Understanding Living With an Ostomy Bag After Colorectal Cancer

For many individuals undergoing treatment for colorectal cancer, surgery can alter how the body eliminates waste, making an ostomy bag a necessary part of recovery and long-term care. Approximately one-third of colorectal cancer survivors will require a temporary or permanent ostomy, underscoring the importance of understanding how these devices function and how they impact daily life.

To provide clarity on this aspect of colorectal cancer care, CURE sat down with Dr. Hazem Tabbaa, a specialist in gastroenterology and advanced therapeutic endoscopy and medical director of gastroenterology and endoscopy at Memorial Healthcare.

In the following interview, Tabbaa discusses when ostomy bags are needed, common challenges patients face and how evolving technology are improving quality of life for those living with an ostomy.

CURE: How does the use of ostomy bags fit into the treatment journey for colorectal cancer patients?

Tabbaa: Many patients treated for colorectal cancer, specifically patients who receive surgical resection of certain parts of their small bowel or colon, require an ostomy bag. An ostomy bag becomes part of care when surgery changes how waste leaves the body. It isn’t needed for every patient, but it plays an important role in some treatment plans, either temporarily during healing or permanently if the rectum or colon cannot be reconnected (this is called an anastomosis).

A colostomy is needed for diversion of the colon to the abdominal wall, and an ileostomy is needed for diversion of the small intestine to the abdominal wall. This allows an alternate path for waste (bowel movements) to exit the body safely. An ostomy is the name of the bag that is placed over the surgical opening (stoma) made in the abdominal wall.

What are the most common challenges patients face when adjusting to life with an ostomy bag?

The most common challenges related to life with an ostomy bag include needing to empty or change the bag, obtaining a proper seal between the skin and the pouch, preventing leaks, skin irritation that can result and dealing with odor and gas. Anatomically, challenges including parastomal hernia (bulge near the stoma), stoma prolapse and obstruction from narrowing or stricturing can occur and cause mild to severe symptoms, sometimes even requiring surgical intervention.

Then, there are the extraintestinal changes and challenges that come with wearing an ostomy bag, which include body image worries and self-consciousness about the bag, concerns about attractiveness and intimacy as well as anxiety about clothes fitting properly. These things can affect self-esteem, relationships and sexual/romantic confidence.

What strategies or recommendations do you provide to help patients optimize quality of life after surgery?

To optimize quality of life after surgery for colorectal cancer, patients are encouraged to combine medical follow-up with practical self-care and support. Education from a wound-ostomy nurse helps patients confidently manage a colostomy or ileostomy, including proper pouch care and skin protection. Gradual diet adjustments, staying well hydrated, and returning to regular physical activity can improve digestion and energy levels.

Emotional support, through counseling, peer support groups, or patient organizations like the United Ostomy Associations of America, can also help address body image concerns and anxiety. Together, these strategies help many patients regain independence and maintain a strong overall quality of life.

How have advancements in ostomy bag technology improved patient outcomes or comfort over the years?

Advancements in ostomy bag technology have significantly improved comfort, safety, and quality of life for patients with ostomies, such as a colostomy or ileostomy. Modern systems use skin-friendly adhesives, hydrocolloid barriers, and flexible materials that reduce irritation and provide a more secure seal, lowering the risk of leaks and skin complications.

Newer pouches are also slimmer, odor-controlled, and more discreet, helping patients feel more confident in daily activities.

Are there specific considerations for younger patients or those with complex surgical histories when using an ostomy bag?

Younger patients, and those with complex surgical histories, often need individualized planning when living with an ostomy, from procedures like a colostomy or ileostomy, after treatment for colorectal cancer. Younger patients may face greater concerns about body image, physical activity, dating, fertility, and overall long-term lifestyle impact.

In these cases, counseling and support resources are especially important. Patients with prior abdominal surgeries or complicated anatomy may also have challenges such as scar tissue, irregular stoma placement, or higher risk of complications, requiring customized pouching systems and closer follow-up with specialized ostomy nurses to ensure comfort, proper fit, and long-term stoma health.

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