Changing an ostomy bag is a straightforward process once you learn the steps, and most people get comfortable with it within a few weeks of practice. You’ll typically need to change your pouching system every 2 to 4 days, emptying it when it’s about one-third full between changes. The key to a good experience is having your supplies ready, keeping the skin around your stoma clean and dry, and getting a secure seal every time.
Gather Your Supplies First
Before you start, lay everything out within arm’s reach. You don’t want to be halfway through a change and realize something is across the room. Here’s what you need:
- New pouching system (one-piece or two-piece, depending on what you use)
- Measuring guide or pre-cut template for sizing your stoma opening
- Scissors (if your skin barrier isn’t pre-cut)
- Warm water and soft wipes or washcloths
- Adhesive remover wipes (optional but helpful)
- Barrier rings or paste (if you use them for a better seal)
- A small trash bag for the used pouch
Some people change their bag in the bathroom, others at a table with a mirror. Either works. Choosing a time when your stoma is least active helps keep things clean. For many people, that’s first thing in the morning before eating or drinking.
Removing the Old Pouch
Start by gently peeling the skin barrier away from your skin. Pull it downward slowly while pressing your skin flat with your other hand. This “push-pull” technique reduces tugging and irritation. If the adhesive feels stubborn, adhesive remover wipes make a real difference. They dissolve the bond without pulling at the skin.
Once the pouch is off, place it in your trash bag. Take a moment to look at the skin around your stoma. Healthy peristomal skin should look like the skin on the rest of your abdomen. If you notice white or gray, waterlogged-looking patches, that’s a sign of too much moisture getting trapped under the barrier. A solid red rash with small spots spreading outward from it can indicate a fungal issue. Red, raw, or inflamed skin right where the barrier sits could mean the output is leaking under the seal and irritating your skin, or less commonly, an allergy to the product itself.
Cleaning the Skin Around Your Stoma
Use warm tap water and a soft wipe or washcloth to gently clean the skin around your stoma. That’s it. Warm water is all you need for routine changes.
Avoid using soap regularly because it dries out the skin over time. Skip wet wipes for everyday use too, since many contain moisturizers or chemicals that leave a residue on the skin. That residue can prevent your new barrier from sticking properly. Save wet wipes for situations when you’re away from home and don’t have access to warm water. Pat the skin completely dry before applying anything new. Moisture is the enemy of a good seal.
Preparing and Applying the New Pouch
The opening in your skin barrier needs to match the size and shape of your stoma as closely as possible. Use your measuring guide to check, since stomas can change size in the months after surgery. Cut the opening so it fits right up to the edge of your stoma without leaving exposed skin between the barrier and the stoma itself. A gap there lets output sit on unprotected skin, which leads to irritation.
One-Piece Systems
With a one-piece system, the skin barrier and pouch are a single unit. Peel the backing off the adhesive, center the opening over your stoma, and press the barrier firmly onto your skin. Start from the bottom and smooth outward to push out air bubbles. Hold gentle pressure with your hand for about 30 seconds. Body heat helps activate the adhesive, so some people press a hand against the barrier for a minute or two after application to improve the seal.
Two-Piece Systems
With a two-piece system, you apply the skin barrier (also called a flange or wafer) to your skin first. Center it over your stoma and press it down the same way. Then snap or attach the pouch onto the barrier ring. You’ll usually hear or feel a click when the pouch locks into place. The advantage of a two-piece system is that you can swap the pouch without removing the skin barrier every time, which means less adhesive contact with your skin.
Getting a Better Seal With Barrier Rings
If you have skin folds, creases, or uneven contours near your stoma, a flat skin barrier alone may not create a reliable seal. Barrier rings are soft, flexible strips that you mold around the stoma opening to fill in those uneven areas and create a flatter surface for the barrier to stick to.
To use one, peel the protective coverings off both sides, stretch and shape it with your fingers, then press it around the stoma opening. You can apply it directly to your skin or to the adhesive side of your skin barrier before you put the barrier on. Barrier rings can also be cut into pieces or stacked for a thicker fill. They’re alcohol-free, so they won’t sting if your skin is already irritated.
Many people find barrier rings easier to work with than paste, which can be messier to apply and harder to remove. Rings also hold up better against the digestive output from your stoma, making them a good option if you’ve had trouble with leaks.
When and How Often to Change
Plan to change your entire pouching system every 2 to 4 days. Some people settle into a consistent schedule, like every 3 days, while others adjust based on how the seal is holding up. If you notice the edges of the barrier starting to lift, or if the skin underneath feels itchy or damp, change it sooner rather than waiting for your usual day.
Between full changes, empty the pouch when it’s about one-third full. Letting it get heavier than that puts extra weight on the adhesive and can break the seal. Most drainable pouches have a clip or integrated closure at the bottom for emptying.
Common Problems and How to Fix Them
Leaking is the most common frustration, and it almost always comes down to one of three things: the opening is too large and leaves exposed skin, the skin wasn’t fully dry when you applied the barrier, or body contours are preventing a flat seal. Resizing the opening, being more thorough about drying, or adding a barrier ring usually solves it.
Skin irritation around the stoma is the second most common issue. When output reaches skin that isn’t protected by the barrier, it causes redness, soreness, and eventually breakdown. The fix is ensuring a snug fit between the barrier opening and the stoma edge. If your skin is already irritated, switching to a different brand of barrier can help rule out an allergic reaction to a specific product. Persistent or worsening skin problems around the stoma warrant a visit with a wound and ostomy care nurse, who can assess the fit of your system and recommend adjustments specific to your body.
Odor concerns are common early on but manageable. Modern pouches have built-in odor barriers, and pouch deodorant drops can be added inside the bag at each change. Odor that you notice while the pouch is sealed usually means a leak somewhere in the system.