I am going through some old post topics. I saw this and wanted to try to explain further to benefit wearing the pouch horizontally. My toilet is an ADA approved one. I think 17 inches high is the max, so that helps. I am 5 ft 11" so kinda tall to be squatting on it in regular or reverse fashion. Plus the knees... aren't working like when we were at age 25. My stoma is on my right where I believe all ilios are supposed to be. My bag horizontally wraps somewhat around my right hip where the opening of the bag held closed by Velcro lays. I use a stoma wrap which is wide. It has a pouch area to hold the pouch naturally. So I stand before the throne, facing it, lay the TP down, pull out the pouch from the wrap, slowly unfold it while taking aim. One hand holds the bag from swinging, the other unvelcros the strap, and it all falls out effortlessly. I do bend at the knee. I don't get into the toilet completely. I see what you meant, but the bag hangs down far enough where I don't have to kneel. Nothing gets "dirty" as I tilt myself forward to unload the contents. Always two hands, not allowing the bag to swing freely. No mess, and I have mastered it well. Maybe having the higher toilet helps or the longer bag, but horizontally emptying it is no problem, no issue thing. I hope you can try it and it improves your life a little. I just can't stand having it swing vertical or just be vertical. Pants, bending would be my complaint vertically speaking. Also, I should add, I am pretty much a solid output most of the time, so there is that plus. I know it's unusual, but I have been called worse, so I don't get the "high liquid output" of the other osties. Nope. So combining the height of the toilet, the length of the pouch, and the solid output, and going vertical all seems like the perfect match for me at least.