How to change your ostomy bag easily

The following is an in-depth guide on how to change an ostomy bag easily.

Mastering Your Ostomy Bag Change: A Definitive Guide to Confidence and Comfort

Living with an ostomy is a significant life adjustment, but it doesn’t have to define your everyday. One of the most crucial aspects of managing an ostomy effectively is mastering the art of changing your ostomy bag. This isn’t just about hygiene; it’s about comfort, confidence, and preventing potential complications. While it might seem daunting at first, with the right knowledge, preparation, and practice, changing your ostomy bag can become a routine, almost second-nature task that empowers you to live a full and active life. This comprehensive guide will equip you with everything you need to know, from the initial preparations to advanced tips, ensuring a smooth, secure, and stress-free ostomy bag change every time.

Understanding Your Ostomy System: The Foundation of a Successful Change

Before we delve into the step-by-step process, it’s vital to understand the components of your ostomy system. Most systems consist of two main parts: the wafer (or flange) and the pouch (or bag).

The Wafer (Flange): This is the adhesive barrier that sticks to your skin around the stoma. Its primary purpose is to protect your skin from output and provide a secure base for the pouch. Wafers come in various types:
- Flat Wafers: Suitable for stomas that protrude well and have a relatively flat abdomen.
- Convex Wafers: Designed for stomas that are flush with the skin, retracted, or located in a skin fold. The convex shape applies gentle pressure around the stoma, encouraging output into the pouch and providing a better seal.
- Extended Wear Wafers: These have a more durable adhesive and are designed to stay on for longer periods, typically 3-7 days, depending on individual skin type and output consistency.
- Standard Wear Wafers: Usually worn for 1-3 days, suitable for those with sensitive skin or who prefer more frequent changes.
The Pouch (Bag): This collects the output from your stoma. Pouches also come in different varieties:
- Drainable Pouches: Most commonly used for ileostomies and colostomies, these have an opening at the bottom that allows for emptying of contents throughout the day.
- Closed Pouches: Typically used for colostomies with more predictable, formed output. These are designed for one-time use and are discarded after they are full.
- Urostomy Pouches: Specifically designed for urostomies, these have a tap or valve at the bottom to drain urine. They also feature an anti-reflux mechanism to prevent urine from flowing back towards the stoma.
- Filter Pouches: Many pouches, especially for colostomies and ileostomies, incorporate an odor-reducing filter to allow gas to escape while neutralizing smell.
One-Piece vs. Two-Piece Systems:
- One-Piece System: The wafer and pouch are combined into a single unit. This can be simpler for some as there’s less to align, but the entire system must be removed for each change.
- Two-Piece System: The wafer and pouch are separate. The wafer adheres to the skin and can remain in place for several days, while the pouch can be snapped on and off as needed for emptying or replacement. This offers flexibility and can be gentler on the skin for frequent pouch changes.

Understanding your specific system and its components is the first step towards a smooth changing process. If you’re unsure, consult your ostomy nurse or healthcare provider.

Essential Supplies: Gathering Your Toolkit for a Seamless Change

Preparation is key to a stress-free ostomy bag change. Having all your supplies readily available and organized before you begin will prevent unnecessary fumbling and potential mess. Here’s a checklist of essential items:

New Ostomy Pouch and Wafer: Ensure it’s the correct size and type for your stoma and system.
Stoma Measuring Guide: Crucial for accurate sizing of the wafer opening, especially in the initial stages post-surgery or if your stoma size changes.
Scissors (Curved): If you use a cut-to-fit wafer, curved scissors are ideal for precise cutting.
Adhesive Remover Wipes (Optional but Recommended): These help to gently and painlessly dissolve the adhesive, making removal easier and reducing skin irritation.
Skin Barrier Wipes/Sprays (Optional but Recommended): These create a protective film on the skin around the stoma, acting as a barrier against output and preventing irritation from adhesive.
Soft Washcloths or Non-Woven Gauze Pads: For cleaning the skin around your stoma. Avoid cotton balls as fibers can stick to the stoma.
Mild Soap (pH-Neutral and Scent-Free): Only if needed for cleaning; plain water is often sufficient. Avoid soaps with lotions, oils, or heavy perfumes, as these can interfere with adhesive.
Warm Water: For cleaning.
Clean Towel or Paper Towels: For drying the skin.
Disposable Bag: For discreet disposal of the used pouch and supplies.
Mirror (Optional but Helpful): Especially for those with stomas in hard-to-see areas.
Stoma Paste or Rings (Optional): These can be used to fill in any uneven skin surfaces around the stoma, creating a flatter surface for the wafer and preventing leaks.

Gathering these items in a dedicated “ostomy kit” or a designated area will streamline your changing routine.

Timing is Everything: When and How Often to Change Your Pouch

The frequency of your ostomy bag changes depends on several factors:

Type of Ostomy: Urostomy pouches typically need to be drained more frequently than ileostomy or colostomy pouches, but the wafer may last similar durations.
Type of Wafer: As mentioned, standard wear wafers are changed more often than extended wear wafers.
Output Consistency and Volume: High-volume or very liquid output may necessitate more frequent changes to prevent leaks.
Skin Condition: If your skin around the stoma is irritated or red, you may need to change more frequently to address the issue.
Personal Preference: Some people simply prefer more frequent changes for hygiene or comfort reasons.

General guidelines for wafer changes are every 3-5 days for extended wear and 1-3 days for standard wear. However, it’s crucial to change your wafer immediately if you experience:

Itching or Burning: These are signs of leakage or skin irritation that need immediate attention.
Lifting or Loosening of the Wafer: A compromised seal will lead to leaks.
Visible Output Under the Wafer: This is a clear sign of leakage.

Ideal Time for Change:

The best time to change your ostomy bag is when your stoma is least active. For most people, this is:

First thing in the morning, before eating or drinking.
Before bed.
A few hours after a meal.

Changing when the stoma is less active minimizes output during the process, making it cleaner and easier.

The Step-by-Step Guide to a Flawless Ostomy Bag Change

Now, let’s walk through the process of changing your ostomy bag with confidence and precision.

Step 1: Preparation is Paramount

Gather All Supplies: Lay out everything you need within easy reach on a clean surface (e.g., a counter, a towel on your lap).
Wash Your Hands: Thoroughly wash your hands with soap and water to prevent contamination.
Ensure Privacy and Comfort: Find a private, well-lit space where you feel comfortable and undisturbed. You might prefer to do this in the bathroom or your bedroom.
Consider Your Position: Some people find it easier to change while standing, others sitting, and some even lying down. Experiment to find what works best for you and allows you to see your stoma clearly.

Step 2: Gently Removing the Old Pouch and Wafer

Empty the Existing Pouch (if drainable): Before removing the whole system, empty the contents of your drainable pouch into the toilet.
Support Your Skin: With one hand, gently press down on the skin around the edge of the wafer. This counter-pressure helps prevent pulling on the skin as you remove the adhesive.
Peel Slowly and Carefully: With your other hand, begin to gently peel the wafer away from your skin, starting from the top and working downwards. Pull the wafer down and away from your body, rather than straight out.
Use Adhesive Remover (Optional but Recommended): If the adhesive is particularly strong or your skin is sensitive, use an adhesive remover wipe. Gently rub the wipe along the skin where the wafer is lifting, allowing the solution to dissolve the adhesive as you peel. This significantly reduces discomfort and skin trauma.
Observe Your Stoma and Skin: As you remove the old wafer, take a moment to observe your stoma (it should be moist, reddish-pink, and typically painless) and the surrounding skin (it should be intact, free from redness, irritation, or breakdown). This is your regular skin check.
Dispose of the Old System: Place the used pouch and wafer directly into your disposable bag.

Step 3: Cleaning and Preparing Your Skin

This is a critical step for skin health and ensuring a good seal for your new wafer.

Gentle Cleaning: Using a soft washcloth or non-woven gauze pads moistened with warm water, gently clean the skin around your stoma. Clean from the stoma outwards.
Mild Soap (If Necessary): If there’s any residue or odor, you can use a very mild, pH-neutral, scent-free soap. Rinse thoroughly with warm water afterwards to ensure no soap residue remains.
Pat Dry Completely: This is extremely important. Pat the skin completely dry with a clean towel or paper towels. Adhesive will not stick to wet or damp skin, leading to leaks. You can even use a cool setting on a hairdryer to ensure thorough drying.
Hair Removal (If Needed): If you have hair growth around your stoma, it’s best to trim it with scissors. Do not shave, as this can cause razor burn and folliculitis, leading to irritation and difficulty with adhesion.
Skin Barrier Wipe/Spray (Optional): If you use a skin barrier, apply a thin, even coat to the clean, dry skin around your stoma. Allow it to air dry completely (it should feel slightly tacky, not wet) before proceeding. This creates a protective film and can enhance adhesion.

Step 4: Measuring and Preparing the New Wafer

This step is crucial for preventing leaks and skin irritation.

Measure Your Stoma: Use your stoma measuring guide to determine the exact size and shape of your stoma. Hold the guide over your stoma, finding the circle that most closely matches its size without touching the stoma itself. Stomas can change in size, especially in the first few weeks or months post-surgery, so measuring each time is recommended initially.
Trace and Cut the Opening: If you have a cut-to-fit wafer, trace the measured opening onto the back (paper side) of the wafer. Use curved scissors to carefully cut the opening, ensuring a smooth, even edge. The opening should be approximately 1/8 inch (0.3 cm) larger than your stoma, allowing for slight changes in stoma size and preventing friction. Do not cut the opening too large, as this will expose skin to output and lead to irritation.
Smooth Edges: After cutting, you can gently rub your finger around the cut edge to smooth any rough spots.
Apply Stoma Paste or Rings (If Used):
- Stoma Paste: If you have uneven skin surfaces or scars around your stoma, apply a thin bead of stoma paste around the outer edge of the cut opening on the adhesive side of the wafer. This fills in crevices and creates a flatter surface for adhesion.
- Barrier Rings: These can be stretched or molded to fit snugly around the base of your stoma, providing an extra layer of protection and seal. Apply the ring directly to the skin around your stoma, or to the adhesive side of the wafer around the cut opening.

Step 5: Applying the New Pouch and Wafer System

This is the final and most critical step for a secure seal.

Remove the Adhesive Backing: Carefully peel off the protective paper backing from the adhesive side of the wafer.
Align and Position: Gently center the wafer opening over your stoma. Take your time to ensure proper alignment.
Apply and Press Firmly: Once aligned, press the wafer firmly onto your skin, starting from the area immediately around the stoma and working your way outwards to the edges. Apply gentle, even pressure with the palm of your hand for at least 30-60 seconds. The warmth from your hand helps to activate the adhesive for a stronger bond.
Ensure No Wrinkles or Gaps: Visually inspect the wafer to ensure there are no wrinkles, creases, or gaps where output could potentially leak underneath.
Attach the Pouch (for Two-Piece Systems): If you have a two-piece system, align the ring of the pouch with the ring on the wafer. Press firmly until you hear or feel a “click” indicating it’s securely attached. Give it a gentle tug to confirm it’s locked in place.
Close the Pouch (if drainable): For drainable pouches, ensure the bottom closure (clamp, velcro, or integrated closure) is securely fastened.

Step 6: Post-Change Checks and Disposal

Check for Comfort and Security: Take a moment to ensure the new system feels comfortable and secure. There should be no pulling, pinching, or discomfort.
Final Disposal: Tie up your disposable bag containing the old system and place it in the regular trash. Do not flush ostomy pouches or their contents down the toilet (unless it’s a flushable liner, which is rare).

Advanced Tips for a Superior Ostomy Bag Change

Beyond the basic steps, these tips can further enhance your comfort, extend wear time, and prevent complications.

Warmth is Your Friend: The adhesive on wafers often benefits from warmth. After applying the wafer, placing your hands over it for a minute or two will help activate the adhesive and ensure a better seal. You can also gently warm the wafer with your hands or by placing it between your thighs before peeling the backing.
Preventing “Pancaking”: This occurs when output gets trapped at the top of the pouch, potentially interfering with the filter and causing the pouch to stick to itself.
- A puff of air: Before applying the pouch, blow a small amount of air into it to inflate it slightly.
- Lubricating deodorant: Use a few drops of lubricating deodorant or an anti-stick spray inside the pouch. This creates a slippery surface, helping output slide to the bottom.
- Stay hydrated: Dehydration can lead to thicker output.
Dealing with Gas and Odor:
- Dietary Awareness: Certain foods are known to cause more gas or odor (e.g., beans, broccoli, eggs, carbonated drinks). While you don’t need to eliminate them entirely, being aware can help.
- Pouch Filters: Most modern pouches have integrated filters. If yours doesn’t, or if the filter becomes clogged, consider internal pouch deodorants or external drops.
- Deodorizing Products: Drops, gels, or sprays can be added directly into the pouch to neutralize odors.
Managing Leaks:
- Identify the Cause: Leaks are usually due to an improper seal, incorrect sizing, or skin irritation.
- Skin Care is Paramount: Healthy skin is the foundation of a good seal. Any redness, irritation, or breakdown needs to be addressed immediately.
- Re-measure: Stomas can change size, especially with weight fluctuations or after surgery.
- Consider Convexity: If your stoma is flush or retracted, a convex wafer might provide the necessary pressure for a better seal.
- Stoma Paste/Rings: These are invaluable for creating a smooth surface and preventing leaks around uneven areas.
Sleeping with an Ostomy:
- Empty Before Bed: Always empty your pouch before going to sleep to prevent it from becoming overly full and potentially leaking overnight.
- Night Drainage Bag (for Urostomy): If you have a urostomy, connecting to a night drainage bag is essential to allow for continuous drainage and prevent pouch overfilling.
- Pouch Covers: These can add comfort and discretion while sleeping.
- Body Position: Experiment with sleeping positions that are comfortable and don’t put excessive pressure on your stoma.
Bathing and Swimming:
- Yes, you can! Water will not harm your stoma. Most ostomy appliances are water-resistant.
- Check the Seal: Before bathing or swimming, ensure your wafer has a secure seal.
- Pouch Covers: Special swimwear or pouch covers are available for discretion.
Traveling with an Ostomy:
- Pack Extra Supplies: Always pack more supplies than you think you’ll need, especially in your carry-on luggage.
- Medical Exemption Letter: Carry a letter from your doctor explaining your medical condition and the need for ostomy supplies, especially for airport security.
- Pre-cut Wafers: If you use cut-to-fit wafers, consider pre-cutting some to save time and hassle.
When to Seek Professional Help:
- Persistent Skin Irritation: Redness, itching, burning, or skin breakdown that doesn’t improve with your current routine.
- Recurrent Leaks: If you’re consistently experiencing leaks despite following proper changing techniques.
- Changes in Stoma Appearance: Significant changes in color, size, shape, or if the stoma becomes painful.
- Unusual Output: Changes in consistency, color, or odor of your output that concern you.
- Fever or Abdominal Pain: Any signs of infection or other complications. Your ostomy nurse is your best resource for ongoing support and guidance.

Building Confidence and Embracing Life with an Ostomy

Learning to change your ostomy bag effectively is a fundamental step towards regaining control and confidence after ostomy surgery. While the initial learning curve might feel steep, remember that practice makes perfect. With each successful change, you’ll become more adept, and the process will become less daunting.

Don’t be afraid to experiment with different products and techniques to find what works best for your unique body and lifestyle. Every ostomate’s journey is different, and what suits one person might not suit another. The world of ostomy care products is constantly evolving, offering innovative solutions for comfort and security.

Embrace this new chapter in your life with knowledge, preparation, and a positive mindset. Mastering your ostomy bag changes isn’t just about managing a medical device; it’s about empowering yourself to live freely, comfortably, and confidently. You are in control, and with these guidelines, you’re well on your way to a seamless and secure ostomy routine.