Changing Your Ostomy Pouch

At first, changing your ostomy pouch might make you feel nervous.  This is completely normal.  With practice, you will be able to change your ostomy pouch easily and confidently.

Step One: Gather Supplies

Make sure you have everything ready before you start.

• Plastic bag for trash disposal
• Warm water
• Paper towels or wash cloths
• Stoma measuring guide (usually in the skin wafer box)
• Pencil
• New appliance
• Ostomy scissors gloves (optional)
• Gloves (optional)
• Adhesive remover wipe (if needed)
• Ostomy powder (if needed)
• Ostomy paste (if needed)
• Mirror that allows you to see the stoma easily

Place all supplies on a bathroom counter or table within easy reach.

Step Two: Remove Appliance

1. Wash your hands.
2. Empty the pouch before removing it.
3. Starting from the top, gently remove the appliance by pressing the skin away from the tape/barrier (don’t pull the tape from the skin). You may use an adhesive remover wipe if needed.
4. Place the used appliance in a trash bag. Throw it in the regular trash.

Step Three: Skin Care & Cleaning

1. Gently wash the stoma and the skin around it with warm water and paper towels or washcloth. Do not use soaps or wipes, as it can leave a residue that prevents the skin barrier from sticking.
2. It’s normal if the stoma bleeds a little. If the bleeding is heavy or doesn’t stop, call your clinician.
3. Pat your skin dry, or let it air dry. Cover the stoma with a moist paper towel or washcloth to keep stool or urine from touching the clean skin.
4. Check the stoma. It should be red, moist, and "perky." If it looks purple, dark, or black, or if it is dry or limp, call your doctor.
5. Look at the skin around the stoma. If there is any irritation, use ostomy powder to crust the area. Apply a VERY thin layer of powder to the area of irritation and tap it gently with a damp finger, and let it dry. This is called “crusting.” You can repeat crusting up to 3 times if needed.

Step Four: Measure Stoma

After surgery, your stoma will shrink for about 6-8 weeks. Measure the stoma each time you change your appliance until it reaches its final size. 

1. Using the stoma measuring guide, size the hole in the skin barrier 1/8 to 1/4 inch larger than the stoma. The skin barrier should leave a little space around the stoma when in place.
2. Cut the skin barrier to match the size and shape of your stoma. Be careful not to cut the pouch if you’re using a one-piece appliance.

Step Five: Apply New Appliance

1. Remove the paper backing from the skin barrier. You can also remove the paper from the adhesive tape border if it’s there.
2. If you have leaking problems, apply a small ring of ostomy paste around the hole of the skin barrier (on the sticky side). Wait about 1 minute for the paste to set. Urostomy patients - do not use paste, as it melts when urine touches it.
3. Remove the paper towel or washcloth from the stoma. Make sure the skin is dry and then place the skin barrier down onto the skin. Make sure the hole is centered over the stoma. If using a two-piece appliance, attach the pouch securely.
4. Hold the appliance in place with your hand for 2-3 minutes. The heat from your hand will help the skin barrier form a strong seal.
5. If you haven’t already, remove the paper backing from the tape edges and smooth them onto your skin.
6. Double-check that the pouch is closed tightly!

Tip: For the first 30 minutes after changing your appliance, try to limit your activity to allow the skin barrier to fully stick for better wear time

How to Empty Your Pouch

It is important to empty your pouch when it is about 1/3 to 1/2 full. This helps prevent the pouch from pulling away from your skin or leaking.

• Position: Sit, stand, or squat by the toilet. You can also empty it into a container on the counter, then pour it into the toilet. Some people sit on a stool in front of the toilet.
• Before Opening: Hold the end of the pouch up so nothing spills out.
• Emptying: Point the pouch into the toilet or container. Pinch the sides to make a funnel. If stool is thick, gently "milk" it out.
• Clean the Opening: Wipe it with tissue or a wipe. It doesn’t have to be spotless.
• Close the Pouch: Make sure it’s securely closed.

Tips: 

• Let Out Air: If the pouch is full of gas, let the air out to prevent it from popping.
• Odor Control: Use a room freshener if needed before and after emptying.
• No Rinsing Needed: Pouches are odor-proof, so rinsing isn’t necessary. If you rinse, use cool water to avoid damaging the pouch. Warm water can affect the pouch's odor-proof quality and might make it wear out faster.

When to Contact Your Healthcare Provider

If you have a colostomy or ileostomy, call your ostomy care nurse if you notice any of the following:

• You are changing your pouching system more often than expected
• Skin irritation and/or pain
• Leaks under your pouching system or skin barrier
• Excessive bleeding from your stoma
• Blood in your stool
• A bulge around your stoma
• Persistent diarrhea
• Diarrhea with pain or vomiting
• A stoma that seems to be getting longer

If you have a urostomy, call your ostomy care nurse if you notice:

• Any signs of a urinary tract infection
• Skin irritation
• Urine crystals around your stoma
• Leaks under your pouching system or skin barrier
• Warty or discolored skin around your stoma
• Excessive bleeding from your stoma
• Blood in your urine