Gas.

It’s normal for the stoma to produce gas (flatulence), which accumulates in your pouch – sometimes filling it up like a balloon.  

Many foods and beverages are said to increase gas. Other potential causes of excess gas are drinking through a straw, chewing gum, slurping or gulping your food, not chewing well, and talking while eating. Turns out your mother was right!   

Many ostomates take over the counter (OTC) gas and bloating remedies like BEANO® and GAS-X®. 

Remember that people without ostomies produce a surprising amount of gas every day too. The only difference is where it comes out. When it comes out of your rectum, it dissipates into the air behind you. But when it comes from a stoma, it builds up in your pouch until it’s released … right under your nose.  

Ballooning (and not the fun kind, either) 

An unreleased build-up of gas will cause the pouch to inflate like a balloon. It could even inflate to the point of causing smells, leaks, or a dreaded blow-out. 

Another problem with ballooning is trying to empty the contents of a pouch filled with gas, particularly if the output is watery. As soon as you open the pressurized pouch, it’s liable to spew.  

So how do you deal with ballooning? There are 3 options: filters, vents, and burping.  

• Filters 

Many pouches come with filters that allow gas to escape, but trap or neutralize odor. They’ll stop working if they get wet. Some claim to be waterproof; others come with stickers to place over the filter, supposedly to prevent water from coming in (when showering, bathing, swimming, etc.). A far more common problem is watery output from inside the pouch wetting the filter, or thicker output clogging it.  

However it happens, if your filter becomes wet or clogged you’ll have to change to a new pouch if you want to avoid filling up with gas. 

When I use pouches that come with filters, I usually keep them blocked with the stickers all the time. I don’t have a high gas output and don’t mind if the pouch inflates with a little gas because it makes some space for my output to drop down inside. Of course, people with a higher gas output are at more risk of ballooning if they block the filter.  

Many people claim they can get at least a few days’ wear out of a pouch with a filter before it clogs and/or stops working. Others say they’re lucky to get one day. There are several different companies making these products, so you have lots to try out to see if you can find one that works well for you.  

I use bag liners inside my pouch. The instructions say to puncture a couple of holes near the top of the liners, to allow gas to escape. You don’t need to do that (I don’t), but if you have a higher gas output, you might want to try it. It’s meant to allow the gas to escape from the bag liner into the pouch and out through the filter.  

• Vents 

Another option is to use a small vent mechanism called OSTO-EZ-VENT® - that you buy separately and attach to your pouch. This brand may not be the only externally applied vent out there but it’s the only one I know of, and it’s very popular.  

The vents come with detailed instructions and there are good videos online showing how to attach them. Basically, you peel off the backing and stick it on the outside of your pouch, near the top. Then you poke through a small hole in the center of the vent, making an opening into the pouch. The vent has an outside cover that you flip open to let gas escape, as needed. Some ostomates find all this a bit “fiddly.” But for many others, it’s a very workable solution to the problem of gas build-up. When they get a new supply of pouches and vents, they simply attach a whole batch of them at one time, assembly line fashion, so they have a good supply of vented pouches on hand, ready to go.   

• Burping the pouch 

If you have a 2-piece appliance, with or without a bag liner, you may find the easiest way to get rid of gas build-up is to burp the pouch (like a TUPPERWARE® food container). Just open it a bit at the top to let the air escape, usually with a satisfying “pffffttt,” then close it up again. Voilà!  

This works best with a pouch that attaches mechanically to the baseplate, by clicking or locking into place. Self-adhesive pouches may not re-adhere well to the baseplate after you’ve peeled the top back to burp a few times. When I used an adhesive pouch, I found I could actually completely remove and re-attach it several times, with little or no loss of adhesion. But every product is different. You won’t know till you try. 

If there’s watery output in your pouch along with a lot of gas (in other words, if the pouch is very inflated and ready to spew), it can spray out when you burp it. Under those conditions, if you have a drainable pouch, you’d be safer to release the gas from the bottom opening while standing over a toilet.  

Some ostomates find that their pouches inflate significantly overnight, so they wake up with a pressurized balloon on their stomach. This isn’t just uncomfortable. It also poses a risk of the pouch pulling away from the baseplate or bursting if you roll over on it. The best strategy here is to reduce gas as much as possible by paying attention to what, when, and how you eat, and/or by taking anti-gas remedies before bedtime.  

Some folks say they’ve gotten used to waking up during the night, burping or emptying their pouches, and then going right back to sleep. If you’re fortunate enough to master this trick, it’s a great solution to overnight ballooning. 

Abdominal discomfort 

Gas isn’t just a pouch problem. It can also be painful. In addition to learning what to eat and what to avoid, tips for reducing abdominal gas pains include applying a heating pad across your stomach, a light massage, exercise like walking, and hot drinks.  

Keep in mind that if this becomes a chronic problem, or is accompanied by other symptoms you can’t explain, like nausea or vomiting, maybe it’s not just gas. There are many other causes of abdominal pain. Worth checking out with your doctor.  

Courtesy Joan Scott, author of The Ostomy Raft