Ostomy Uncovered: How to Change a Stoma Bag

Disclaimer: This information is based on my own research into this particular aspect of stoma care as well as some personal experience and should not be used as medical advice or a diagnostic tool. The suggestions given within are taken from sources laid out in the references header.  If you seek advice regarding the things you experience within your own disease, please contact your SCN  for medical advice.

If you are looking for the entire ‘Ostomy Uncovered‘ series, you can find them all here.

Why is this important?

If you have a stoma, you will have to become and get use to change your bag. Depending on the type of stoma you have and the type of bag you choose to use, the timing will vary but hopefully below will show you how to do the basics of changing a stoma bag.

NB: It’s important to note that whilst closed pouches (bags) will always be changed when full, drainable and urostomy pouches are best changed went empty. This is, of course, personal preference at the end of the day, but an empty drainable or urostomy pouch is easier to handle and less messy. 

Step by Step Guide

I’ve written about my own personal stoma bag change before, but this is a general step by step with where is it is most common to use particular stoma products and when they would be generally needed.

1. Gather your supplies. This will at least be a new pouch – cut if needed –  a disposal bag, dry wipes and a remover spray / wipe.
2. Where you choose to change it is dependent on the individual. Some change standing up over the basin in the bathroom. Some do it in front of a mirror so they can see the underneath the stoma. And others choose to lie down.
3. When do to is also is personal choice – some prefer morning when the stoma is generally less active. Some do it after a shower; some even choose to shower / bathe without a  bag on for ultimate freedom! Some do it in the evening, and some just do it when it needs changing and have no set pattern or routine time to do this.
4. Both these two points depend on you and what you feel most comfortable about. I admit, its hard to break out of one routine but changing it up every so often is good to make sure everything is going the way it should. But, if it ain’t broke, don’t fix it!
5. Place your disposal bag in front of you. Tuck some dry wipes into your waistband to protect your clothes. Get everything you need ready, so its close to hand.
6. Gently pull back a piece of the baseplate, spray your skin and the bag should begin to come away. Give it a moment or two to work, then spray on the left and right hand side of what has already begun to peel off. Continue to peel the bag away from your skin and place in the disposal bag.
7. Wipe away the output from your skin and clean the area. You can do this with water and a dry wipe. It is important to not use soap so that they product you use later on a) work and b) help your bag actually skin.
8. Make sure you get all of the adhesive from around your stoma. You can do this with a wetted dry wipe or with a remover wipe also.
9. This is a good time to check your peristomal skin for any changes and to make sure your stoma is the same size, ready for the new bag.
10. If things have changed; use products to help – usually ostomy powder to heal broken skin or paste to even out any dips or creases in the peristomal skin. If your stoma has changed size, adjust your new bag accordingly. This is the first point of call if you are having leaks or experiencing sore skin close to your actual stoma.
11. Apply your other products, if you need them. This would be barrier spray / wipe / cream, seals / rings / washers – to help aid with keeping your skin healthy. These products should be discussed with your SCN because sometimes, some are not suitable to every skin.
12. If you notice anything on or around your peristomal skin or even your stoma, consult your SCN to get advice and support. If anything feels unusually or you’re unable to fix it yourself, make sure you contact a SCN for guidance.
13. Once supporting products are applied / used, it’s time to apply your new bag.
14. Remove the backing and working from the bottom, ease the bag onto your stoma. Press the bag to your abdomen, and feel around the edge of the baseplate to ensure its securely stuck down.
15. At this point, close the end of your drainable pouch; urostomates usually keep the bung in the end of their bag at all times, when applying a new bag.
16. Make sure you put all rubbish into your disposal bag and tie it up.
17. Wash your hands and put your products away.

Variations

• Position – there is alot to be said for position. Standing v lying down. For some, one is preferred over the other simply because its more comfortable. I’ve always found that standing made it easier to apply the bag and not get any air pockets at the edge of the baseplates; theoretically make it more susceptible to leaks. Where as with lying down, you are more relaxed and able to actually do it if you are feeling physically weak. I chose this position when I was fresh out of surgery and it worked well for many months. However, when lying down, you do get a false sense of your stoma’s size and length. Standing, you get a better view and great advantage of cutting your bag correctly (if you do this yourself).
• Time of day – It is generally best to change a stoma bag when its less active. Of course, this sometimes varies. But as your grow in confidence with a stoma, you’ll learn when your own stoma is less active. I’ve found if I go without anything to eat for approx 4 hours, I can usually change my bag without much output coming through. Also, in the morning, before my bowels have had chance to wake up properly, is a good time to change. A quick but effective bag change is good habit to get into – it means you use less products, it takes less time, you feel more confident and you get used to your stoma. Of course, it’s not always perfect and quick, but bad experiences still chalk up as experience and lessons learnt. Plus, you’ll have some funny poop stories!
• Before or after a shower – this is a tough one. I’ve always showered and bathed with my bag on. But I always shower the night before I am due to change my bag, just because I’m generally not bothered about my bag getting abit wet and damp, if I know it’s coming off anyway. Some find showering without the bag helpful as they know their skin will be clean, any output goes down the drain and generally it gets some air and water to the skin that is per mentally covered by the bag. This is something you’ll learn to experiment with, if you so wish.

Important information

• Please do not use wet wipes / baby wipes / anything fragrance on or around your stoma. These products can leave residues behind that can prevent the adhesive properties of the baseplates from working. The last thing you want is a bag that doesn’t stick or one that begins to peel off without you noticing and a big leak happens.
• Always use curved stoma scissors to cut your bags. The curve allows the cutting to not damaged the bags internal structures. You might accidentally pop the bag in the front and cause a leak.
• It’s always good to try new products but if you do try something and you react – as in it cause more soreness, itchy or any irritation to your skin or surrounding area – please discontinue it.
• That being said, lots of companies offer free samples – take advantage!
• You should try to only use products that are deemed necessary; ie. they are used for a purpose. Ideally, you want to be using as little as possible to keep your skin healthy, but of course, if you need something for an issue, you have to use it. One example would be; using powder when you have broken and sore skin; it is not necessary to use it on every change. If sore and broken skin persist, you need to seek advice from your SCN.
• Changing in a public bathroom – you will usually find you have more space in a disabled toilet. You can gain access to these with a Radar key – you can buy one here or your stoma delivery company can provide you with one. My advice would be to make sure you have everything in front of you and try and do the change over the toilet. Usually, changes in public toilets are due to leaks, so its likely that your stoma will be active. It’s easier to just let the output fall into the toilet instead of using dry wipes to clean it all up constantly.
• Changing your bag will become second nature. You will get into a natural rhythm and it’ll just flow like anything else you do on a regular basis.
• Did you know there is some guidance on how to change your stoma bag if you break your arm or hand? The IA – Ileostomy Association – created a wonderful PDF, it’s below in the sources. Just in case, eh?

My Experience

I have written about my stoma bag changed before. Once when I was quite new to it and one more recently when I had a new routine. You can read them here and here.

Currently, I’ve gotten used to standing up to do my change, and I find evenings after work now to be best time for a change. I usually get two days wear out of my bag, but it depends on how much I empty my bag. I always check my filter on my Sensura Mio to determine how much long I might have left. I also use the filter stickers provided, on all my bags, because I do not like pancaking. I place it fully over the charcoal filter to help stop air escaping. So, if you ever meet me, I’ll most likely have a full, ballooning bag on my belly! I embrace this, it’s just easier. And it’s a handy alert system to remind me to empty! 🙂

How do you change your stoma bag? Do you have an tips or hints that might help? Maybe in different circumstances?

Do you have any questions or queries? Or just want to share your own experiences? Leave me a reply or tweet me @sapphire20 or find my blog page on Facebook!

Sources:

The IA’s PDF on One Handed Appliance Change and document outline.

Vegan Ostomy’s How to Change an Ostomy Bag 

Vegan Ostomy’s When to Change an Ostomy Appliance