Caring for Your Ostomy

After your surgery, you’ll wear a pouching system over your stoma, which is waterproof and provides odor control. The system is made of a skin barrier (wafer) and a collection pouch. There are many different sizes and styles of pouching systems:

• One-piece – barrier and pouch are connected
• Two-piece – barrier and pouch are separate
• Open-end pouch – empty, clean and reclose from the bottom
• Closed-end pouch – disposable one- and two-piece styles; no emptying necessary
• Precut – a hole is already made for a stoma
• Cut-to-fit – need to cut to make a hole to fit a stoma

You will leave the hospital with a cut-to-fit pouch. Your WOC nurse will show you how to size it. It will likely change size as the swelling in your stoma goes down.

It’s recommended that you empty your ostomy pouch when it’s 1/2 to 1/3 full or as needed. If your pouch gets too full, it could pull off. Also, gas may need to be released. There are sitting, standing and kneeling positions that people use to empty their pouch. It depends on your personal preference and what you find works easiest for you. Placing a piece of toilet paper in the toilet will prevent splashing. After you’ve emptied the pouch, use toilet paper to clean the end, then fold the closure and flush the toilet. Always wash your hands before and after emptying your pouch.

Changing your pouch may seem overwhelming or difficult at first but you will soon get used to the routine. Over time you will find that a bag change will only take you a few minutes to complete. Change your pouch at least twice a week, or when you notice leaking and/or itching or burning under the pouch. Follow the steps below:

1. Gather the supplies you’ll need:
   • Scissors
   • Measuring guide
   • Washcloth or soft paper towels
   • Towel
   • Adhesive remover spray or wipes (optional)
   • Barrier spray or wipes (optional)
   • Paste or ring (optional)
   • Paper towel rolled into a wick
   • New pouch
2. Remove your old pouch. After emptying, remove the pouch by carefully lifting up on the tape while pressing underneath on the skin. If you rip or tear the pouch off, you will irritate your skin. Use a wet washcloth or adhesive remover spray/wipes to press on the skin behind the barrier if it’s sticking too much.

3. Clean around your stoma. A wet paper towel or washcloth can be used to clean around your stoma (do not use wipes that have lotion in them, such as baby wipes). If you use a non-moisturizing mild soap, be sure to rinse thoroughly and allow the skin to dry. While your pouch is removed, take time to check for any changes to your skin and stoma.

4. Measure your stoma. Before you apply a new pouch, remeasure your stoma and make note of the size of the opening. Trace the opening on the back of the wafer and cut it out. For the first six to eight weeks after surgery, measure your stoma every time you change your pouch and adjust the size as needed.

5. Prepare the wafer/pouch. Remove backing from the wafer barrier (for a two-piece system, you would be removing the back from the wafer). If you use any barrier spray/wipes, rings or paste, now is the time to apply them. Make sure they are completely dry before applying your new pouch.

6. Apply pouch. To apply your new pouch, make sure the skin around the stoma is flat and free from creases. Fold back the wafer in half to line up the hole with your stoma. Starting from the bottom, roll the bag over your stoma and smooth the wafer down to remove any creases or gaps. Cover the top of the wafer with your hand as the warmth from your hand will help the wafer to adhere to your skin.

You should always carry an extra cut-to-fit pouch when you leave home, including when you visit your doctor, hospital or WOC nurse. Do not leave a stoma pouch and accessories in a hot trunk or in direct sunlight of a car because they will melt.