Changing a stoma bag is a straightforward process once you’ve done it a few times. The basic steps are: gather your supplies, gently remove the old bag, clean and dry the skin around your stoma, cut and fit a new bag, and press it firmly into place. The whole process typically takes 10 to 15 minutes.
How Often to Change Your Bag
How frequently you change depends on the type of bag you use. If you have a colostomy with a closed bag, you’ll likely change it after every bowel movement, roughly one to three times a day. If you have an ileostomy, you’ll most likely use a drainable pouch that you empty throughout the day and replace every two to three days, or whenever the adhesive wafer starts to loosen. There’s no single rule here. Change your bag as often as you feel you need to.
Supplies You’ll Need
Lay everything out before you start so you’re not reaching for things mid-change. You’ll need:
- A new pouch (either a one-piece system or a two-piece system with a wafer)
- Scissors
- A measuring card and pen
- Clean towels or paper towels
- Skin wipes or a soft washcloth
- Stoma powder
- Stoma paste or a ring seal
- A pouch clip (for drainable bags)
- A disposal bag
If you find the old adhesive difficult to peel away, adhesive remover wipes or sprays can help. Your stoma nurse can recommend a specific product. As an NHS patient, you’re entitled to free prescriptions for all stoma supplies if you have a permanent stoma, since it qualifies for a medical exemption certificate. Your GP surgery or stoma nurse can help you apply.
Removing the Old Bag
Start by emptying the contents of the bag into the toilet. If it’s a drainable pouch, open the outlet at the bottom. For a closed pouch, you’ll remove the whole thing. To peel the adhesive away from your skin, press down on your skin with one hand and gently lift the edge of the wafer with the other. Work slowly around the edges rather than ripping it off in one go. Pulling your skin taut helps reduce discomfort.
If you use an adhesive remover, spray or wipe it along the edge of the wafer as you peel. This dissolves the adhesive and makes removal much easier, especially if you have sensitive skin or body hair in the area. Once the bag is off, wrap it in a disposal bag. Don’t flush it.
Cleaning the Skin Around Your Stoma
Use a soft cloth, paper towel, or piece of gauze with plain warm water to clean the skin surrounding your stoma. You don’t need soap for routine changes. If the skin looks inflamed, a mild antibacterial soap is fine as long as you rinse it off thoroughly, since soap residue can stop the new adhesive from sticking properly.
Pat the skin completely dry. Moisture trapped under the wafer is one of the most common causes of skin irritation and poor adhesion. If your stoma is active while you’re cleaning (output keeps coming), holding a folded piece of tissue or gauze over it can catch any flow while you work.
If the skin around your stoma looks red or raw, dust a light layer of stoma powder over the affected area and brush away the excess. You can seal the powder in place with an alcohol-free skin sealant or a little water. This creates a smoother surface for the adhesive and helps protect broken skin while it heals.
Managing Hair Growth
Hair around the stoma can interfere with adhesion and cause pain when you remove the wafer. Clip hair short with scissors or shave gently with a disposable razor, moving in the direction of hair growth and away from the stoma. Avoid hair removal creams, as they can irritate the skin and affect the adhesive seal.
Measuring and Cutting the New Bag
Your stoma can change size, especially in the first few months after surgery, so measure it each time you change your bag. Place the measuring card over your stoma and find the circle that matches its diameter. Trace this onto the backing of your new wafer and cut the hole with scissors.
The goal is a snug fit. The opening should sit right where your stoma meets your skin, with minimal exposed skin between the stoma and the edge of the wafer. A gap that’s too large leaves skin exposed to output, which causes irritation. A hole that’s too small can press against the stoma and damage it. If there are any uneven contours, creases, or folds around your stoma, use stoma paste or a mouldable ring seal to fill them in and create a flat surface for the wafer.
Applying the New Bag
Warm the wafer between your hands for a minute or so before applying it. Body heat makes the adhesive more flexible and helps it mould to your skin. Peel off the backing paper, position the opening around your stoma from below (so you can see what you’re doing), and press it firmly into place. Smooth outward from the stoma to push out any air bubbles.
If you’re using a two-piece system, attach the wafer first and then click or press the pouch onto the flange. You should feel or hear it snap into place. Give the whole wafer a good press with the flat of your hand for about 30 seconds. Some people find it helpful to rest a hand over it for a few more minutes, since sustained warmth and pressure improve the seal.
If you use a drainable pouch, make sure the outlet at the bottom is securely closed with your clip or integrated closure before you walk away.
Disposing of Used Supplies
NHS guidance is to empty the contents of used bags down the toilet, then wrap the bag itself and place it in your household waste bin. Don’t put stoma bags in your recycling. Some local councils offer a clinical waste collection service, so it’s worth checking with your council to see what’s available in your area. Your stoma nurse may also have specific advice about disposal options.
Signs That Something Isn’t Right
A healthy stoma is red or pink and moist, similar to the inside of your mouth. It doesn’t have nerve endings on its surface, so it shouldn’t hurt when you touch it. Light bleeding when you clean around it is normal, but heavy bleeding or bleeding that doesn’t stop is not.
Contact your stoma nurse or GP if you notice changes in your stoma’s size, shape, or colour (particularly if it turns dark purple or black, which can indicate poor blood supply). Persistent skin irritation that doesn’t improve with powder and barrier products also warrants a review, as it may signal a poorly fitting bag, a fungal infection, or an allergic reaction to the adhesive.
Seek urgent medical help if you experience cramping that lasts more than two or three hours, severe or persistent vomiting, no output and no gas from your stoma for more than four to six hours (especially with cramping and nausea), or very watery output that could lead to dehydration. These can be signs of a blockage or other complications that need prompt attention.
Getting Confident With Bag Changes
Most people feel nervous about their first few changes, and that’s completely normal. Your stoma nurse is your most valuable resource during this time. They can watch you do a change, suggest products suited to your body shape and stoma type, and troubleshoot issues like leaks or skin soreness. NHS hospitals and community teams have specialist stoma nurses, and you can usually contact them directly without needing a GP referral. Many also offer follow-up appointments at home in the weeks after surgery. If you weren’t given a stoma nurse contact, ask your GP practice to refer you.