Changing your ostomy pouch

Your stool may be liquid or solid, depending on the kind of surgery you had. You may need your ostomy for just a short time. Or, you may need it for the rest of your life.

The ostomy pouch attaches to your belly, away from your belt line. It will be hidden under your clothing. The stoma is the opening in your skin where the pouch attaches.

Usually you can do your normal activities, but you will have to change your diet a bit and watch for skin soreness. The pouches are odor-free, and they do not allow gas or stool to leak out when they are worn correctly.

Your nurse will teach you how to care for your ostomy pouch and how to change it. You will need to empty it when it is about 1/3 full, and change it about every 2 to 4 days, or as often as your nurse tells you. After some practice, changing your pouch will get easier.

Collect your supplies before you start. You will need:

• A new pouch (a 1-piece system, or 2-piece system that has a wafer)
• A pouch clip
• Scissors
• A clean towel or paper towels
• Stoma powder
• Stoma paste or a ring seal
• Skin wipes
• A measuring card and a pen

Many medical supply stores will deliver right to your home. Your nurse will get you started with the supplies you will need. After that, you will order your own supplies.

The bathroom is a good place to change your pouch. Empty your used pouch into the toilet first, if it needs emptying.

Gather your supplies. If you have a 2-piece pouch, be sure you have the special ring seal that sticks to your skin around the stoma.

Follow these steps to prevent infection:

• Wash your hands with soap and water. Be sure to wash between your fingers and under your fingernails. Dry with a clean towel or paper towels.
• If you have a 2-piece pouch, press gently on the skin around your stoma with one hand, and remove the seal with your other hand. (If it is hard to remove the seal, you can use special pads. Ask your nurse about these.)

• Keep the clip that is with the pouch. Put the old ostomy pouch in a bag and then place the bag in the trash.
• Clean the skin around your stoma with warm soap and water and a clean washcloth or paper towels. Dry with a clean towel.

Check and seal your skin:

• Check your skin. A little bleeding is normal. Your skin should be pink or red. Call your doctor if it is purple, black, or blue.
• Wipe around the stoma with the special skin wipe. If your skin is a little wet, sprinkle some of the stoma powder on just the wet or open part.
• Lightly pat the special wipe on top of the powder and your skin again.
• Let the area air-dry for 1 to 2 minutes.

Measure your stoma:

• Use your measuring card to find the circle size that matches the size of your stoma. Do not touch the card to your skin.
• If you have a 2-piece system, trace the circle size onto the back of the ring seal and cut out this size. Make sure the cut edges are smooth.

Attach the pouch:

• Attach the pouch to the ring seal if you have a 2-piece ostomy system.
• Peel the paper off the ring seal.
• Squirt stoma paste around the hole in the seal, or place the special stoma ring around the opening.
• Place the seal evenly around the stoma. Hold it in place for a few minutes. Try holding a warm washcloth over the seal to help make it stick to your skin.
• If you need them, put cotton balls or special gel packs in your pouch to keep it from leaking.
• Attach the pouch clip or use Velcro to close the pouch.
• Wash your hands again with warm soap and water.

Contact your provider if:

• Your stoma smells bad, there is pus draining from it, or it is bleeding a lot.
• Your stoma is changing in some way. It is a different color, it is getting longer, or it is pulling into your skin.
• The skin around your stoma is bulging.
• There is blood in your stool.
• You have a fever of 100.4°F (38°C) or higher, or you have chills.
• You feel sick to your stomach, or you are vomiting.
• Your stools are looser than normal.
• You have a lot of pain in your belly, or you are bloated (puffy or swollen).
• You have had no gas or stool for 4 hours.
• You have a big increase in the amount of stool collecting in your pouch.

Ostomy - pouch change; Colostomy - pouch change

American College of Surgeons website. Ostomy home skills program. www.facs.org/for-patients/home-skills-for-patients/ostomy/. Accessed December 27, 2022.

Raza A, Araghizadeh F. Ileostomies, colostomies, pouches, and anastomoses. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 117.

Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Bowel elimination. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2016:chap 23.

Updated by: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.