Caring for Your Ostomy | Torrance Memorial

Caring for Your Ostomy

A wound, ostomy and continence (WOC) nurse and other nursing staff will teach you how to care for your ostomy/stoma while you’re recovering in the hospital. Upon discharge, you’ll be given the basic supplies you need for the first two weeks. After your discharge, a home health registered nurse (RN) will follow up, reevaluate your ostomy supplies and how they are working for you, and show you how to order more.

Pouching (Bagging) Systems

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.

Emptying Your Pouch

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

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.

What if My Skin is Irritated?

The skin under your wafer will be slightly pink (if you have light skin) or gray-brown (if you have dark skin) when first taking off your pouch. This is normal and due to the pressure of your pouching system. Color should return to normal after 10 to 15 minutes.

If your skin is irritated, it may:

  • Appear very red or different from the skin on the rest of your body
  • Have an open wound or rash
  • Feel like it’s burning or itching, and even cause pain

If your skin is irritated, take the following steps to treat it:

  1. Carefully remove the pouch
  2. Gently clean with a wet washcloth
  3. Dry the skin thoroughly
  4. Use the “crusting technique” – sprinkle ostomy protective powder on any open ulcers
  5. Dust off excess powder with a dry cloth; powder will stick to the irritated skin and provide a dry surface for the wafer to stick to
  6. Dab a protective barrier wipe over the powdered skin
  7. Double-check the size of the stoma opening and be sure the wafer opening is the same size as your stoma
  8. Prep and apply your wafer and pouch as usual

If you develop any skin problems around your stoma, visit, answer the questions, and follow the suggested solutions at the end. You can also discuss with your RN or MD.

When Should I Call My Doctor?

Your doctor will schedule a follow-up visit after your surgery to check on your healing progress. If you notice any of the following, call your doctor immediately:

  • Your stoma changes color from pink/red to purple/black
  • Your stoma opening is bleeding excessively
  • Bleeding between your stoma and skin that won’t stop
  • Unusual bulging around your stoma
  • The stoma is protruding out more than it did before
  • If you have an ileostomy and it’s been more than two days since a bowel movement
  • Abdominal pain or nausea and vomiting
  • Large volume of stool output and feeling dizzy or thirsty
  • Bloody urine if you have a urostomy

Learn more about life after ostomy surgery

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