How to Change an Ostomy Pouch

Most people change their ostomy pouch anywhere from 3-7 days. The biggest sign that you need to change your ostomy pouch is if you feel itching or burning under your baseplate, as it can indicate skin irritation. One method for figuring out a length that works for you is to start changing it every three days, and if you feel like it still has a good seal on the third day, push it to four days. Continue pushing until you get to seven days. It is not advised to wear your ostomy pouch longer than seven days, though some people occasionally get away with it.

Some people sit or lay down to change their ostomy pouch, but my ostomy nurse suggested standing up at a sink and that’s what seems to work best for me. When you’re standing, you can tape or tuck something into your pants to catch a mess if your stoma starts to poop, and you’ve got water handy for clean up if you need it. Standing also allows you to lean forward if your stoma starts to poop, so that the poop doesn’t pool on your skin.

If you have a hernia, it’s recommended that you stand or sit when attaching a new wafer. Hernias shrink when you lay down and if you put on your wafer when it’s small and then stand it can tear your skin (ouch!) and be really painful.

Some options I’ve come across include keeping a small cup handy so you can catch the output to keep it off your skin.

For fecal ostomies, taking a piece of paper towel or gauze and wrapping it around your stoma can help to keep the output contained and off your skin (this works best with slightly thicker output).

It’s not scientifically proven, but many ostomates swear by the marshmallow trick. Something in marshmallows (the gelatin perhaps) seems to help to slow and thicken digestion temporarily so eating a few marshmallows ahead of a pouch change can help give you a window for your pouch change.

For urostomies, a tampon, washcloth or gauze can be your best friend. It’s not advised to actually stick a tampon in to your ostomy, but tampons are pretty absorbent and you could use any absorbent material up to your stoma with one hand to collect urine while cleaning your skin with the other hand.

Most importantly, try to stay calm and be patient – it’ll stop eventually and you’ll find your rhythm.

There are so many products it’s overwhelming to know which product of each brand is works best. Ultimately, it’s about finding the products that work best for you. If what you got at the hospital is working for you, you probably don’t need to try something new. At some point, you may decide you want to try a new brand; many manufacturers of ostomy appliances and accessories are really good about sending samples of whatever products you want to try. When you’re on the phone with them, ask them for enough samples to really see how they work for you.

• Get everything set up and ready before you take off your appliance. I use a tv tray table to set everything up on because my sink doesn’t have much counter space.
• Unwrap your wafer and don’t forget the pen to draw the correct size of your stoma on the back of it.
• Once you know the general size of your stoma, it’s handy to draw it on the wafer during set up. It’s also really important to measure your stoma every change (in the beginning) and periodically (once the swelling is down) to make sure you’re cutting the hole in your wafer to the right size.
• Tuck a towel into your pants to keep them clean. I usually stand at the sink and put the towel in my pants and then up on the sink counter. Then, when I take my ostomy pouch off, I lay it on the towel wafer-side up so that if I have output while it’s off I can lean over and try to catch it on my already-dirty pouch.
• Another idea, instead of the towel, would be to tuck a plastic grocery bag into your pants, that way it’s like you have a trashcan right under your stoma to throw paper towels, your old pouch and wrappers from whatever supplies you’re using and it can catch any poop that comes out if your stoma acts up.
• If you use adhesive remover spray, you can spray it directly on your wafer and it comes off so easily! Remember to hold the wafer and push the skin down when removing, as opposed to pulling the wafer off to make for less skin irritation.
• After using the adhesive remover, clean the skin around your stoma with soap that doesn’t have any oils/scent/moisturizers (soap that doesn’t leave a residue).
• If you have a urostomy that is small enough to fit within a pill bottle, cut the bottom off and stuff it with tissue, then hold it over the stoma to catch drips after you’ve cleaned the skin while it’s drying and you do any other prep you need to do before placing the baseplate and pouch.
• Inspect your skin at every appliance change to make sure it’s in good shape. If you have any irritation on your skin that doesn’t clear up after a few days, contact your stoma nurse for advice.
• My stoma is kind of mushroom shaped, it’s smaller where it meets the skin, which makes measuring it and cutting the wafer to fit really challenging. Using the eakin seal and putting it around the stoma (make sure it’s right up against it), allows you to cut the wafer big enough to go around the mushroom head and sit on the eakin seal. It’s still important to try to get the closest fit you can with your wafer.
• Try to stand up as straight as you can (or lean back somewhat, if you’re sitting) when you apply the wafer. You want the skin to be stretched as flat as possible to get a good fit and also because if you’re bent over when you stick it on, you won’t be very comfortable when you try to sit up straight! If your skin has folds or wrinkles, try to change positions to find one that stretches the skin out most to give you a better fit. You can also use paste to fill in any folds, talk to your stoma nurse for more advice.
• Wafers tend to stick better when they’re warm. Warming it up a little bit before application can help, I use a blow dryer sometimes. It’s also suggested to place your hand over the appliance for 30 seconds to 1 minute once it’s on. This can help it adhere and adjust to your body shape.
• Avoid pancaking by making sure your pouch has a little bit of air in it before sealing it off so the output has some room to go and doesn’t feel like it’s vacuumed in.
• When your testing new products, testing them on a different patch of skin is a good idea, anything to avoid irritating the skin around the stoma!
• I use a mini binder clip as an extra measure to make sure that my ostomy pouch stays closed. This also comes in handy when I want to make my pouch shorter/smaller, I just fold it up to the length that I want and then use the clip to keep it there.