little output inevitably gets on the place where I am supposed to affix a clean one. I then have to fully clean this in order to get the fresh pouch to stick. It ends up being too messy and hard to deal with in the wilderness where there is no water to clean up with. I find it much easier to use the traditional two-piece appliances with plastic rings. Even if a small bit of output gets on the ring, it still snaps together fine and is not messy at all.

In adhesive coupling two-piece systems, the wafers and pouches stick together with an sticky ring. They are low profile, but I find them messy to swap out when on outdoor trips.
In adhesive coupling two-piece systems, the wafers and pouches adhere together with an sticky ring. They are wonderfully low profile, but I find them messy to swap out when on outdoor trips. Pictured on the left is a Convatec Esteem Synergy adhesive coupling system and on the right is a Coloplast SenSura Flex wafer and pouch.

A downside of closed-end pouches is that they are a disposable item. I try to make the best environmental choices possible in my daily activities, so I do sometimes cringe when I throw away my bag of closed-end pouches after a climb knowing I have added more to the landfill than I would have if I would have stuck to a drainable that day. I try to remind myself that I do this for a medical reason and to deal with a basic life process of bodily waste removal. In other aspects of my life, I try my best to be gentle on the earth. I take reusable bags to the store, drive a fuel-efficient vehicle, use public transit, buy organic produce to protect wildlife from pesticides, use eco-cleaners to keep toxins out of our water supply, recycle every item possible, and make wise purchases. I hope that, in the grand scheme of things, the impact of the pouches that I throw away is small. I really do only try to use them when absolutely necessary.

When I was on Mount Sniktau on Sunday and decided draining wouldn’t be possible, I even began to wonder if I could find a good place to take off my full pouch and put an empty closed-end one on. It was so windy and there were people everywhere on the ridge. Once my pouch was 1/3 full, I couldn’t find a place to make the switch. I decided I would wait until later to deal with it. The good thing about my ostomy is that, unless I eat something that irritates my stomach and gives me pure liquid output, I have plenty of time to get around to emptying. It is rarely urgent.

On the summit of Sniktau. It was really cold and windy up there with very little shelter.
On the summit of Sniktau. It was really cold and windy up there with very little shelter.

As I made my way down the ridge from the summit, more and more people were coming up and I realized I couldn’t be fussy with my site selection for swapping. My pouch was now 1/2 full and I needed to take care of it soon. I ran ahead of Doug and his dad but also saw that some people were heading towards me.  I had about 5 minutes before they reached me so I tossed my pack to the side of the trail next to a small pile of rocks and tried to create a wind break. I then dug my supplies out and tied a small doggie poo bag to my pack strap so it wouldn’t blow away (this is what I would throw the full pouch into). Next I pulled down the front of my pant waistband, took my hernia prevention belt off, and quickly swapped out the full pouch for the clean one. Just as I had gotten my clothing back into place and was bagging up my trash, the two hikers approached me. I said hello and we talked for a second about the route. They clearly had no idea I had just dealt with my ostomy. To them, from a distance it probably looked like I was futzing around with my clothing or backpack. One can very discreetly manage their ostomy on the trail with a two-piece system and closed-end pouches.

With all the options out there, it pays to experiment with all the different brands and styles. Don’t feel like you have to use only one type of appliance. Have a dressy occasion where you definitely don’t want your appliance to show? Wear a sleek one-piece that week. Hanging out at the beach all day? Go for a mini drainable pouch that won’t hang out beyond the bottom of your suit. And if, like me, you find yourself needing to empty on a wind-swept ridge with sheer drop-offs on both sides — a two-piece with a closed-end pouch may be just the ticket. Take advantage of all the products out there to make life with your ostomy the best it can be.

This is the spot where I swapped out my pouch. By the time Doug caught up and snapped this photo, I was finished managing my ostomy and was changing my camera battery. However, from a distance swapping out a pouch doesn't look much different than this. It can be done very discreetly.
This is the spot along the trail where I switched out my pouch. By the time Doug caught up and snapped this photo, I was already finished managing my ostomy and was changing my camera battery. However, from a distance, swapping out a pouch doesn’t look much different than this. It can be done very discreetly.
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11 thoughts on “How to select ostomy pouch styles for the outdoors

  1. One piece and two piece drainble bags are perfectly normal (usually) for ileostomy indoor and outdoor use. Most of us won’t be scaling mountains, however envious we might be. I do find that in the summer when I’m swiming regularly that weartime reduces by about 2 days but that’s a price I’m willing to pay. I used a one piece drainable for 35 years and only, recently, switched to a two piece drainable, because the one piece drainable no longer agreed with my skin and reduced my wear time quite a bit. I experimented with different brands, found a 2 piece that agreed with my skin, and now back up to 6 – 7 day wear time with my two piece (which I wear like a one piece ie I only change it all at once).

    1. Hi Shaz,

      Thank you so much for the comment. It made me realize that I somehow accidentally deleted a short paragraph from my post when I was writing it, and then failed to catch that it was missing in my final edit. (I guess that is what happens when I try to write blog posts at 11 p.m.!) In that missing paragraph, I did mention that I do use drainable pouches most of the time outdoors. I made sure to add the missing text back in to the post. You are absolutely right that it is totally normal to use drainables both indoors and outdoors. I only use the closed-end pouches for those extreme situations mentioned.

      Thanks also for sharing your experiences. It is crazy how one can suddenly develop allergies to certain products—even after they have used something for a long time. Glad you found a new product that works for you. You are right that a two-piece basically functions the same as a one-piece when you don’t swap out pouches. Weeks go by sometimes when I don’t use any closed-end pouches on my two-piece. 6-7 days is an impressive wear time. I am in the 3-4 day range so swimming doesn’t affect my wafer adherence much for this short period of wear time. I can see how it might when you wear a wafer for a longer period of time though.

      I also want to thank you for your amazing ostomates.org site. I read just about the entire website when I was facing surgery. In fact, your site was the very first place I read about suggestions for stoma length and location. I made sure to inquire about this with my surgeon and stoma nurse and ended up with an awesome placement and stoma length! Not to mention that it was great to hear the perspectives of someone who has been happily living with their stoma for a long time. Thanks for all you do to help ostomates!

      Cheers,
      Heidi

      1. Heidi I had my surgery on July 9th and this is my 5th week. Can’t wait to start hiking again. I usually just hike 3 to 4 miles around Canon and areas close to Florence. I will try different appliances but right now I use Hollister 2 piece. I have developed a red rash at times but it goes away. Maybe I am doing something wrong. When I go to change everything for a new one the rash is red underneath but it is not bad. Any suggestion might help me out. Also when hiking how do I go about cleaning out my pouch. Do I pour it in a bag and dump it in the trash or just dig a little hole way off some where? I am new at this so I would appreciate your help. I had a illiostomy done too! Seem to be healing okay. Also, was wondering what kind of pants or hiking pants can I wear that look nice and are comfortable.

      2. Hi Carol,

        Finally a chance to write. Whew! Things have been busy since returning. So much to catch up on!!!

        I am so relieved to hear that your surgery went well and that you are healing up okay. Don’t worry if things feel rough right now. It will get sooooo much better once you become a pro at managing your ostomy.

        Rashes are tricky because there are so many things that can cause them. It could simply be irritation to the follicles from pulling the old appliances off. I find that I need to use adhesive remover to get my wafers off or I end up irritating or injuring my skin. Most adhesive removers are oily and can keep the next wafer from sticking unless you wash the residue off really well with soap and water. However, there is one adhesive remover called Niltac (http://www.niltac.com/website/index.html) that is silicone based. It works really well and does not leave a residue. It comes in spray and wipes. I like the spray for use when peeling off the wafer and then the wipes for removing any tape residue. I always get it from the Ostomy Secrets online store, though Convatec recently purchased Niltac, so I need to check to see if it is available from my supplier so that my insurance might cover it. It is pricey without insurance, but it is such a superior product that it is totally worth it.

        If you do get a little skin injury rash under your wafer from time to time, you can also coat it with a layer of skin prep. Just swab a bit of prep over the irritated area and then put on your wafer. I know that most wafer info materials say that putting skin prep under a wafer can lesson wear time, but I have not noticed it to be a problem as long as I use the prep sparingly. I like Smith and Nephew or Cavillon brand skin prep wipes the best. Often if I put a little on an area that has been irritated from pulling off my wafer, the irritation is cleared up by the next change.

        I also had a rash once that developed from bacteria getting into the hair follicles (folliculitis) due to mechanical trauma to my skin. You can read about that and my solution the following post. This is still how I trip and tape my wafers a year later and the rash never came back. https://ostomyoutdoors.com/2012/06/12/skin-sleuthing/

        Rashes can be caused by yeast as well. You could also be allergic to the adhesive in the wafer. If you are having something persistent, schedule a visit with your stoma nurse. They will surely have some good tips.

        As far as emptying on the trail… there are lots of options. You could empty into a bag and toss it into the trash, though it seems whenever I have tried this method it has been messy because wind catches the bag I am trying to empty into… or my output misses the bag. I find it much easier to dig a hole. I made a video and blog post that discusses this: https://ostomyoutdoors.com/2011/09/03/dealing-with-output-on-the-trail/

        Another option if you are using a two-piece ostomy system is to use closed-end pouches during hikes. When a pouch gets full, simply pop it off, snap a clean one on and then pack out the old in a double-layer ziplock (I also like to first put the full pouch in a black opaque doggie poo bag so that I don’t have to look at its contents spill all over the inside of the ziplock:) Using closed-end pouches is really helpful on winter hikes and in places where it is hard to dig a hole. Also, if I am hiking in our local open space parks which are very crowded with people, I like to use closed-end pouches. It is much more discreet to pop off a pouch than to dig a hole to empty. I can stand behind a tree and do it with just lowering the front waistband of my pants. My insurance company allows me either 20 drainable pouches a month or 60 closed-end ones. Every few months or so, I order a box of the closed-end instead of the drainables and it is usually enough to last me for a lot of hikes. This post talks a bit about closed-end and drainable pouches: https://ostomyoutdoors.com/2013/05/16/how-to-select-ostomy-pouch-styles-for-the-outdoors/

        As far as pants, I didn’t have to change my clothing after my ostomy surgery. I found that the pants I used to wear hiking still worked just fine. My favorite pants lately have been the REI Acme women’s softshell pants. I bought them for Rainier, but I absolutely love them for any hiking where it is going to be a little chilly out. The Acme pants are made out of a thicker fabric, so they are not best for lower elevation summer hikes though. I love how they have a slightly higher rise than some of my other pants so the waistband rests above my stoma. I may check out some of the other REI brand hiking pants to see if they have any styles that have a similar fit only with lighter weight fabric. I did notice the REI Acme pants are discontinued right now… but I suspect they may be bringing them back for the winter season. My advice is, when you are feeling up to it, just head to the store and try a lot of stuff on. You will undoubtedly find something that works with the myriad of brands out there. As far as everyday pants–I have really good luck with Eddie Bauer brand. They have a lot of different fits… straight, curvy, slightly curvy. The Eddie Bauer curvy fit trouser style jeans and pants are my favorite for my shape and stoma placement. Plus with the outlet store nearby, I can always find a good deal:) Of course, everyone’s body shapes and stoma placements are different so what works for me may not work for you. Again though, I really haven’t had to change my clothing. I still wear all my pre-surgery pants and shorts. The only thing I changed clothing-wise is that I now wear a tankini instead of a bikini.

        Hope this helps and thanks for your patience in waiting for a reply. Sorry it took me so long to write. Thinking of you as you continue to heal up.

        Cheers,
        Heidi

  2. When I did a backpacking trip in Colorado with Outward Bound they had bio hazard bags that I could since I had to pack out any empty ostomy bags. I will be taking a trekking tour in Nepal in October and I’m thinking bio hazard bags will work well but I don’t know where to get some. Do you have any suggestions?
    Great article. I haven’ ever used closed pouches because I have an ileostomy and usually have to empty the bags several times a day but I see they could have advantages.

    1. Hi Joe,

      A trek in Nepal sounds like such a fun adventure! How great that you did Outward Bound with your ostomy too. I don’t know where to get biohazard bags. I just use the opaque black doggie poo bags that you would get at any regular store. If you tie a knot in them very tightly they do not leak. I then toss this into a Ziplock for extra protection until I can toss the whole thing in the trash can. If I am packing out pouches for multiple days (which can get a little stinky even when double-bagging in regular Ziplocks), I will put the double bag in a third layer– an odor proof Opsak bag (http://www.loksak.com/products/opsak). These are expensive though. Because they are just used for an outer layer for scent control and never get poo on them, I reuse them. Did Outward Bound give you those bags because they considered the waste a biohazard or just because they were durable and handy? I have never thought of ostomy pouches as a biohazard. Lots of hikers pack out used TP and throw it in the garbage at the trailhead without a thought. I figure tossing away ostomy pouches in mainstream trash is no different than throwing away used baby diapers either. Plus I have never heard of ostomy wastes being considered a biohazard when throwing soiled supplies away at home… so I don’t know why it would be any different when tossing something in a trashcan anywhere.

      Yeah- I would never use closed-end pouches for every day use at home… but they are incredibly handy for use outdoors in situations where it is impossible to empty. I just used them on Rainier and it was so simple. I was even able to discreetly swap them out while roped up with my teammates on the glacier.

      Hope your trip is amazing!

      Cheers,
      Heidi

      1. Hi Heidi
        Thanks for the info. The biohazard bags were just durable and handy and maybe trapped odor. I just put them in the trash when we got back to civilization. I was glad that they gave thought to carrying used bags out because I hadn’t given that process enough thought. Outward Bound in Colorado really did a great job making a rigorous trip very enjoyable for me.

  3. Hi there. Nice blogg you got there. A lot of information.
    I have tested a lot of bandages and i have found out that the 2-piece works best for me.
    I use Coloplast sensura 2-piece click with xpro baseplate. Works in all condition. At home, out fishing, swimming, sexual activities. Works for everything.
    I am using three diffrent sizes of ostomybags depends on what i am doing.
    The midi size am i using on daytime.
    The Maxi size am i using mostly during the night or when i am out fishing.
    The Mini size is perfect to use during intimit activity. I even got a dark red silk cover for my mini bags. Then the bax could be something more beautiful.

    I have been told that the ostomy materials are very expensive if you dont got a good health insurance (in the USA).
    I live in Sweden at the west coast. The state i live in are paying for everything i need. I dont need to pay anything at all.

    Best regards from Sweden

    1. Thanks for sharing information about the supplies that you like. The two-pieces are great aren’t they? I love being able to attach any size or type of pouch to my wafer depending on what activity I want to do. I am glad you found a system you like using. I used Coloplast Xpro in the 5 months after surgery and really liked the pouches. Unfortunately, my skin became sensitive to the material in the wafers and I started to develop a rash. I switched to Convatec which my skin likes better and works really well too through all my workouts and outdoor adventures.

      Yes- ostomy supplies are expensive. I consider my health insurance very good and I still have to pay 25% of the cost of my order each month. I can’t complain though as it could be a lot worse. Ostomy supplies aren’t something I pinch pennies on though… I buy whatever I need to make life with my ostomy as easy and enjoyable as possible. I can cut other stuff out of the budget:).

  4. Great article with lots of useful info! I love to hike, camp and go boating so I will probably try some of your suggestions. I have a urostomy and a colostomy but this info can work for either one. Thank you for sharing!!!! Cheryl

    Sent from my iPhone

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